Are there recommended treatment strategies for abnormal bleeding?
Dr. Bradley: The win-win situation for women is that we now have better imaging that can be done in the office -- transvaginal ultrasound and saline-infusion sonography (SIS) -- which provides an excellent snapshot of the uterus, myometrium, endometrium, and adnexa. Such imaging allows rapid diagnosis of pelvic pathologic conditions that could be associated with irregular menses. This information can help guide the physician to a more definitive treatment, thereby reducing the chances of unneeded invasive surgical procedures. For instance, if SIS demonstrates an endometrial polyp as the cause of bleeding, a brief outpatient hysteroscopic polypectomy could be performed.
For regular but excessive bleeding, the pill remains the least invasive option to regulate the menstrual flow without substantial risks. Another option is NSAIDs (e.g., Meclomen (meclofendamate) and Ponstel (mefenamic acid), which are branded generics). Among women who have a negative workup and fail medical therapy and who are not desirous of fertility, endometrial ablation can be a brief outpatient procedure to minimize bleeding. If drugs are not indicated because of an ulcerative condition or cigarette smoking, endometrial ablation, which causes cessation or very light bleeding in the future is an option.
For older women who are suffering from atrophic endometrium, acknowledgment that their aging tissue is the cause of the episodic bleeding often is sufficient. For those who need a more active approach, the treatment of choice is a moisturizer in the form of a short course (1-2 months) of low-dose estrogen. If the bleeding returns within 12 months of the initial evaluation, the physician can repeat a short course of estrogen.
Hysterectomy is an option for women with large fibroids. However, a hysteroscopic myomectomy can achieve the needed results in an outpatient setting depending upon the size, number, and location of the fibroids. Similarly, a hysteroscopic polypectomy is effective for polyp removal. Uterine fibroid embolization is an option so long as pregnancy is no longer an expectation.
Dr. Schrager: There are many nonsurgical options for treatment of abnormal bleeding. The treatment will clearly depend on the type of bleeding and the cause. For acute, heavy bleeding, high doses of estrogen or OC pills work very well. High-dose medroxyprogesterone is also useful for acute treatment. For anovulation, treatment depends on the amount of distress the woman is experiencing and her desire for pregnancy. OC pills or depomedroxyprogesterone can control bleeding and provide contraception. Clomiphene citrate is one example of a medication that can induce ovulation and help a woman achieve pregnancy. Scheduled NSAIDs can reduce the amount of bleeding in women with menorrhagia.
© 2004 Mary Ann Liebert, Inc.
Cite this: Toward Optimal Health: The Experts Discuss Abnormal Uterine Bleeding - Medscape - Apr 01, 2004.