Abnormal Uterine Bleeding, Endometrial Biopsy and Endometrial Ablation

Abnormal uterine bleeding is irregular bleeding from the uterus.  In some cases, the cause of the bleeding isn’t known.  Often the bleeding is not serious, but it can be annoying and disrupt your life.

In most cases, this problem is related to changes in hormone levels. However, it may be caused by other medical conditions, such as miscarriage, fibroids, cancer, or blood clotting problems. We will perform a comprehensive evaluation to rule out out these and other causes of vaginal bleeding.

You may have abnormal uterine bleeding if you have one or more of the following symptoms:

• You get your period more often than every 21 days or farther apart than 35 days. A normal adult menstrual cycle is 21 to 35 days long. A normal teen cycle is 21 to 45 days.

• Your period lasts longer than 7 days (normally 4 to 6 days).

• Your bleeding is heavier than normal. If you are passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours, your bleeding is considered severe and you should call your doctor.

Please consider coming in for evaluation if you have had irregular vaginal bleeding for three or more menstrual cycles, or if your symptoms are affecting your daily life. First, we will rule out the causes of the abnormal bleeding. To do this, we will discuss how often, how long, and how much you have been bleeding. You may also have a pelvic exam, urine test, blood tests, and possibly an ultrasound. These tests will help us assess for other causes of your symptoms. We may also need to take a tiny sample (biopsy) of tissue from your uterus for testing.

There are many things we can do to treat abnormal uterine bleeding. Some are meant to return the menstrual cycle to normal. Others are used to reduce bleeding or to stop monthly periods. Each treatment works for some women but not others. We will discuss all the options and find a treatment that is right for you.  Treatments include:

• Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen). These hormones help control the menstrual cycle and reduce bleeding and cramping.

• A short course of high-dose estrogen. Estrogen is a hormone that is often used to stop dangerously heavy bleeding.

• Use of the hormone releasing IUD, which releases a hormone called progestin into the uterus. This reduces bleeding while preventing pregnancy.

• Rarely used medicines that stop estrogen production and menstruation, such as gonadotropin-releasing hormones. These drugs can cause severe side effects but are used in special cases.

• Surgery, such as uterine artery embolization, endometrial ablation or hysterectomy, when other treatments do not work.

Endometrial ablation destroys the lining of the uterus. It stops or reduces the total amount of bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until after menopause.

Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow. Another treatment, myomectomy, removes the fibroids but not the uterus.

Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed. Hysterectomy also is used to treat endometrial cancer. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods.

If you also have menstrual pain or heavy bleeding, you can take regular doses of a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen.

Find more information on Ablation here.

Find more information on Uterine artery embolization here.