Menstrual cycles of 21-35 days are considered normal. Cycles longer or shorter than this are irregular and should be evaluated by your doctor. Irregular cycles may occur because of weight loss or gain, vigorous exercise, stress illness, or other changes that affect your body. For the first few years after menarche, menstrual periods are often irregular. A young woman may have only three or four periods a year. Menstrual cycles usually become lighter and less frequent as menopause approaches and hormone levels decrease. In some cases the cycles will become erratic and heavier around perimenopause.
Bleeding that is heavier than usual, or lasts longer than a week may also be abnormal. It can have a number of abnormal causes such as hormonal imbalance, coagulation disorders( problems with blood clotting) uterine polyps, uterine fibroids (benign tumors of the uterine muscle), uterine adenomyosis (sponginess), hyperplasia (pre-cancerous growth), cancer.
Medical treatment with birth control pills, hormones, and other homeopathic and conventional medications is the first line of therapy for the treatment of irregular bleeding and heavy periods in our practice.
If medical options do not work or are not the appropriate treatment option for the disorder, the following surgical options can be recommended. The goal in our practice is to allow every patient to explore all options prior to definitive surgery. We feel it is your right to know that there are other methods of treatment besides hysterectomy, and we are willing to try all options. It is important to understand that your physicians will educate you about the best route of surgery for your particular case. Our goal is to have our patients have the safest, most comfortable surgery and to be able to return to normal activity as soon as possible.
- Dilation and Curettage
- Uterine Lining Ablation – Endometrial Ablation
- Radiologic Fibroid Embolization
D&C is a very common surgical operation. The procedure is performed under general anesthesia which is very safe. The cervix (opening to the uterus) is dilated with the help of instruments, and the lining of uterus is then removed. Sometimes doctors may perform hysteroscopy at the same time as the D&C. A thin telescope – like instrument is inserted through the cervix and allows the doctors to visualize the lining of the uterus directly. These procedures are performed to empty the uterus after a miscarriage to remove polyps in the uterus which may cause irregular bleeding to remove pre-cancerous or cancerous overgrowth of the lining of the uterus.
Many women have long, heavy and painful periods. This is known as abnormal uterine bleeding. One treatment for this is uterine ablation also referred to as endometrial ablation. This procedure involves destroying cells in the endometrium or lining of the uterus. The lining of the uterus is burned with special equipment under general anesthesia. Patients do not feel any burning pain. The scar tissue which forms from the burning process will either stop any bleeding from the uterus, or minimize it during the menses. The success rate of this procedure in our practice is 75-80%. This procedure is performed as a treatment for the following problems:
- Heavy menstrual cycles
- Adenomyosis – which causes heavy bleeding
- Uterine fibroids
Who Should Consider This Treatment?
Women who have heavy, long and/or painful periods. Women who are finished with childbearing and no longer wanting pregnancy.
How Effective Is Ablation?
Ablation helps decrease the amount and length of your periods. Most women see a significant decrease. Some women may have very minimal to no period after ablation. Additionally, some women may require a repeat ablation or further treatment. Approximately 92% of women are satisfied with their ablation.
What Tests Will I Need Before Ablation?
Women considering ablation will need to have a sonohystogram and endometrial biopsy. These tests allow us to see the lining of the uterus to check for causes of abnormal uterine bleeding such as polyps, fibroids, etc. These tests are performed in out office.
Is Ablation Birth Control?
No, although ablation destroys endometrial cells in the lining of the uterus, it does not prevent ovulation. It may still be possible to become pregnant. After ablation, it will still be necessary to use some type of birth control.
How Is Ablation Performed?
Uterine ablation is performed vaginally. There are no incisions necessary.
What Are The Options For Ablation?
Dr. Simon and Dr. Brodkin offers two types of ablation: Her Option and Novasure. Her Option is cryoablation that involves freezing the endometrial cells with a wand. It may be necessary to freeze several zones of the uterus. This procedure is performed in our office. Novasure is ablation that involves heating and burning the endometrial cells. A gold mesh expands within the uterus, heats and is then retracted. This procedure is performed in an outpatient surgical center. Both Novasure and Her Option were approved by the in 2001.A comparison of these 2 procedures is provided below.