Many women experience what they describe as “abnormal uterine bleeding”. What each women describes as abnormal is very different. So it is important to have the same
definitions to describe bleeding patterns. Vaginal bleeding that occurs less frequent than
every 21 days is called polymenorrhea. Bleeding that happens less frequent than every
45 days is called oligomenorrhea. Excessively heavy bleeding or prolonged bleeding is
called menorrhagia. Bleeding that is irregular in timing is called metrorrhagia. And
finally, bleeding that is both irregular and heavy is called menometrorrhagia. Each type
of bleeding has different causes and treatments and will be addressed below.
Menorrhagia in most cases is caused by an anatomic abnormality such as fibroids or
polyps. These causes of bleeding can be diagnosed by ultrasound and/or an endometrial
biopsy (insertion of thin plastic tube into uterine cavity and aspirate a few cells).
Metrorrhagia many times if related to being anovulatory (not ovulating). This is
evaluated by blood work.
Once the etiology or cause of the bleeding is determined there are many options for
treatment:
If there is a structural problem then the best treatment is to remove the cause of the
abnormal bleeding. There are many minimally invasive techniques to treat abnormal
uterine bleeding. A simple dilation and curettage has historically been the initial
treatment but studies have show that it is not a great treatment modality. A better option
is to combine that with a hysteroscopy (looking inside the uterus) with direct resection of
the abnormality. For the women who has completed her family the options for treatment
of structural abnormalities also include endometrial ablation (a procedure by which the
uterine lining including any small fibroids or polyps are cauterized or destroyed by either
electrocautery, hot water or freezing. Hysterectomy (removal of the uterus) is also an
option. Recovery from the minimally invasive vaginal hysterectomy or the laparoscopic
assisted is quite short and has distinct advantages over the total laparoscopic
hysterectomy. The ovaries are treated as a separate procedure. If the ovaries are left in
place women go through a natural menopause. They do not need to address hormone
replacement until menopause.
If the bleed is caused by hormonal abnormalities then options for treatment include
treatment with estrogen, progesterone or both. The estrogen containing compounds
include oral contraceptive pills, rings and patches. The progestin only compounds
include the “mini” pill, natural progesterone, Depot Provera, The Mirena IUD
(progesterone IUD) or implants.
Treatments can include any or a combination of options. It is important to discuss your
symptoms and desired goals for treatment with your provider so they can individualize a
treatment plan.
