GYN.COM PRESENTS

LIFE LONG WOMEN'S HEALTH CARE

ERIK N. COHEN, M.D. AND ASSOCIATES

Abnormal Uterine Bleeding & Hysterectomy Alternatives

Many healthy women will seek medical care for disturbances in their menstrual cycle. Estimates are that nearly one quarter of healthy menstruating women will complain to their health care provider of an irregularity in the menstrual cycle.  Many of their concerns will be due to anovulatory bleeding, which is the most common form of noncyclic uterine bleeding. This may range from spotting  to excessive. The failure to produce the "egg" leads to a hormonal imbalance. This imbalance  causes a variety of irregular bleeding patterns.

Your physician may use other terms to describe this anovulatory bleeding.  The following terms are equivalent: Dysfunctional Uterine Bleeding or DUB, irregular bleeding, and Abnormal Uterine Bleeding or  AUB.

There are many causes for anovulation. The diagnosis is made after your physician by means of diagnostic testing rules out anatomical pathology. Testing may include ultrasound, direct viewing into the uterus, biopsy, cultures, and evaluation of hormones by a blood test.

Causes of Anovulation include: Age, Menopause, Pre-menopause, Lactation, Pregnancy, Breast Feeding all of which are normal events in a women's life.  Abnormal causes include abnormalities of the thyroid gland, pituitary gland, premature menopause, drug actions, and abnormalities of adrenal hormones.

Besides anovulation as causing menstrual irregularities, benign uterine tumors (fibroids, polyps) are commonly associated as a basis of the problem. Other underlying causes include: Infection, glandular development in the uterine muscle (adenomyosis), pregnancy problems, blood disorders, medications, and systemic diseases.

Treatment options are dependent upon the patient's age and childbearing desire. Evaluation of the uterine lining (biopsy) can be performed several ways, both in the office and in a surgical area.  For women over age 35 this type of evaluation is recommended to exclude endometrial (uterine) cancer even though rare at this age.

Medical management options are generally tried initially for women under 35 years. Oral contraceptives or cyclic progesterone are initial considerations.  Low dose oral contraceptives may also have additional benefits. After the uterine lining is evaluated and believed to be normal, women over 35 are also offered medical management, which may also include birth control pills, progesterone pills, or estrogen/progesterone replacement.

Surgical treatments are then offered to those patients who fail conservative medical management.  Surgery does not mean removal of the uterus (hysterectomy).  Options to be discussed with you provider include removal of the benign polyps, fibroids or uterine lining. Hysterectomy is not necessarily the only choice.

Over the last 20 or so years, less aggressive surgical procedures have been developed to avoid hysterectomy in many patients. One of the newest procedures, ENDOMETRIAL ABLATION, is the removal of the lining of the uterus only.  The uterus remains. Techniques have changed over time, and the older techniques seemed to have required a high degree of skill to avoid many complications and failures.  However, recently a new FDA approved technique has been introduced to physicians.  The Hydro ThermAblator Endometrial Ablation System (HTA) from BEI Medical Systems seems in initial multicenter studies to offer a safe, effective procedure, using minimal anesthesia and reducing the risks associated with the prior techniques of loop resection, roller ball and balloons.  This office has been trained in all of these older procedures, and we believe that the advantages of this procedure to safely reach all regions of the uterine lining will show this technique to soon become the standard in which to judge all other surgical techniques.

Preliminary indications show that this will work for not only hormonal anovulatory bleeding not controlled by medications, but will also allow a physician to eliminate some polyps and fibroids, depending upon size and location.  

Copyright © 2001 Erik N. Cohen M.D. and Associates
Last modified: June 20, 2002