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Cervical Intraepithelial Neoplasia

Dysfunctional 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 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); PT/von Willenbrands (inherited disorders); Thyroid panel, preg test.

Ultrasound-vaginal probe-Necessary to evaluate structural problems-polyps and fibroids.

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

The Second Visit-treatment options:

Hormonal or functional problems-BCP cycling; Provera cycling; Lysteda, Lupron, Mirena IUD.

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

        -Fibroids-large and multiple and recurrent-discuss Same day surgery TLH

        -Polyps/Postmenopausal thickened endometrium


Chart for options to treat menorrhagia


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