ABNORMAL UTERINE BLEEDING

Dr Rooma Sinha, MD, DNBSenior Consultant Gynecologist & Laparoscopic Surgeon

Apollo Health City; HYDERABADwww.gynecologyhyderabad.com,

drroomasinha@hotmail.com 9550326662; 9849008180

Women have menstrual cycles from the age of 11-12 years to about 50 years. In this time span of 40 years one is likely to have few episodes of bleeding which is not her usual cycle.

Characteristics of Normal Menstruation

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Abnormal uterine bleeding can be as follows-One must be concerned and consult gynecologist

• Bleeding between periods • Bleeding after sex • Spotting anytime in the menstrual cycle • Bleeding heavier or longer than normal - Passage of clots• Absence of menstrual periods for 3 normal cycles or 6 month• Severe pain associated with periods

Why Worry?

• Excessive bleeding can lead to anaemia, weakness

• Pain can affect daily activities

• Can be initial indication of a serious disorder

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Abnormalities that cause abnormal bleeding

• Fibroid uterus/Adenomyosis• Pelvic inflammatory disease• Cancer of uterus • Dysfunctional Uterine Bleeding• Endometriosis• PCOS• Pregnancy complications

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How We Evaluate Abnormal Bleeding?• Pelvic USG

• Dilatation & curettage

• Hysteroscopy & directed Endometrial biopsy

• Thyroid profile

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Maintain a menstrual calendar - it gives a good insight into the problem if the bleeding pattern is

available over 4-6 months for the doctor to evaluate

Ask Questions from your doctor• Medical intervention?• Surgical intervention?• Era of minimally invasive surgery!! • Look carefully for reasons for not

going for key hole surgeries• All Gynecological surgeries can be

done with key hole

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Medical treatment

DEPENDS ON -cause, age, severity ; desire for future pregnancies

•Antifibrinolytic medication to reduce the blood loss during periods •HORMONES-– Progesterone alone (for endometrial hyperplasia)– Combined pills – MIRENA- intrauterine device with impregnated

hormone

Surgical method

• Removal of fibroid- Laparoscopy /Robotic / Hysteroscopy

• Hysterectomy—removal of the uterus—is another procedure that may be used to treat abnormal bleeding

• Thermal balloon ablation is a method to treat dysfunctional bleeding without removing the fibroid

Advantage of minimally invasive surgery- LAPAROSCOPY/ROBOTIC

• No Scar- beautiful body

• No pain

• Quick return to normal activity

• Less postoperative problems- as less tissue handling so less damage!!

• NO HERNIAS

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Finally...

• If you notice that your cycles have become irregular, it is better to consult a gynecologist. Abnormal bleeding has a number of causes.

• There is no way of telling why your bleeding is abnormal until a gynecologist has made an assessment of your problems.

• Once the cause is found, abnormal bleeding often can be treated with success.