Most women will face a time in their lives when irregular menstrual bleeding, medically known as abnormal uterine bleeding, causes concern and interruption in daily life. While not all irregular bleeding is dangerous, the inconvenience and discomfort affects normal daily living. Women face the task of finding a solution to this complex problem that is compatible with their active lifestyle. Finding the right doctor is critical to proper evaluation and treatment.
Irregular bleeding occurs at vario3us stages of a woman's life for different reasons. In general, adolescent girls usually have some irregular bleeding during the first one or two years after the start of menstruation. Bleeding at this age is mostly due to the normal physiologic process of anovulation, or lack of regular ovulation during menstrual cycles.
The concern for cancer increases with age, necessitating the need for more invasive diagnostic testing. Causes of bleeding may be grouped into anatomical, hormonal and physiological. Anatomical causes include endometrial polyps, fibroids and lesions on the cervix, uterus or vagina, leading to disruption in normal tissue. Endocrine causes include hypothyroidism and polycystic ovarian syndrome. Even stress, anorexia or obesity may lead to irregular bleeding. Other physiologic causes include some of the most common causes, including birth control use.
Evaluation of abnormal uterine bleeding takes place by reviewing the patients' risks. A physical exam is critical. Often tested are hormonal and endocrine blood tests. Included in this workup is an ultrasound to make sure anatomical disorders are not the cause. Once the easily treatable causes are ruled out, one needs to consider how to effectively treat the irregular bleeding. Generally in women older than age 35, the workup may include an endometrial biopsy in the office or a diagnostic dilation and curettage. Often this includes hysteroscopy, where a camera is placed into the uterus to help visualize and treat any abnormalities.
Treatment of abnormal uterine bleeding has advanced tremendously recently. Depending on the degree of severity, age and desire for fertility, there are several treatment options. Many have become less invasive. Hysterectomy often may be avoided. The traditional treatment and management of adolescent and reproductive age women is to treat with birth control pills. As women age, more concerning is the anatomical and hormonal or endocrine causes of bleeding. Some women may need a dilation and curettage and/or endometrial ablation, if desiring no more children. Endometrial ablation is a process now being done in the office, where a layer of the uterine cavity, the endometrium is removed or ablated via several different methods. This helps women achieve a satisfactory result forgoing a hysterectomy.
As women approach menopause, endometrial cancer must be ruled out. Endometrial cancer is often curable due to early detection secondary to abnormal or irregular bleeding. If there is detection of precancerous hyperplasia, which is an overgrowth of tissue, there are medical treatments available. However, if cancer is diagnosed, a hysterectomy and possibly larger surgery and treatment must be performed.
The key to diagnosing and treating irregular menstruation is to look for the cause and treat that cause rather than the symptoms alone. Many people don't get the proper workup and feel as if there is no hope in management. Proper workup is critical to the treatment of this easily managed but often frustrating disorder. Partnership with a physician who realizes the importance of the physician-patient relationship and discussing the issue is critical. Finding a gynecologist willing to spend the time to discuss the issues and find a suitable solution is half the battle.
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StoneSprings Hospital Center
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Dulles, VA 20166