Guest Author - Denise Howard, M.D., M.P.H.

Abnormal uterine bleeding is the primary reason for surgery and emergency gynecologic visits in the premenopausal woman. Previous articles have discussed the problem of abnormal uterine bleeding and the evaluation process.

Treatment options are dependent on the results of the test ordered to evaluate the cause of the abnormal uterine bleeding. Other factors include the size of the uterus and individual health problems. In many cases reassurance that there is nothing wrong is all that is required. Assuming that there is no evidence of malignancy, the options for treating abnormal uterine bleeding are listed below.

Medications
1. Birth controls pills are commonly used to treat abnormal uterine bleeding. They contain a combination of estrogen and progestin hormones. They typically regulate the cycle and result in a shorter and lighter menstrual flow.
2. Progestin only pills can be used alone either in a continuous fashion or for 10-14 days of the month. The result is irregular light bleeding or no periods at all.
3. Depoprovera is a progestin medication that is delivered as an intramuscular injection. It is given every 12 weeks and in most cases the person may not experience any bleeding.
4. Mirena is an intrauterine device that delivers progestin directly into the endometrium. The result is a lighter period or in many cases completes cessation of menses.


Minor Surgery
1. Dilatation and Curettage (D&C) can provide some relief by simply denuding the lining of the uterus. Used in conjunction with a hysteroscopy, it can also identify abnormal uterine structures such as polyps or fibroids. Polyps can easily be removed at the time of a D&C.
2. Hysteroscopic Resection of fibroid can be done if there is a fibroid in the lining. This procedure essentially trims away the portion of the fibroid that is growing into the lining of the uterus.
3. Ablation procedures are very effective, simple to perform and pose minimal surgical risk to the patient. They destroy the lining of the uterus either by heating or freezing. The result is either a normal or lighter period or no period.
4. Uterine fibroid embolization is a procedure performed by an interventional radiologist. Small amounts of inert material are injected into the uterine artery to obstruct the blood supply to the uterus resulting in fibroid shrinkage over time.

Major surgery

1. Myomectomy is a surgical procedure designed to remove fibroids from the uterus. It is done either via a laparotomy incision or in some cases laparoscopically. Once the fibroids are removed the uterine defect is repaired by sewing the edges together.
2. Hysterectomy is a procedure in which the uterus is removed. This is the ultimate cure for abnormal bleeding. The ovaries can be left in place. This can be done through an abdominal incision, vaginally or laparoscopically.


Women who smoke and are over the age of 35 should not use hormonal therapies. Women with a history of a heart attack, stroke, and deep venous blood clots should also avoid these medications. Caution should also be taken in women with multiple medical problems, especially a history of diabetes and hypertension.

There are also certain contraindications to ablation procedures but this varies by technique. In addition when considering surgery, an individual’s health status should be considered. Some women will be at increased risk of problems such as heart attack, stroke, infections and deep venous thrombosis.

It is therefore important to have a thorough evaluation by an experienced Gynecologist. A discussion of options and a consideration of your individual health risk should be undertaken. There are many options available to address the problem of abnormal uterine bleeding and I encourage every woman who is suffering from this problem to at least seek an evaluation.