Abnormal Bleeding

The average menstrual cycle lasts about 28 days, counting the first day of menstrual bleeding as day one. There is variability and it is normal to have a cycle interval from 23 to 35 days.

 

There are a number of problems that can occur with menstrual bleeding, including heavy bleeding, long menstrual periods, irregular cycle length or bleeding between cycles. Each problem can have a range of causes and my responsibility is to diagnose and recommend appropriate management.

The evaluation may involve testing of hormone levels and a biopsy of the lining of the uterus. The biopsy is a simple procedure done in the office. The results of the testing will help to establish the cause of the problem and the best option for treatment. On occasion, an ultrasound or other imaging test may be needed to complete the diagnosis.

 

Many times use of oral contraceptives or other hormonal treatments are the easiest approach and are effective. In other cases, a procedure, known as a dilatation and curettage (D&C), is the best management. This is a relatively simple procedure done in the operating room in which the lining of the uterus is scraped to remove the abnormality. This is often coupled with hysteroscopy, in which the lining of the uterus is examined with a microscope. Hysteroscopy can also be used to remove lesions, such as polyps or fibroids, that may be in the lining of the uterus.

Most problems of abnormal menstrual bleeding can be fixed relatively simply. On occasion, the tests do not identify the cause and the heavy bleeding does not respond to medical therapy. In this setting, an endometrial ablation may be considered. This is the destruction of the lining of the uterus using a heating device. This is done in the operating room and is a simple “in and out” procedure. This procedure is not done on women who wish to consider having a child in the future as the procedure usually prevents pregnancy. Having said that, this procedure is not a method of contraception and pregnancy can occasionally occur after it is performed.