Abnormal Uterine Bleeding: Diagnosis & Treatment
Diagnosing abnormal uterine bleeding
Medical professionals have several options for helping to uncover the cause of abnormal bleeding:
A medical history can reveal much about abnormal bleeding. A doctor or nurse practitioner can review symptoms that accompany the bleeding (any fever, pain or vaginal odor), including an increase in bleeding after sex. The doctor or nurse may also want to know about medications the woman is taking, any significant weight changes, any sudden lifestyle shifts such as new diet or exercise programs, and if there is family history of bleeding.
A transvaginal ultrasound measures the shape and size of the uterus. In this procedure, a small probe is inserted into the vagina. Through the use of sound waves, ultrasound equipment can provide an image of the uterus, measure the thickness of the endometrium, and help determine overall uterine health.
Saline infusion sonography, or sonohysterography (also called a hysterosonogram), is a test in which a transvaginal ultrasound is performed after saline is injected into the uterus. The saline yields better images of the uterus, allowing detection of smaller lesions. The disadvantage is that tissue samples cannot be taken, so additional evaluation may be necessary. This can include hysteroscopy with dilation and curettage (see below).
A dilation and curettage, or D&C, can be done both for diagnosis and treatment. It is a procedure in which the cervix is dilated so that instruments can remove the lining of the uterus. A D&C can halt the bleeding, while the removed lining can be checked in a laboratory for abnormal tissue. A D&C is performed under anesthesia.
A magnetic resonance image (MRI) is sometimes useful for determining whether there are uterine fibroids or other structural abnormalities.
Hysteroscopy involves insertion of a small scope through the cervix and into the uterus. Air or liquid is then injected to expand the uterus and allow a doctor to look inside and also take tissue samples. This procedure is performed under anesthesia and often along with a D&C.
Treatment for abnormal uterine bleeding
There are also numerous treatment options for abnormal bleeding:
Birth control pills can stop the endometrium (uterine lining) from growing too thick, as well as help regulate menstrual periods and reduce menstrual cramping. However, some birth control pills – notably, the progestin-only pill, also known as the “mini-pill” – can actually cause abnormal bleeding in some women.
Progesterone is a hormone produced in the ovary. A synthetic form of progesterone, progestin, can be an effective treatment for women with abnormal bleeding caused by irregular ovulation. Progestin usually comes in a pill form and is taken daily or for 10 to 12 days each month to control vaginal bleeding.
An intrauterine device (IUD) is a small, plastic device inserted into the uterus through the vagina to prevent pregnancy, and can also reduce abnormal bleeding. A progestin-releasing IUD also decreases menstrual bleeding by 40 to 50 percent (or even halting it all together for some women) and can ease menstrual pains. However, an IUD can also be the cause of bleeding, so women already using an IUD and experiencing bleeding should consult a doctor.
Endometrial ablation is a type of surgery that destroys the endometrium (the lining of the uterus.) This kind of surgery removes fibroids and polyps and can be a good option for women who have completed childbearing. There are several technologies for endometrial ablation, including use of heat, cold or a laser.
The newer technologies do not require general anesthesia or a hospital stay and require less recovery time than a hysterectomy, which can be an alternative to ablation. Some women still have bleeding or spotting after endometrial ablation. A few even experience regular periods again. Women who have had this procedure still need to use birth control afterward, despite having low chances of pregnancy.
A hysterectomy, or removal of the uterus, is usually the last option when other treatment attempts have failed. A hysterectomy can be performed through traditional open surgery, in which the uterus is taken out through an incision in the belly, or through what’s known as a minimally invasive procedure. This latter procedure can be performed through a small incision in the vagina or through use of a scope, which may also be robotically assisted.