As we get started in a new decade at Modern Gynecology & Reproductive Health, we are looking forward to expanding our services and continuing to offer the best, most innovative treatment options for many common concerns. We have an excellent approach to the evaluation and management of one of the most common gynecologic concerns, which is problematic vaginal bleeding!
What is problematic vaginal bleeding?
A large percentage of women will have an episode of bothersome bleeding at some point. For up to 40%, it will be an ongoing, chronic, debilitating problem.
Bleeding is problematic if it affects your quality of life! There are no specific ways to easily measure the amount of blood loss. If periods are causing you pain or discomfort or are affecting your ability to do normal activities, they are a problem for you!
Heavy or irregular periods are a major cause of discomfort, cost and disability and many people suffer in silence. There are a large number of causes of heavy periods and irregular bleeding and many can be treated either medically or with minimally invasive surgery in an outpatient setting without requiring hospitalization or major surgery.
Common causes of problematic bleeding
- Uterine fibroids
- Uterine or cervical polyps
- Pelvic infection
- Cancer (rare)
- Hematologic bleeding disorder
- Ovulatory disorder
- Endocrine disorder (thyroid dysfunction)
- Unexplained (Idiopathic) heavy bleeding
How do I find my diagnosis?
The first step for evaluation of heavy bleeding is to have a thorough discussion and examination with your provider. The history and physical as well as laboratory evaluation are key to starting down the path for diagnosis and treatment. A pelvic ultrasound is often a useful tool to further elucidate anatomy and a more involved ultrasound called a sonohysterogram or a procedure called hysteroscopy may also be helpful. Sometimes a biopsy of the uterine lining is also necessary.
What do I do next?
After a careful discussion and exam with your physician, you should be able to come up with a treatment plan that fits your circumstances. Issues to take into consideration include:
- Presence or absence of fibroids
- Desire for future fertility
- Medical and surgical risks
- Hormonal status
What are some treatment options?
The mainstays of treatment for problematic bleeding are:
- Medical & Hormonal therapy
- Endometrial Ablation
- Non-invasive Fibroid Embolization
Medical & Hormonal therapy
Medical & Hormonal therapy may be indicated for people that need contraception in addition to management of bleeding and for those that plan to become pregnant in the future. Mainstays of therapy include oral contraceptives (birth control pills), patches, Nuvaring, DepoProvera, Nexplanon hormonal implant and Levonorgestrel IUDs. Some patients also benefit from a medication called Lysteda (Tranexamic acid) for episodic, short term use or Lupron for surgical pre-treatment. Many people reach a point at which they prefer not to use hormonal management, particularly after child bearing is complete.
Endometrial Ablation is a minimally invasive procedure that can be done in the office setting or in outpatient surgery. Our endometrial ablation device of choice is called Novasure, which is the market leader in endometrial ablation treatment. The technology has been on the market for almost 20 years and has been used to successfully treat over 3 million women. It uses individually measured radio-frequency energy to remove the uterine lining with a probe that is placed in the uterus through the cervix. The procedure takes approximately 5 minutes. Dr. Lacy has over 15 years of experience with Novasure and has had hundreds of patients who had excellent results with ablation. The patient satisfaction rate with Novasure is excellent.
Hysteroscopy is a procedure that can be done in the office or outpatient surgical setting. It is mainly indicated for the removal of smaller polyps or fibroids that are contained within the uterine cavity. It is often done in conjunction with Novasure.
Fibroid Embolization is a procedure done by interventional radiologists. We have a good referral relationship with Vascular Access Centers and can help facilitate the procedure where appropriate. Fibroid embolization is used for patients who have isolated, problematic small- or medium-sized fibroids.
Hysterectomy, surgical removal of the uterus, is the second most common female surgical procedure done in the United States. While hysterectomy is a common procedure, it can usually be reserved for patients with large fibroids or significant pelvic pain accompanying heavy or irregular bleeding or patients with a history of more complicated problems. We have excellent referral sources for hysterectomy when indicated.