Diagnosis and Treatment of Abnormal Uterine Bleeding

Women's health is a critical issue that significantly influences the overall well-being of both society and individuals. Women may encounter various problems that can significantly impact their quality of life. In my three-part series, I have addressed a condition known as "Abnormal Uterine Bleeding." In the first article, I discussed the topic of the "Normal Menstrual Cycle," and in the second article, I covered the "Causes of Abnormal Uterine Bleeding." This final article of the series focuses on the “Diagnosis and Treatments of Abnormal Uterine Bleeding.”

What Are the Symptoms of Abnormal Uterine Bleeding?

• Bleeding or spotting outside the menstrual period
• Increased duration of menstrual periods
• Excessive menstrual bleeding (menorrhagia)
• Irregular menstrual cycles
• Abdominal pain
• Fatigue, weakness, palpitations, darkening of vision

How Is the Diagnosis of Abnormal Uterine Bleeding Made?

The diagnosis of abnormal uterine bleeding should be conducted by a gynecologist. Firstly, a detailed assessment of the regularity of the menstrual cycle is performed. The duration and amount of bleeding are calculated, and if there is intermittent bleeding, it is determined whether it is cyclical. Patient-specific risk factors are thoroughly examined. Family history is also scrutinized in detail, followed by a physical examination of the patient. Physical examination involves ultrasound examinations conducted abdominally or in the vaginal region, camera-based systems to observe the uterine wall (hysteroscopy), and sometimes MR (magnetic resonance) and CT (computed tomography) to check for any structural anatomical issues. Blood tests are conducted to evaluate the patient's clotting, specifically looking at hormones such as thyroid hormone and prolactin. In patients over 35 with risk factors (obesity, diabetes, a family history of uterine cancer, some hereditary disorders), and even in those over 40 without specific risk factors, a biopsy sample is taken from the uterine wall to manage the process and not overlook irregularities in the uterine wall and uterine wall cancer associated with abnormal uterine bleeding.

The diagnosis of abnormal uterine bleeding can vary depending on the patient's specific situation and symptoms. A gynecologist will direct appropriate tests and examinations to establish a diagnosis and identify the underlying cause. Treatment options are determined based on the diagnosis and aim to improve the patient's health.

What Are the Treatment Methods for Abnormal Uterine Bleeding?

Treatment methods for abnormal uterine bleeding can vary depending on the underlying causes, the patient's age, health condition, and the severity of symptoms. Treatment is personalized by a gynecologist. Here are the treatment methods for abnormal uterine bleeding:

• Hormonal Therapy:
  • Oral Contraceptives (Birth Control Pills): Birth control pills can control irregular or excessive bleeding through the estrogen and progesterone hormones they contain. They regulate hormone levels and can establish a more regular menstrual cycle. In patients with risk factors for estrogen, bleeding can be regulated using hormonal medications that contain only progesterone.
  • Hormonal Intrauterine Device (Mirena): The hormonal intrauterine device is a device placed inside the uterus, providing long-term birth control. It can help reduce excessive bleeding by releasing progesterone hormone significantly.
• Hysteroscopy: Hysteroscopy is a camera system used to directly observe the inside of the uterus. If the cause of abnormal bleeding is a polyp or a myoma extending to the uterine wall, they can be quickly and easily removed using hysteroscopic methods. It is a day procedure and does not require hospitalization.
• Endometrial Ablation: Endometrial ablation is a procedure to thin or completely remove the inner layer of the uterus (endometrium). By using energy to burn the uterine wall, the functional uterine wall is eliminated. This procedure can be used to alleviate issues of excessive bleeding. It is suitable for patients who do not want their uterus removed.
• Myomectomy: In patients experiencing abnormal uterine bleeding due to fibroids, myomas can be removed using laparoscopic (closed technique), abdominal (open technique), or vaginal approaches, depending on their location.
• Hysterectomy: Hysterectomy is the removal of the entire uterus. This option is used as a last resort to solve problems of excessive bleeding. It can be performed using laparoscopic (closed method), abdominal (open method), vaginal, or robotic techniques. Nowadays, minimally invasive laparoscopic surgeries are more prominent. This method has advantages such as less time in the hospital, fewer incision site infections, less pain, and a quicker return to social life.
• Other Treatment Options: Other treatment options may include embolization (used to block blood vessels), radiotherapy, or chemotherapy (in cases of cancer).

Treatment is determined based on the patient's specific situation and the cause of abnormal bleeding. It is important to monitor the patient's symptoms during treatment and continue regular doctor check-ups. The treatment of abnormal uterine bleeding is generally successful and can significantly improve the quality of life for patients.

Conclusion

Abnormal uterine bleeding is a significant health issue encountered by many women in their daily lives. While every woman may have her own menstrual cycle, it should be recognized that not every menstrual cycle is normal, and there are limits to these norms. With early diagnosis and appropriate treatment, this issue can be managed. If a woman experiences any signs of abnormal bleeding, it is crucial for her to consult a gynecologist.

Op. Dr. Erkan Aslan

Gynecologist