women s health issues
Abnormal Uterine Bleeding (AUB)
Treatment of Abnormal Uterine Bleeding
A drug to control the bleeding If bleeding continues, a procedure to control the bleeding If abnormal cells are present in the uterus, a progestin orprogesteroneor, in postmenopausal women, sometimes removal of the uterus If iron deficiency anemia is present, iron supplements Treatment of abnormal uterine bleeding depends on How old the woman is How heavy the bleeding is Whether the uterine lining is thickened Whether the woman wishes to become pregnant Treatment focuses on controlling the bleeding and, if needed, preventing endometrial cancer. Bleeding can be controlled using medications, which may be hormones or not. Medications that are not hormonesare often used first, especially in women who want to become pregnant or to avoid the side effects of hormone therapy and in women with heavy regular bleeding. These medications include Nonsteroidal anti-inflammatory drugs (NSAIDs) Tranexamic acid (such as Oral Contraceptives ) is often tried first in women who do not want to become pregnant or who are approaching or just past menopause (this time period is called When the uterine lining is thickened but its cells are normal (endometrial hyperplasia), hormones may be used to control bleeding. Often, abirth control pillthat contains estrogen and a progestin (a combination oral contraceptive) is used. Besides controlling bleeding, oral contraceptives decrease the cramping that may accompany bleeding. They also decrease the risk of endometrial (and ovarian) cancer. Bleeding usually stops in 12 to 24 hours. Sometimes high doses are needed to control the bleeding. After bleeding stops, low doses of the oral contraceptive may then be prescribed for at least 3 months to prevent the bleeding from recurring. Some women should not take estrogen, including that in combination oral contraceptives. Such women include Women with significant risk factors for a heart or blood vessel disorder or who have had blood clots Women who have had a baby within the last month Aprogestin orprogesterone(which is similar to the hormone the body makes) may be used alone when Women should not take Hormone Therapy for Menopause (that is, when estrogen is contraindicated). Treatment with estrogen is ineffective or not tolerated. Women do not wish to take estrogen. can be given by mouth for 21 days a month. When these hormones are taken this way, they may not prevent pregnancy. Thus, if women do not wish to become pregnant, they must use another method of birth control, such as an Intrauterine Devices (IUDs) or Other medications that are occasionally used to treat abnormal uterine bleeding include Drugs used to treat endometriosis (a synthetic male hormone, or androgen) and If heavy menstrual bleeding is thought to be caused by fibroids, other oral medications, some of which contain hormones, may be used (see also Treatment ). If women are trying to become pregnant and bleeding is not too heavy, they may be givenclomiphene(a fertility drug) by mouth instead of hormones. It stimulates ovulation. If women have iron deficiency anemia or symptoms of iron deficiency without anemia, iron supplements are usually given by mouth but sometimes must be given by vein (intravenously). Normal consumption of iron in the diet usually cannot compensate for iron loss due to chronic bleeding, and the body has a very small iron reserve. Consequently, lost iron must be replaced by taking iron supplements. If the uterine lining (endometrium) remains thickened or the bleeding persists despite treatment with hormones, hysteroscopy is usually done in an operating room to look into the uterus. It is followed by dilation and curettage (D and C). For a D and C, tissue from the uterine lining is removed by scraping. This procedure may reduce bleeding. However, in some women, it causes scarring of the endometrium (Asherman syndrome), Scarring can cause menstrual bleeding to stop (amenorrhea) and make biopsy of the endometrium difficult later. Endometrial ablation does not prevent pregnancy. If bleeding continues after a D and C, a procedure that destroys or removes the lining of the uterus (endometrial ablation) can often help control bleeding. This procedure may use burning, freezing, or other techniques. It may help 60 to 80% of women. If fibroids are the cause, blood flow to the fibroids may be blocked with small, synthetic particles injected through a thin, flexible tube (catheter) into these arteries (called artery embolization). Alternatively, fibroids may be removed through a catheter inserted into a small incision just below the navel (laparoscopy), through a catheter inserted into the vagina (hysteroscopy), or through a larger incision into the abdomen. If bleeding continues to be substantial after other treatments have been tried, doctors may recommend removal of the uterus (hysterectomy). If the uterine lining contains abnormal cells and menopause has not occurred, women may be treated with one of the following: A high dose ofmedroxyprogesteroneacetate (a progestin) Norethindrone Micronizedprogesterone(a natural rather than syntheticprogesterone) An intrauterine device (IUD) that releaseslevonorgestrel(a progestin) A biopsy is done after 3 to 6 months of treatment. If the cells appear normal, women may be givenmedroxyprogesteroneacetate for 14 days each month. If they want to become pregnant, they may be givenclomipheneinstead. If the biopsy detects abnormal cells, a hysterectomy may be done because the abnormal cells may become cancerous. If women are postmenopausal, hysterectomy is usually done. If women have a condition that makes surgery risky, a progestin is used. Rarely, very heavy bleeding requires emergency measures. They may include fluids given intravenously and blood transfusions. Occasionally, doctors insert a catheter with a deflated balloon at its tip through the vagina and into the uterus. The balloon is inflated to put pressure on the bleeding vessels and thus stop the bleeding. Very rarely, estrogen is given intravenously. Treatment is limited to 4 doses because this treatment increases the risk of blood clots. Immediately afterward, women are given combination oral contraceptives until bleeding has been controlled for a few months. 