Excessive or irregular menstrual bleeding can happen for different reasons and occur at certain times throughout a woman’s reproductive years. Most often hormonal imbalances, irregular ovulation, perimenopause, uterine fibroids and endometrial polyps are common causes. However, miscarriage, ectopic pregnancy, infection, vaginitis, hyperplasia (thickened endometrium) and cancer of the uterus, cervix or vagina can also cause abnormal menstrual bleeding.
Our patients are advised to notify us if their periods occur closer than every 21 days, last more than 10 days or if you bleed greater than 1 soaked pad (2 tampons) per hour.
Fibroids (Myomas) are benign uterine growths made from cells of the uterus that occur in 20-25% of women. Some fibroids are as small as a pea, while others can take up most of the pelvis. In addition, women may have only one fibroid, while others may have multiple. There is little known as to what causes fibroids; however, we do know that estrogen and fertility medications fuel their growth.
Symptoms of fibroids may include heavy/frequent periods, pelvic pressure/pain, back pain, urinary/bowl changes, miscarriages and infertility. If fibroids are present in the even of a pregnancy, they can impede embryo implantations and continuation of fetal growth.
The diagnosis of fibroids may include pelvic examination, ultrasound, SIS(saline infused sonogram), laparoscopy, hysteroscopy and possibly and x-ray called a hysterosalpingogram.
Image 1: UTERINE FIBROIDS: Two uterine fibroid tumors are seen on the surface of the uterus through the laparoscope. These may be treated by laser myolysis at the time of diagnosis, as an outpatient.
Image 2: LARGE FIBROIDS: These fibroids are usually removed through a larger incisions, using the microscope and CO2 laser, to enhance or preserve reproductive function.
Image 3: SUBMUCOUS FIBROID: This hysteroscopic view of an intrauterine fibroid helps determine the cause of excessive uterine bleeding, recurrent miscarriages, or infertility.
Polyps are smooth, soft, pink-red growths common in the uterus or cervical canal and may be caused by inflammation, infection, congestion of blood or response to a rise in estrogen levels.
Some women with polyps may be asymptomatic, others may complain of abnormal bleeding between periods or after intercourse. Polyps can be attributed to infertility by interfering with embryo implantation. Polyps are most often benign and once detected, Dr. McLaughlin may surgically remove and send to the lab for evaluation.
Image 1: ENDOMETRIAL POLYPS: Spotting or irregular menses may occur due to an accumulation of the endometrial lining in polyps. Usually, these are benign, but they may be a precursor of malignancy. Often, they can be detected on vaginal ultrasound, and confirmed hysteroscopically.
Endometrial hyperplasia occurs when the endometrium (lining of the uterus) grows and becomes too thick. If left untreated, the cells in the lining can become abnormal and may lead to uterine cancer.
Abnormal bleeding is a common symptom seen in a hyperplasia. This thickened lining is often caused by irregular or infrequent menstrual periods, or seen in menopausal women receiving estrogen replacement without receiving progesterone.