Posts tagged ‘hysteroscopy’

So, you think you have heavy periods?

Whenever I ask a patient “do you have heavy periods?”  I feel like I deserve the kinds of answers I receive.  I’m just as likely to hear “Yes.  I have to change a panty liner every few hours.” As to hear, “No.  I only go through one box of super-overnight maxi-pads per day now.  It used to be two boxes.”  Which is to say that every woman perceives whether or not her periods are heavy through the filter of her own personal experience.  

So, what exactly is a heavy period?  Well, the standard definition is a period that lasts longer than 7 days or in which a woman loses more than 80 millileters of blood.   The first definition is easy.  You just count the days on a calendar.  The second is much more difficult to determine.  (Unless you go wringing your sanitary products into graduated cylinder flasks.  In which case, maybe you need a psychiatrist, not a gynecologist.) 

So, how is the average woman to know what constitutes a truly heavy period?  If you’re saturating your pad or tampon every hour, it’s a good bet your period is heavier than average.  Similarly, if you tend to bleed through your tampon, onto your pad, and soak your pants, you probably need to see a doctor (and a good dry cleaner).  

There are lots of reasons why women get heavy periods.  The medical term for them is menorrhagia. Heavy menses aren’t just an inconvenience.  They’re a real medical problem which can result in anemia (a reduced blood count) and fatigue.  They can also be a sign of other serious medical conditions. 

Adolescents and teens may have heavy, irregular periods as they begin to establish their menstrual cycle.  These natural fluctuations in the menstrual cycle are often temporary, and usually resolve when monthly menses begin over the next few months to years.  Adolescents and teens with very heavy menses, or whose cycles do not become lighter on their own, may need to be evaluated for bleeding disorders, such as von Willebrand disease.

Women in their reproductive years may have heavy menses or irregular cycles because of hormonal conditions, such as polycystic ovarian syndrome (PCOS), which can cause irregular menses and heavy menstrual bleeding on the rare occasions when menses take place.  Another hormonal condition which can case heavy menses is an underactive thyroid gland (hypothyroidism).  Both of these conditions can cause excess weight gain.  Being overweight (even in the absence of other medical conditions) can worsen heavy menstruation.  This is because adipose (fat) tissue produces excess estrogen, thickening the lining of the uterus.  When the lining is shed at the end of the menstrual cycle, heavier bleeding occurs.

Hormonal conditions may be suspected on the basis of a physical exam, history, blood tests, ultrasound (sonogram) or a combination thereof.  A combination of medication and dietary and/or lifestyle changes may be helpful in regulating the menstrual cycle and reducing bleeding.

Certain medications can lead to heavy menses.  Blood thinners (Coumadin, Lovenox) and Non-steroidal anti-inflammatory medications (Motrin, Advil, Ibuprofen and Aspirin) can increase menstrual bleeding.  Missed doses of oral contraceptives can also lead to heavy menses or irregular cycles.

Some women have heavy menses due to abnormalities of the uterus and its lining.  An endometrial polyp is a growth of tissue in the lining of the uterus.  Because polyps have a rich blood supply, they can cause heavy bleeding either during or between menses.  Uterine fibroids can also cause heavy menses.  Fibroids are benign muscle tumors which can impinge on the lining of the uterus, causing heavy menstrual bleeding.  They can also cause other symptoms (such as pain, pelvic pressure, frequent urination, miscarriage) which likewise bring them to a doctor’s attention.  Both endometrial polyps and uterine fibroids are readily diagnosed by an ultrasound (sonogram).  Bleeding due to polyps and fibroids can often be managed with the use of minimally invasive surgical techniques (such as hysteroscopy and laparoscopy).

The most serious cause of heavy menstrual bleeding, especially in women who resume menstrual-like bleeding after the cessation of normal periods (menopause), is endometrial cancer.  This type of cancer is rare in women under the age of 35 and is much more common after menopuause.  Endometrial cancer may be suspected on the basis of an ultrasound (sonogram).  It can be diagnosed by a biopsy or by a surgical procedure called a dilatation and curettage (D and C).  Endometrial cancer is often responsive to treatment when caught early.  

In summary, heavy menses are very common.  They may represent a normal variation in a healthy woman’s cycle, or they may be due to a medical condition which requires treatment.  Attention from a skilled healthcare provider can help determine whether additional care is needed.

A Good Resource:

ACOG Guide to Abnormal Uterine Bleeding

One Last Cartoon:

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October 7, 2011 at 3:34 am 33 comments

Minimally Invasive Gynecologic Surgery: Pursuing a gentler path

Minimally invasive surgery includes a diverse and varied set of techniques which differ from traditional “open” surgery.  When open surgery occurs in the abdomen, it is performed through an incision called a  laparotomy.  Put simply, the goal of minimally invasive gynecologic surgery is to avoid unnecessary laparotomy.

Avoiding large incisions allows a surgeon to offer patients a faster recovery, decreased pain from surgical incisions, a more rapid return of bowel function, and decreased risk of certain types of complications.  Patients usually go home the same day or stay in the hospital only one night.

There are several common techniques used in minimally invasive surgery.  These include the use of laparoscopy (aka bandaid surgery, keyhole surgery, or pinhole surgery) and mini-laparotomy.

Laparoscopy is a type of sugery in which a camera is attached to a thin instrument (the laparoscope) which can be inserted into the abdomen through a very small incision.  This allows the surgeon to see the entire abdominal cavity without creating a large incision.  Additional small incisions may be made so that thin surgical instruments can be inserted into the abdominal cavity. 

Many types of surgery can be performed in this manner, including certain types of hysterectomy (removal of the uterus), removal of fibroids and ovarian cysts, treatment of endometriosis, and treatment of other kinds of gynecologic disorders.

Mini-Laparotomy is sometimes combined with laparoscopy to allow a much smaller abdominal incision in certain types of surgery which would otherwise have to be done by laparotomy.

When you need surgery, it is important to have a discussion with your doctor about how your recovery can be optimized.  Minimally-invasive surgery could be the best option for you.

May 9, 2010 at 8:02 pm 5 comments

I’m The Gynecologist!

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

Continue Reading May 6, 2010 at 4:32 pm 13 comments


Linda M. Nicoll, MD

Welcome to my blog! Here you will find information about minimally invasive gynecologic surgery as well as some more general information about common gynecologic disorders such as endometriosis, ovarian cysts, fibroids, infertility, and pelvic pain.

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