Uterine Fibroids and Polyps

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Uterine Fibroids and Polyps

Uterine Fibroids and Polyps

Abnormal Uterine Bleeding (AUB) refers to any deviation from a woman's normal menstrual cycle. It can include changes in the frequency, duration, or amount of bleeding. AUB can occur in women of any age and may be caused by a variety of underlying health conditions.

Types of Abnormal Uterine Bleeding:

  1. Heavy Menstrual Bleeding (Menorrhagia):

    • Excessive bleeding during regular menstrual periods, often with clots.
    • Periods last longer than 7 days or require frequent pad or tampon changes.

  2. Intermenstrual Bleeding:

    • Bleeding occurs between regular periods.
    • Spotting or bleeding that happens outside the usual menstrual cycle.

  3. Polymenorrhea:

    • Menstrual cycles that occur too frequently, often shorter than 21 days apart.

  4. Oligomenorrhea:

    • Infrequent menstrual periods, often with cycles longer than 35 days apart.

  5. Amenorrhea:

    • Absence of menstruation for 3 or more months (not related to pregnancy).

  6. Postmenopausal Bleeding:

    • Any bleeding that occurs after a woman has gone through menopause (after 12 consecutive months without a period).

Common Causes of Abnormal Uterine Bleeding:

  1. Hormonal Imbalances:

    • Disruptions in the balance of estrogen and progesterone can cause irregular periods or heavy bleeding.
    • Common in adolescents, women approaching menopause, and those with conditions like polycystic ovary syndrome (PCOS).

  2. Uterine Fibroids:

    • Non-cancerous growths in the uterus that can cause heavy or prolonged bleeding.
    • Can also lead to pelvic pain or pressure.

  3. Polyps:

    • Small growths on the inner lining of the uterus or cervix that can lead to bleeding between periods or after intercourse.

  4. Adenomyosis:

    • A condition where the inner lining of the uterus (endometrium) grows into the uterine muscle, causing heavy or painful periods.

  5. Endometriosis:

    • A condition where tissue similar to the lining of the uterus grows outside the uterus, leading to irregular bleeding, pain, and fertility issues.

  6. Ovulatory Dysfunction:

    • Lack of ovulation (anovulation) can cause irregular or absent periods. This is common in PCOS, thyroid disorders, or during perimenopause.

  7. Thyroid Disorders:

    • Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can cause changes in menstrual cycles.

  8. Blood Clotting Disorders:

    • Conditions like von Willebrand disease or other bleeding disorders can lead to excessive menstrual bleeding.

  9. Medications:

    • Certain medications, such as hormonal contraceptives, blood thinners (anticoagulants), or treatments for cancer (like chemotherapy) can cause irregular bleeding.

  10. Pregnancy-Related Issues:

    • Miscarriage or ectopic pregnancy can lead to abnormal bleeding.
    • Placenta previa or placental abruption in pregnancy may also result in bleeding.

  11. Cancer:

    • Endometrial cancer, cervical cancer, or ovarian cancer can cause abnormal bleeding, particularly in postmenopausal women.

Diagnosis of Abnormal Uterine Bleeding:

To determine the cause of AUB, a healthcare provider may perform the following:

  1. Medical History and Physical Examination:

    • Detailed menstrual history, including frequency, duration, and volume of bleeding.
    • Physical and pelvic exams.

  2. Laboratory Tests:

    • Blood tests to check for anemia, thyroid function, and hormone levels.
    • Pregnancy test to rule out miscarriage or ectopic pregnancy.
    • Coagulation tests to identify bleeding disorders.

  3. Imaging Tests:

    • Ultrasound to check for structural abnormalities like fibroids or polyps.
    • Hysterosonography (saline infusion ultrasound) to better view the uterine cavity.

  4. Endometrial Biopsy:

    • A sample of the uterine lining is taken to check for cancer, pre-cancer, or other abnormalities, especially in women over 35 or those with risk factors.

  5. Hysteroscopy:

    • A thin, lighted tube is inserted through the cervix to directly view the inside of the uterus and take biopsies if necessary.

Treatment Options for Abnormal Uterine Bleeding:

  1. Medications:

    • Hormonal therapies such as birth control pills, progesterone, or hormone replacement therapy to regulate the menstrual cycle.
    • Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to reduce bleeding and pain.
    • Tranexamic acid to reduce heavy menstrual bleeding.
    • GnRH agonists to shrink fibroids or manage symptoms of endometriosis.
    • Thyroid medication if a thyroid disorder is the underlying cause.

  2. Surgical Options:

    • Dilation and curettage (D&C): The cervix is dilated, and the uterine lining is scraped to reduce heavy bleeding and investigate abnormal tissues.
    • Endometrial ablation: The uterine lining is destroyed using heat, cold, or other methods to reduce bleeding. This is usually for women who don’t want more children.
    • Myomectomy: Surgical removal of fibroids while preserving the uterus.
    • Hysteroscopy: To remove polyps or fibroids.
    • Hysterectomy: Removal of the uterus, recommended in severe cases where other treatments have failed.

  3. Lifestyle Changes:

    • Weight loss, exercise, and a healthy diet can improve hormonal balance, particularly in conditions like PCOS.
    • Quitting smoking and managing stress may also contribute to more regular cycles.

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