Abnormal Uterine Bleeding
Abnormal Uterine Bleeding Treatment in Mumbai
Abnormal uterine bleeding is menstrual bleeding of more than 80 ml (usually more than 5 pads per day) or less than 40ml (less than 2 pads per day), bleeding for less than 2 or more than 7 days, interval between menses of less than 21 days and more than 35 days.
Scanty bleeding is caused by hormonal problems, perimenopause or or adhesions in the uterine cavity due to surgery or infection.The treatment includes treatment of the underlying hormonal problem or cutting the adhesions inside the cavity by hysteroscopy.
Delayed periods are again due to perimenopause or due to hormonal problems such polycystic ovarian disease (PCOD), thyroid hormone deficiency (hypothyroidism), adrenal gland problems (congenital adrenal hyperplasia) or increased prolactin hormone levels (hyperprolactinemia). Correcting the underlying hormonal defect usually restores normal menstruation.
Heavy menses (more than 80 ml or lasting more than 7 days) or more frequent menses (interval less than 21 days) or bleeding in between menses is usually due to some pathology within the uterus although, occasionally, some hormonal problem may be responsible.
The common pathology that we deal with are:
Uterine Fibroids: These can cause heavy bleeding or, if coming into the cavity, even intermenstrual bleeding. These can be tackled by hysteroscopic or laparoscopic surgery (myomectomy) or hysterectomy (removal of the uterus) in elderly women with multiple fibroids, recurrence of fibroids or associated pathology.
Adenomyosis: This is thickening of the muscle of the uterus due to ingrowth of the lining of the uterine cavity (endometrium) into the muscle. This can lead to heavy bleeding (menorrhagia), severe pain during menses (dysmenorrhoea) and heaviness in the pelvis. The treatment is either laparoscopic excision of the adenomyosis or a hormone releasing intrauterine device called LNG-IUD (Mirena). This is a small plastic device placed in the uterine cavity as an outpatient procedure which releases a hormone called levonorgestrel locally.This shrinks the adenomyosis and reduced the amount of bleeding and pain.
Endometrial Hyperplasia: This is overgrowth of the lining of the uterus which can lead to heavy bleeding and, in later stages, a malignancy. The treatment is oral hormones, the LNG-IUD or in some cases a hysterectomy.
DUB without any pathology: In such a scenario, the endometrium and the uterus is normal and bleeding is because of some local endocrine disturbance. Treatment involves hormonal medication or endometrial ablation. Ablation involves destruction of the lining of the uterus through a device inserted inside the cavity. This can be a hysteroscope wherin the lining is destroyed with an electrode (transcervical resection of the endometrium or TCRE) or by a catheter through which hot fluid circulates destroying the lining. (Thermal balloon ablation). There is 80-90% reduction in menstrual blood flow and complete cessation of menses in some women. However the ovarian function, which is needed for the well being of the woman, continues normally.
Gynecological Malignancy: Cervical cancer and endometrial cancer (cancer of the mouth and lining of the uterus respectively) can present with intermenstrual irregular bleeding or bleeding after intercourse often with foul smelling discharge. These cancers are often detected early and can be treated by laparoscopic surgery.
In addition to these therapies, lifestyle modification & maintainence is extremely important. This includes appropriate diet and exercise.