Category: Greenville Women’s Clinic Blog

Abnormal uterine bleeding is a common problem in women’s health. It may present as bleeding that is excess in volume or that occurs at an unexpected time. When a woman sees her physician to evaluate the cause of the abnormal bleeding, the explanation will fall into one of two categories. The first category is an imbalance of hormones (dysfunctional bleeding) that may be treated with hormones such as oral contraceptives or progesterone. The second category is an anatomic change involving a new growth of tissue in the uterus, such as polyps or fibroids (benign muscle tumors), or less commonly, cancer that can develop in the uterine lining. The evaluation may include a pelvic exam (with a pap smear if one has not been done recently), lab work including a pregnancy test, complete blood count, and occasionally hormone tests that check the function of the thyroid and pituitary glands. Pelvic ultrasound is a very useful test, showing the anatomy of the uterus and ovaries. A sonohysterogram is a procedure in which sterile saline is advanced through the cervix into the uterine cavity during the ultrasound. This allows a detailed image of the uterine cavity and may reveal small changes in the lining. An endometrial biopsy may be performed to assess for pre-cancers, cancers, or infection within the lining of the uterus. This specimen is then sent to the pathologist for evaluation. If the pathologist sees evidence of cancer, the treatment plan will include urgent consultation with a cancer specialist and surgery that includes a hysterectomy and cancer staging procedure.

Most often, the abnormal bleeding is found to be due to a benign cause. If cancer has been ruled out, benign growths in the uterine cavity can be removed through an out-patient surgical procedure called hysteroscopy, where a fiber-optic device inserted through the cervix can be used to remove abnormal tissue and restore the uterus to a healthy condition. In cases of dysfunctional bleeding where hormonal treatment does not resolve the problem, a good surgical option is endometrial ablation, a minor procedure where the uterine lining is destroyed. For many women, endometrial ablation is a good alternative to hysterectomy due to the rapid recovery and conservation of normal anatomy.

In summary, abnormal uterine bleeding is a common problem that can be evaluated and managed by hormonal or surgical treatment, depending on the findings. Women who develop abnormal bleeding should promptly see advice from their health care providers for timely diagnosis and appropriate treatment.

Having a hysterectomy can be a serious decision and one that should be made carefully. Your physician may have recommended a hysterectomy, but, in many cases it’s optional. You need to be fully informed of your options and the risks and benefits in order to make an informed decision.

Hysterectomy is the surgical removal of the uterus. This procedure ends menstruation and the ability to become pregnant. Therefore, women who want to have children should consider alternatives.

A hysterectomy is only one way to treat problems affecting the uterus. For some conditions, hysterectomy may be the best choice. With uterine or cervical cancer and in cases where a uterine growth causes a blockage of the bladder or intestines, you may have no other option.

The following conditions affect the uterus and require treatment. The treatments may include medication, hysterectomy, or other surgeries:

Uterine fibroids, benign tumors which have increased in size, are painful, or cause bleeding. Hormone medications can be prescribed to shrink uterine fibroids, but they can return when medication is stopped. Medications mimic menopause, so they may also cause symptoms of early menopause. Uterine artery embolization is a non-surgical option performed by a radiologist. During the procedure the uterine artery is blocked and since this artery supplies blood to the fibroid, blocking the flow helps shrink the fibroid. Depending on the severity and positioning of the fibroids, a myomectomy can be performed to remove the fibroids while keeping the uterus intact.

Severe endometriosis, uterine tissue that grows outside the uterus. Since preventing ovulation can reduce the discomfort associated with this endometriosis, oral contraceptives can be used to treat this condition. Hormone medications may also be used to shrink the endometrial tissue. If medications do not effectively treat the endometriosis, laparoscopic surgery may be helpful.

Uterine prolapse, a uterus that has “dropped” into the vaginal canal due to weakened muscles, which can lead to urinary incontinence or difficulty with bowel movements. In some cases, this condition may be improved with Kegel exercises. Since obesity can cause the muscles to stretch, losing weight and quitting smoking can also help relieve pressure on the muscles. Another treatment for uterine prolapse is a pessary, a device inserted in the vagina which holds the uterus and bladder in place. For women past menopause, taking hormones may help keep the pelvic muscles stronger.

Cervical or uterine cancer. Precancerous changes of the cervix which are detected early by a Pap test can be treated with a loop electrosurgical excision procedure (LEEP). LEEP removes the abnormal cells. If the cervical disease moves into deeper layer of tissue or other organs, hysterectomy is usually necessary.

Abnormal bleeding. Treatment for irregular, heavy or severe bleeding depends on the cause. Fibroids, endometrial polyps, hormone level changes, infection, and cancer can all cause abnormal bleeding. Treatments for abnormal bleeding include dilatation and curettage (D&C), hormone medications and nonsteroidal anti-inflammatory medications (NSAIDs.) Hysteroscopic assessment and management may also be effective.

How will you know which treatment is right for you? Based on your condition, you and your doctor should discuss the risks and benefits of each treatment. The treatment used should depend on the nature of your problem and the severity of your symptoms. But, whatever method or option you choose, it’s in your best interest to explore all the treatment options available for your particular condition before choosing hysterectomy.

I get a lot of questions from friends and family about my job. The most frequent question I get when I tell people my chosen profession is “Why would you choose that?” The second is “Did you deliver your own babies?”

My answer to the first usually depends on where I am, who I am with, and (most importantly) what kind of a mood I’m in. If I’m well rested, and I think you are actually interested in my response, I’ll tell you about the first baby I delivered; how it was one of the most awe-inspiring moments of my life, and what a privilege it is to help women welcome a new life into the world. If I’m tired (or at a dinner party), I’ll tell you “I thought it would be a good way to meet chicks” or “the proctologists weren’t hiring.”

My answer to the second, however, is always the same. “No. I just wanted to be the dad.”

I’d probably delivered close to six or seven hundred babies by the time my wife brought our first child and only son Jack into the world. While I will tell you assisting in the birth of a child is never routine, and I am always amazed every time I get to do it today, most of the time there is a anticipated routine that is going to play out. I coach pushing the same way, deliver the baby the same way, and make the same bad jokes about the not charging you if you cut your own baby’s umbilical cord. So as the due date approached and the overnight bag for the hospital sat patiently by the backdoor, I waited, with much overconfidence and arrogance I might add, for her water to break, or for contractions to start, so we could get on doing the same thing I had done hundreds of times before.

Then it started. Somewhere between the screams of pain (peppered with some of the most colorful profanity I have ever heard coming from my sweet Southern Bell of a wife) and the not-so-great fetal heart rate tracing, it became abundantly clear I was in way over my head. I had a head full of knowledge. I knew where L&D was, I knew how to diagnose labor, and I even knew when a C-Section would be indicated. I was technically proficient, but lacked true experience. I was prepared for the what, the when, the where and the how. What I wasn’t ready for was the who. What I wasn’t ready for was to see what labor looked like for MY WIFE.

I knew the definition of labor and how frequent someone needs to contract, but I didn’t know the look of pain on my wife’s face during a really bad set of contractions. I knew sometimes the baby’s heart rate dropped as the cervix was changing, but I didn’t know how it would feel to hear MY baby’s heart rate go to the 60s and sit there (it was really scary, by the way). I certainly have counted to 10 hundreds of times, but I was completely unprepared for how momentous it was to see the woman I love bring another human being into this world with a startling combination of determination, courage and love. I knew how to help deliver a baby, but I never really understood what it meant until I watched my wife make me a dad.

Dad’s, if you feel unprepared for your wife’s upcoming labor, you are. If you are nervous about what’s going to happen, you should be. If you’re scared about all the stuff that could go wrong, that’s OK. And if you think there is anything I can tell you that can get you ready, there isn’t. My wife has given me so much over the years (except my fair share of the comforter… she takes way more of that than she is entitled). But the gift of fatherhood is second to none. I thought I married a strong woman before she gave me Jack and Katherine. Turns out I didn’t know what strong was.

So fellas, be prepared for the unexpected. Trust the amazing staff at Greenville Women’s Clinic and Vidant to take excellent care of your wife and to bring your healthy child into this world. And enjoy every second of being “just dad.”

David Ryan

P.S. Tell the proctologists I’m all set.

At the age of 4, according to my mother, I decided I wanted to be a nurse.  With 5 siblings, I kept myself busy taking care of everyone when they were sick or injured or taking care of the sick dogs, chickens, or cows.  Being a softie at heart, it was difficult to see anyone or anything suffer.  When I got to be a little older, my diabetic grandmother would let me give her insulin injections and I found that to be quite exciting.  At the age of 13 my brother was born and had a cleft lip and cleft palate.  He was quite sickly and required 10 surgeries.  I spent many hours helping take care of him and this was the “decision maker” for me. 

I attended ECU School of Nursing graduating in 1979.  Immediately after graduating, I started working at Pitt County Memorial Hospital in Labor and Delivery.  I have participated in many deliveries and have delivered quite a few myself.  It was an awesome job and I loved almost every minute of it.  It was adrenaline pumping, exciting, sometimes sad but rarely boring.  I retired in 2012 after 33 years in L&D to come to Greenville Women’s Clinic.  Being very passionate about women’s health, it has truly been a learning experience because GYN was something I knew very little about.  I have learned so much in the short three years I have been here about many different things.  Coming from a tertiary care center to an office setting has also been quite an adjustment.  The stressors are of a  different  magnitude but are as equally critical in the office setting as in the hospital setting.

Nursing continues to be an ever changing and challenging career.  My career has been wrought with many demands, victories, trials and tribulations but I would not trade any part of it.  I cannot imagine spending my life doing anything else!  I have met some awesome people and have had experiences I will never forget.  I could write a book about some of the things I have seen and heard and I imagine it could make the best seller list for a week or two.

Happy Nurses’ Week to all the nurses out there and to those that are toying with the idea of nursing as a career.  It is an awesome profession with many rewards – you won’t regret it!

Dawn Arnold, RN
Clinical Supervisor
Greenville Women’s Clinic