Abnormal uterine bleeding (AUB) is menstrual bleeding that is unrelated to normal menstruation and affects 1 in 5 women. Normal frequency of periods is every 28-35 days with bleeding lasting 5-7 days. AUB can be defined as too much bleeding or an increase in frequency of periods. AUB can also happen after intercourse. There are many causes for these bleeding patterns including fibroids, polyps, and hormonal factors.
When a woman presents with abnormal bleeding that is affecting her activities associated with daily living, her doctor will do testing to try and explain the abnormality. This will include a pelvic exam and some type of imaging, usually a sonogram. Treatment will depend on these results and whether she has completed her childbearing. If she wants to retain fertility, treatments may include low dose birth control pills or a progesterone containing IUD. Once a woman has completed her childbearing an endometrial ablation, a relatively new and minimally invasive procedure that usually results in either no periods or very light periods, can be performed. This procedure destroys or ablates the lining of the uterus and can be done by freezing or heating the endometrial lining.
A common method of endometrial ablation is the Minerva® or NovaSure® ablation which involves using radio frequency energy to destroy the uterine lining. This procedure is very effective for women who have heaving bleeding not associated with fibroids or other structural abnormities of the uterus. This procedure is usually done with a hysteroscopy, a scope that visualizes the inside of the uterus. Also a D & C is done to open the cervix and get a specimen used to rule out endometrial cancer. D stands for dilation which involves opening the cervix. C stands for curettage which is a scraping of the uterine lining for pathologic evaluation.
This procedure does require anesthesia but the recovery period is very short. A day or two of rest is usually all that is needed. This procedure does not affect ovarian function so no hormones are needed after the procedure. Childbearing needs to be completed prior to seeking an ablation. Women usually can’t get pregnant after an ablation but it is not a form of birth control. If a pregnancy does occur it may be abnormal due to the lack of uttering lining. A sterilization procedure such as a tubal ligation can be done at the same time as an ablation, if the patient has not had one performed in the past.
In the past a hysterectomy was sometimes necessary to control heaving uterine bleeding if conservative measures didn’t work. An endometrial ablation is permanent, minimally invasive, surgical procedure that requires less risk than a hysterectomy. The doctors at College Hill OB/GYN would be happy to talk to anyone who is struggling with AUB. Life is too short to live with AUB and an ablation procedure may be the right choice for you.