Abnormal Uterine Bleeding
Many women in their forties and fifties begin to notice changes in their menstrual patterns. This may include irregular, heavier, or more frequent menstrual flow. To evaluate this condition and potentially eliminate significant disease, there are several tools that can be used in the office.
We know that the menstrual cycle is controlled by the coordination of many hormones circulating throughout the body. Any abnormal variation of these hormones can influence the menstrual flow. Blood laboratory studies can be performed to evaluate the inappropriate release of these hormones from certain endocrine glands. Some of the more common hormones found in this age group are thyroid stimulating hormone, follicle stimulating hormones, prolactin, and luteinizing hormone.
In addition to hormonal changes there are other changes that may lead to abnormal bleeding patterns. It is always a good idea to have an annual Pap smear of the cervix. Inflammatory changes involving the cervix arising from bacteria, yeast, or viruses can lead to intermittent bleeding, as can benign polyps of the cervix. As we know, Pap smears are designed to screen for abnormal cellular changes and pre-cancerous changes of the cervix.
An endometrial biopsy is a very important tool in evaluating abnormal bleeding patterns. It can help diagnose inflammatory changes, polyps, and abnormal proliferation or thickening within the uterine lining. It is also a quick and efficient screening test for uterine cancer.
Many offices offer ultrasonography of the pelvis to more completely screen the uterus and ovaries for pathology. We can visualize benign tumors of the uterine wall and ovarian cysts that may cause alteration in the menstrual cycle.
There are many methods of treatment for abnormal uterine bleeding ranging from quite conservative to invasive. If the bleeding does not involve significant disease, hormones may be used to induce a normal cycle. Antibiotics may also be used to clear an inflammatory source. If benign disease is involved, certain in-office or out-patient surgical procedures may be recommended to remove the offending lesions, such as a dilation and curettage, commonly known as a D & C, or a loop electrical excision procedure, also known as a LEEP. In addition, more permanent correction of the problem may be desired by the patient or recommended by the physician including thermal ablation of the uterine lining or hysterectomy.
Most abnormal uterine bleeding experienced by women in the premenopausal years is benign in nature and can be treated effectively; however, it must be thoroughly evaluated by the physician to rule out more serious causes.
Elizabeth Mann, M.D.
Memphis Obstetrics & Gynecological Association, PC (MOGA)