Heavy Menstrual Bleeding
Edward Lichten, M.D.,PC
Is she menopausal (last menstrual period more than 6 months ago)?
Therefore, there are four methods used to determine ovulation: 1) The presence of the ovarian cyst at midcycle, 2) elevated basal body temperature the 10-14 days after ovulation, 3) elevated progesterone in the blood on day 21-24, and 4) changes in the lining of the uterus (endometrium) prior to her next menstrual period.
The most consistent method of determining ovulation in a woman who wishes to conceive is the serum progesterone assay. If the level is less than 2, she is not ovulating. If the level is over 10, there is very strong evidence of ovulation. If the levels are in-between, then the production of progesterone is less than adequate.
Pregnant? Even before a woman is "late" she can determine if she is pregnant with the EPT or home pregnancy tests. These measure the hormone beta-HCG produced only by the placenta (after-birth). Therefore, the diagnosis of pregancy is quite easily confirmed or eliminated from the medical diagnosis of "causation of bleeding."
D&C(Dilitation & Curettage)
Question #3: What is the result of the pathology of the D&C?
Rarely do we find cancer of the endometrium, called "endometrial carcinoma." A thick piece of tissue that is out-of-phase is called a polyp. Tissue that has a "Swiss-cheese" appearance is called cystic hyperplasia. This is not cancer. When the term "adenomatous hyperplasia" is used, this implies a crowding of the endometrial glands. When the term used is "adenomatous hyperplasia with atypia," this is considered pre-malignancy.
Question #4: Does the D&C and medical treatment correct the bleeding problem?
If the problem is anovulation, then the D&C usually corrects the immediate problem. Treatment of anovulatory bleeding can be either birth control pills or pregnancy. If the woman is 14 to 54 years of age, she can be treated with a low dose OC, oral contraceptive (birth control), to regulate her menstrual cycle. This corrects the problem of anovulation (too thick endometrium) by adding the OCs progestin and the atrophic (too thin endometrium) by adding the OCs estrogen. If the woman wishes to conceive, the use of Clomiphene can induce ovulation. Fertilization and pregnancy are effective treatments for bleeding disorders for at least nine months.
Not every woman's bleeding responds to oral contraceptives. They are contra-indicated in women with blood clots, a history of smoking and those with hypertension. But there are other medications that can control almost all bleeding problems.
The medications luprolide acetate or Lupron and Synarel are Gn-RH agonists. That means they prevent the release of FSH and LH from the brain. This creates a state of very low estrogen. And not only does the uterine bleeding usually cease, but also, the fibroids and polyps shrink and might disappear over time. These drugs are usually used for short periods of time, up to 9 months. Further use is associated with osteoporosis and bone thinning. The other choice is Megesterol acetate (Megace). Megace is a drug from the save family as Provera called progestins. Megace is unique in that a low dose of oral Megace is successful in minimizing bleeding while having minimal effects on bone loss. Depoprovera may cause continuous bleeding.
But no medication or out-patient surgery will work for every case of abnormal uterine bleeding!
What then are the options for a woman who has completed her childbearing and needs to stop heavy, irregular and prolonged menstrual periods?
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|Revised: January 1, 2007|