August 2011: Abnormal Menstrual Bleeding
31 Jul 2011
Bruce A Rosenzweig, M.D., is a board-certified, fellowship-trained urogynecologist at Weiss Memorial Hospital. His areas of expertise include pelvic organ prolapse, chronic pelvic pain, interstitial cystitis, pessary use, pelvic floor rehabilitation and surgical management of urinary incontinence.
Bruce A. Rosenzweig, M.D.
Director of Urogynecology
Lakefront Women’s Health
Weiss Memorial Hospital
When a woman has a period more frequently than once a month or her periods become heavier than normal, these symptoms can become quite distressing. She may be concerned she has a serious disorder, but more often than not, a simple problem exists along with a simple cure.
Determining abnormal menstrual bleeding
As a woman matures through adolescence, her menstrual cycle begins. At first, these early periods can be heavy and irregular. This problem invariably corrects itself as her hormonal balance regulates. If a woman’s menstrual cycle becomes erratic later in life, she should probably see her doctor.
When a woman’s period becomes irregular during her reproductive years (14 – 50), it is important to first rule out pregnancy. This can be verified easily in a doctor’s office or with an over-the-counter pregnancy test. If the result is negative, the next step is for the patient to start a menstrual calendar: she documents when her menses starts and ends and also chronicles the heaviness of her blood flow. She can also record the number of tampons or pads used and how soaked the pads were. This record can either prove that the menstrual cycle is truly abnormal or show that the concerns were unfounded.
If the menstrual record shows a problem, a visit to the doctor is warranted. The doctor will review the symptoms and perform a physical exam. A pap smear will also be needed to assure that the cervix is normal.
In addition, the doctor will review all medications, including both prescription and natural remedies, to rule out any drugs or supplements that might interact with the woman’s normal hormonal cycle. These medications can be changed or avoided to see what effect that will have on the menstrual cycle.
If irregular periods persist, the doctor might then conduct an ultrasound examination of the uterus or womb to detect any anatomical abnormalities such as fibroids, non-cancerous muscle tumors of the uterus, or polyps.
Most often a hormonal imbalance is found, which can easily be treated with hormonal medications. These are usually birth control pills or oral contraceptives and additional hormones.
Occasionally surgical intervention may become necessary for diagnostic purposes and/or treatment. For instance, a biopsy of the uterine lining can be performed in conjunction with a hysteroscopy, a procedure where a telescope is placed in the uterus to allow the physician to view the internal structure of the womb. This procedure can identify the presence of fibroids or polyps, and allow the doctor to remove them at that time.
If large fibroids are diagnosed, they can be removed by a myomectomy, a procedure that removes the fibroids while preserving the uterus, or the uterus may need to be surgically removed by a hysterectomy. If the uterus is relatively normal in size, and a woman is finished with childbearing, a procedure called an endometrial ablation can be performed to stop the abnormal bleeding but preserve the uterus. Each of these surgical options should be discussed with a woman’s gynecologist or primary care provider.
While abnormal menstrual bleeding can be distressing, it is often the result of a simple cause that has a simple cure. As explained above, the following steps may help a woman and her doctor diagnose the problem:
• A pregnancy test can exclude pregnancy as a cause.
• A menstrual calendar can be used to obtain important information to share with the doctor.
• A review of all medications may help rule out any drugs or supplements that might interact with a woman’s normal hormonal cycle.
• If abnormal bleeding persists, further testing may be needed. A visit to the doctor can reveal the cause and establish a treatment plan.
For more information
If you would like more information about abnormal menstrual bleeding or other women’s health issues, or would like an appointment, please call Dr. Rosenzweig’s office at (773) 564-6025.