Dysfunctional Uterine Bleeding
Abnormal Bleeding can be quite disruptive to your life; we will follow an orderly investigation of your specific problems and concerns. By working together, within just a few office visits—we can have most patients on their way to a mutually acceptable solution-sometimes per a simple hormonal adjustment and at other times-per minimally invasive surgery such as hysteroscopy or laparoscopy.
There are really two main causes of bleeding—hormonal such as stress(perimenopause) or a structural problem such as fibroids or polyps or precancerous conditions. We will check these out with a couple of office visits, some lab tests, an ultrasound and a possible sampling biopsy.
The first visit:
History-careful attention to details of the menstrual calendar/fertility “app” will aid us in narrowing down the hormonal vs structural nature of the problem-acute vs. chronic; mild vs severe; prior episodes and procedures.
Physical Examination-focuses on structural findings; obtain samples and biopsies.
Lab tests-CBC (anemia); PT/von Willenbrands (inherited disorders); Thyroid panel, preg test.
Ultrasound-vaginal probe-Necessary to evaluate structural problems-polyps and fibroids.
Endometrial sampling—for most women over 35yoa to check precancerous tissue.
The Second Visit-treatment options:
Hormonal or functional problems-BCP cycling; Provera cycling; Lysteda, Lupron, Mirena IUD.
Structural Problems-Fibroids (submucous/lining)-probably hysteroscopy (uterus sparing)removal.
-Fibroids-large and multiple and recurrent-discuss Same day surgery TLH
-Polyps/Postmenopausal thickened endometrium
Chart for options to treat menorrhagia