Gynecology - Abnormal Menses
The cyclic shedding of the endometrial lining of the uterus, as controlled by the ovarian hormones, causes menstrual bleeding. The key in the approach to the problem of abnormal menses is to find out why the menstrual bleeding is abnormal in terms of cycle length, duration or amount. The main causes of abnormal bleeding include:
- Abnormal hormone function – most common in teenage years or before menopause (in the late 40s). The lack of regular ovulation causes excessive estrogen stimulation to the uterus lining without progesterone to balance it, thus causing abnormal menses.
- Abnormalities of the uterine endometrial lining, such as polyps (small benign growth of the lining), hyperplasia (overgrowth of the lining - can be pre-cancerous) or cancer growth.
- Abnormalities of the uterine wall, such as a fibroid tumor (benign, fibrous smooth muscle tumor) of the uterus, adenomyosis (“endometriosis” of the uterine muscle wall), general enlargement of uterus, or cancer.
The treatment should then be tailored to the cause of the abnormal bleeding. The investigation should include blood tests, hormonal tests, ultrasound scan, and, if needed, office endometrial biopsy and hysteroscopy. Although hysterectomy or dilation and curettage may be necessary to treat the abnormal bleeding, new technologies offer many other options in treating abnormal menses. The treatment could be as simple as hormonal therapy, including birth control pills. Minimally invasive surgery, such as endometrial ablation (elimination of the endometrial lining), can stop menses all together or decrease the amount of menstrual flow Cryoablation (freezing) of the endometrium is an office procedure requiring just local anesthesia. The treatment is relatively brief and comfortable, and there is virtually no down time.