The menstrual cycle begins with the first day of bleeding of one period and ends with the first day of the next period. In most women, periods are about 28 days apart.
The following scenarios are considered abnormal bleeding:
- Menstrual cycles that are longer than 35 days or shorter than 21 days
- Absence of a period for more than 6 months (amenorrhea)
- The lack of periods for 3–6 months (amenorrhea)
- Bleeding between periods, after intercourse and after menopause
- Heavy or prolonged bleeding (lasting longer than 7 days)
- Passing large clots with a period
Heavy bleeding (menorrhagia) affects more than 10 million American women each year. One out of every five women has heavy bleeding.
If left untreated, abnormal bleeding will not only interfere with your life (miss work, miss social outings, pass on sexual relations with partners and even become incapacitated due to their periods), but can also cause health complication or be a sign of underlying concerns.
Signs that you may have abnormal bleeding:
- Soaking through one or more sanitary pads or tampons every hour
- Needing to use both pads AND tampons to control your menstrual flow
- Needing to wake up to change pads/tampons during the night
- Bleeding for longer than 7 days
- Passing blood clots with a period (quarter size or larger)
- Restricting daily activities due to heavy periods
- Symptoms of anemia, such as tiredness, fatigue or shortness of breath
- Bleeding after menopause (bleeding after not having a period for 12 months)
- Bleeding more often than every 21 days
- Bleeding during or after sex
- Bleeding after menopause
- Skipping menses for 3-6 months (premenopausal)
- Hormone imbalance- excess estrogen, inadequate progesterone
- Uterine fibroids- usually benign growths of the muscle of the uterus
- Polyps- Small, usually benign growths on the lining of the uterus
- Adenomyosis- a condition where the lining of the uterus grows into the muscle of the uterus
- Intrauterine device (IUD)- heavy and prolonged bleeding is a well-known side effect of using a non hormonal intrauterine device for birth control (Paragard®).
- Pregnancy –due to miscarriage, ectopic pregnancy or other complications
- Cancer of the vagina, cervix, uterus or ovary
- Bleeding disorders- ex. von Wildebrand’s disease, low platelets
- Medications- such as blood thinners
- Other medical conditions- infections, thyroid disease, liver/kidney disease, and endometriosis
- Unknown- heavy bleeding affects 20% of women and often times the cause is unknown
Tests for Abnormal Bleeding
First and foremost, a careful medical history and physical exam is performed. Depending on the patient age, and medical history, other tests may include:
- Endometrial biopsy – this involves taking a sample of tissue from the uterine lining. This test is checking for cancerous or precancerous cells of the uterus. Patients may experience mild to moderate cramping which usually resolves when the test ends. Cramping can be reduced by taking anti- inflammatory medications (ibuprofen, Aleve®) 60 minutes before an endometrial biopsy.
- Ultrasound – this test uses sound waves to look at the pelvic organs. A thin ultrasound probe is inserted into the vagina and used to visualize the uterus, cervix and ovaries.
- Saline infusion ultrasound (sonohysterogram) – This is an ultrasound that goes one step further by using sterile water to expand the uterine cavity to get better visualization of the inside of the uterus. Sonohysterogram may be recommended if fibroids or polyps are suspected. Much like an annual gynecology exam, a speculum is inserted into the vagina and a thin catheter (tube) is inserted into the uterus. A small amount of sterile water is then infused into the uterus. The water helps expand the uterine cavity to give detailed visualization of the cavity of the uterus. Patients may experience mild to moderate cramping which usually resolves when the test ends. Cramping can be reduced by taking anti- inflammatory medications (ibuprofen, Aleve®) 60 minutes before this test.
- Blood work – In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, low iron, thyroid disease, liver/kidney function, blood/clotting disorders. For women with infrequent periods, a thorough hormone evaluation is performed (testosterone, insulin, DHEA etc)
- Hysteroscopy – a camera is inserted into the cavity of the uterus for direct visualization
- Laparoscopy – this is a surgical procedure done at the hospital under general anesthesia where a camera is inserted into the abdomen to survey the pelvic organs
- Pap smear – a sampling of cells from the cervix to look for precancerous or cancer cells
Treatments for Abnormal Bleeding
Treatment will depend on the underlying cause of the the bleeding and if the woman desires future child-bearing. Patients with anatomic causes of abnormal bleeding such as fibroids, polyps, or cancer are managed with surgical therapy. If a systemic or hormonal condition is the cause of abnormal bleeding, treatment of that condition will usually resolve the abnormal bleeding.
- Nonsteroidal anti-inflammatory drugs such as ibuprofen reduce the amount of blood loss and help with pain. In some women, this medication may increase the risk of bleeding
- Systemic Hormone therapy – progesterone, oral contraceptives, Depo-Provera, Nexplanon®
- Progestin releasing IUD (Mirena®or Liletta®)
- Lysteda® (tranexamic acid), a non-hormonal medication that promotes blood clotting
- Iron supplements – iron doesn’t treat the bleeding issue, but is used to replace iron deficiency related to blood loss.
- Operative hysteroscopy – A surgical procedure, using a special camera to look inside of the uterus that can be used to remove polyps and fibroids
- The Myflow® Procedure (endometrial ablation) – This is usually an office procedure that treats (removes) the lining of the uterus. The majority of patients stop having periods altogether, others may continue to have periods but the flow is significantly reduced. Endometrial ablation destroys the lining of the uterus. It stops or reduces menstrual bleeding. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications is greatly increased. Patients need to use a birth control method following endometrial ablation. MyControl® (permanent birth control) may be a good option to prevent pregnancy for women having The Myflow® procedure. Energy-delivering devices used for endometrial ablation include cryotherapy, circulating hot fluid, and radiofrequency devices. At Amy Brenner MD and Associates, we have all the methods for ablation at our facility. The specific device that is used in customized for each patient. Myflow® can be performed in our AAASF accredited office with local anesthesia or IV sedation.
- Hysterectomy – Hysterectomy refers to removal of the uterus only, the ovaries are not removed. Occasionally, women opt to have ovaries removed at the time of hysterectomy. Hysterectomy is used to treat large fibroids, suspected adenomyosis, uterine cancer and when other types of treatment have failed or are not an option. After the uterus is removed, a woman can no longer get pregnant and will no longer have periods. When the ovaries are not removed, hormones are not typically affected.
- Myomectomy is surgery to remove fibroids without removing the uterus. This option is ideal for women who desire future fertility.
WHY CHOOSE US FOR ABNORMAL BLEEDING TREATMENT?
When you suffer from abnormal bleeding, it is important to have a thorough evaluation. It is important to find a GYN specialist whom you trust. It is a big decision to decide which experts and surgeons to depend on.
A general OB/GYN is highly skilled in obstetrics. Over 70% of their time is focused on delivering babies. Dr. Brenner delivered babies for over a decade at her last practice until she decided to focus solely on gynecology and minimally invasive procedures. Dr. Franzese completed advanced training through a fellowship program in minimally invasive gynecologic surgery.
In short, gynecologic procedures is what we do! At Amy Brenner, MD & Associates, LLC, we are completely focused on performing minimally invasive GYN treatments and procedures for optimal results and a quick recovery. Our providers explore all of the treatment options with our patients, getting to know each patient before deciding on the best approach. We also make sure that you are fully informed about the treatment you receive, whether it is a simple prescription for birth control pills, the Myflow® procedure or a hysterectomy.
A safe and speedy recovery is our priority. We have experience with each procedure and have seen all possible outcomes, so we can tell you what to expect to make you feel comfortable.
As a patient, it is your decision where to get treated. As experts in this field, we urge you to visit us and find peace of mind in the form advanced training and years of experience.