Dysfunctional and Abnormal Uterine Bleeding

Abnormal Bleeding can be quite disruptive to your life; we will follow an orderly investigation of your specific problems and concerns.  By working together,  within just a few office visits—we can have most patients on their way to a mutually acceptable solution-sometimes per a simple hormonal adjustment and at other times-per minimally invasive surgery such as hysteroscopy or Robotic laparoscopy.

There are really two main causes of bleeding—hormonal such as stress(perimenopause) or a structural problem such as fibroids or polyps or precancerous conditions. We will check these out with a couple of office visits, some lab tests, an ultrasound and a possible sampling biopsy.

The first visit:

History-careful attention to details of the menstrual calendar/fertility “app” will aid us in narrowing down the hormonal vs structural nature of the problem-acute vs. chronic; mild vs severe; prior episodes and procedures.

Physical Examination-focuses on structural findings; obtain samples and biopsies.

The workup:

Lab tests-CBC (anemia ferritin level ); PT/von Willenbrands (inherited disorders); Thyroid panel, preg test.

Ultrasound- Ultrasound often done same day in office by Dr. K and we also use the Hoag facility and a few others—for their radiologists expertise with US 3d and MRI of pelvis. 

Endometrial sampling—for most women over 35yoa to check precancerous tissue.

The Second Visit-treatment options:

Hormonal or functional problems - Progesterone cooperative cycling, Lysteda, Orilissa, Myfembree.

(though it is known that BCP and IUD can be standard of care for these—we have very good success with the other more natural methods.) 

Structural Problems-Fibroids (submucous/lining)-probably hysteroscopy (uterus sparing)removal.

        -Fibroids - Large, multiple and recurrent-Same day surgery-Robotic myomectomy or RLH 

        -Polyps/Postmenopausal thickened endometrium