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Upset Stomach

Menstrual Disorder

Menstrual Disorder

Many conditions could cause a change in menstrual cycles causing heavy or infrequent bleeding. This change often is linked to pelvic pain like cramps, dyspareunia (pain with intercourse), ovarian cysts, lower abdominal and back pain.  If the bleeding is severe, it can lead to anemia causing weakness, fatigue etc…  Heavy uterine bleeding is often called menorrhagia or menometrorrhagia. When the cause is unknown, it is called DUB (dysfunctional uterine bleeding). Last any bleeding after menopause (called postmenopausal bleeding) is abnormal and needs to be investigated by a gynecologist.

  • Hormonal conditions like PCOS (polycystic ovarian syndrome), ovarian, thyroid, adrenal or pituitary abnormalities

  • Structural abnormalities include endometrial polyps, adenomyosis, endometriosis, fibroid (leiomyomas)

  • Carcinomas: endometrial cancer, leiomyomas

Treatment options

  • Initially start conservative by lifestyle modifications, medications including hormonal like oral contraception or progesterone releasing intrauterine device (IUD). 

  • Therapy can be delivered hysteroscopically (through the cervix with a thin scope) where a polyp or fibroid can be removed, or the endometrium (lining of the uterus) can be ablated (a procedure called endometrial ablation).

  • Minimally outpatient surgeries can be done robotically where the patient goes home the same day to remove a fibroid (myomectomy) or remove the uterus (hysterectomy).  A common misconception: with a hysterectomy, the ovaries are not removed (which is a separate procedure called oophorectomy), so hormones will not be needed since the patient will not go into menopause when the ovaries are preserved. Return to work ranges from as little as 1 week, and as late as 4 weeks.

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