Gynecology


 
Estrogen Replacement Therapy

Estrogen Replacement Therapy

Stephen E. Lamb, M.D.

Menopause is a time of transition that occurs when there are no more eggs for the ovaries to release. When the eggs are gone and ovulation stops, estrogen production markedly drops off and estrogen-deficiency symptoms (such as hot flashes) soon develop. Every woman eventually will face the question of how to best deal with estrogen-deficiency symptoms because every woman will eventually stop ovulating.

Estrogen is the most important sex hormone in women. From the time of puberty until the day of the last menstrual period, estrogen contributes significantly to a woman’s physical and emotional health. It is the hormone that makes a woman a woman by stimulating the development of her breasts and genital tract, helping with reproduction, and contributing to her sex drive and sense of well-being. When women lose their ovarian function at menopause, significant negative consequences follow (these have been summarized in Handout 1). Fortunately, most menopausal problems can be alleviated or prevented through ERT. In fact, hundreds of medical studies have proven its benefit. Estrogen has been shown to significantly reduce hot flashes, diminish night sweats, improve sleep patterns, decrease the incidence of colon cancer, reduce vaginal irritation and dryness, decrease vaginal and bladder infections, lower the rate of osteoporosis and bone fractures, improve lipid profiles, and augment sexual desire and function.

Because of its obvious benefits, the decision to take estrogen seems like an easy one for some women. They readily recognize the good things it can do for them and want to be rid of their problems at almost any cost. But for others the issue is less straightforward. They may have few, if any, menopausal symptoms. Should they take estrogen anyway? Or they may have heard news reports about how dangerous it is. Or they may have a friend or family member who has had problems taking it. Or they may have a personal condition that calls into question whether estrogen is safe. For these women, the choice to take estrogen is not easy and may be made only after serious discussion and thought.

The purpose of this handout is to give you information from which to make a good decision about ERT. But right off the top it should be emphasized that there is no universal answer that applies to all women. In fact, there may be several different, good answers for an individual woman. The decision about whether to take estrogen ultimately has to do with therisk/benefit balance: whether the benefits appear to be worth the risks.

I often use a simple analogy when trying to help patients decide about taking estrogen. It has to do with driving cars. In America, almost everybody drives cars or, at least, takes rides in cars. It is a rare person, indeed, who never gets into an automobile. Yet, why do we do it day after day, when people die in car accidents? It’s because the tremendous benefit of travel by car outweighs the very small chance that an accident will occur on any given day. We call that a favorable risk-benefit ratio.

Does ERT also have a favorable risk-benefit ratio? 

For most women, the answer is “yes.” The benefits appear to outweigh the risks. Yet, some say, this doesn’t jive with what they’ve heard. So let’s talk about what they’ve heard.

In 2002, a landmark study was released called the Women’s Health Initiative (WHI). It was one of the most comprehensive studies about hormone replacement ever done. It involved over 16,000 women who were either given a blank pill (also known as a placebo) or a hormone pill containing estrogen and progesterone. The hormone tablet used was called Prempro, a combination of Premarin and Provera, two synthetic hormones. Premarin is a mixture of horse estrogen hormones and Provera is a progestin (something that acts like progesterone).

The study’s findings, which were trumpeted in every newspaper, news magazine, and television news broadcast in the nation, were so shocking that thousands of women immediately stopped taking their hormones, many at their physician’s behest. Few studies in recent memory have had a greater immediate impact on patient behavior than this one.

So what were the findings and why has there been so much controversy? 

The study showed an increased incidence of several adverse events in the women who took Prempro compared to those who took the placebo. They included more heart attacks (7/10,000 incidence), more strokes (8/10,000 incidence), more breast cancer (8/10,000 incidence) and more deep venous thrombosis and pulmonary embolism (18/10,000 incidence). On the good side, the study also showed less colon cancer and hip fractures from osteoporosis.

The adverse outcomes associated with the WHI surprised many patients, and the knee-jerk reaction of a large number of women was to wash their hormones down the toilet. However, years of retrospection have allowed further analysis of the WHI results. Many of the original conclusions of the WHI have been altered because of flaws that were identified in the way the original study was put together. Time has also allowed for more thorough peer review of the data and a softening of the study’s original conclusions in the light of further research.

Take the issue of breast cancer, for instance. While there was a greater incidence of breast cancer in the Prempro group compared to the placebo group, the difference was small. Women who didn’t take any hormones got breast cancer at a rate of 3 per 1000 women per year. Women taking Prempro got breast cancer at a rate of about 4 per 1000 per year. That is a difference of 1 per 1000 per year, a very small difference, indeed. Is it enough of a difference to allow women to take estrogen without a concern of breast cancer? Every woman must answer this question for herself.

Interestingly, in 2004, the results of the second arm of the WHI study were announced, this time without any media fanfare. The second study group involved almost 11,000 women who took Premarin alone, without the progesterone element (Provera). This arm of the study showed an increase of only two adverse events: increased rates of stroke (12/10,000 incidence) and thromboembolic events (6/10,000). There was no increased risk of breast cancer or heart attack. The benefits in regard to less colon cancer and fewer hip fractures similar to the first WHI study. In summary, this arm of the study showed no increased risk of breast cancer when Premarin was taken alone.

Another feature of both the WHI studies that has been criticized is the choice of hormone that was used. Prempro is a combination of Premarin (derived from pregnant horses’ urine) and Provera (a synthetic hormone derived in the laboratory). Most experts now agree that these non-humans hormones are not the best choice for women. There is currently a strong movement among doctors and patients to switch to what are called bioidentical hormones. Bioidentical hormones are the same as human hormones. When a woman takes a bioidentical hormone into her body she is taking exactly the same hormone she made during her reproductive years. Her body can’t tell the difference between the two. Most people now believe that these “natural” hormones are much safer, although there is no substantive data to support that idea.

Bioidentical hormones can be obtained in two ways. They are commercially available in any pharmacy or they may be obtained through special pharmacies that compound these hormones on the spot. Either way, a prescription from a health care provider is required. Currently, the commercial bioidenticals include pills, patches, gels, and skin creams. Compounding pharmacies can also put these hormones into sublingual lozenges and vaginal suppositories, in addition to pills and creams. Taking hormones through a non-oral route allows hormones to be more effective and takes a lesser toll on the liver, the organ that is ultimately responsible for removing the hormones from circulation in the blood.

The bottom line on estrogen is that ERT will do a number of wonderful things for you, but it’s not without some risk. Whether the risk-benefit ratio is favorable enough for you to consider using ERT is up to you. Your health care provider will be happy to discuss all these alternatives and answer questions. Remember, if you have a uterus, progesterone must also be taken with estrogen in order to protect it against uterine cancer. Testosterone may also be added to further augment sexual desire and responsiveness. Each hormone regimen must be tailored to the specific needs of each woman, taking into consideration their overall health, risk factors, and personal preferences.

Vaginitis

Vaginitis is a very common condition characterized by inflammation of the vagina. Symptoms include irritation, redness or swelling of the vaginal tissues. Vaginitis can also cause a discharge, itching, odor or a burning sensation. The most common cause of vaginitis is infection, but other causes include irritation from products like soaps and the lack of estrogen that accompanies menopause.

To diagnose vaginitis, a sample of the woman’s vaginal discharge is viewed under a microscope. Treatment depends on the cause of the vaginitis and may include oral medication or a cream or gel to be applied to the vagina.

The risk of getting vaginitis can be reduced by using condoms during sexual intercourse, washing diaphragms and cervical caps carefully after each use, and abandoning the use of feminine hygiene sprays, deodorant tampons and douches.

Atrophic Vaginitis 

An inflammation of the vagina caused by degeneration of the vaginal tissue. Atrophic vaginitis is the most common cause of vaginal irritation in postmenopausal women. After menopause, as estrogen production decreases, the walls of the vagina become drier, thinner, less elastic and more likely to bleed. Vaginal dryness can cause irritation, burning, or itching and a feeling of pressure, all of which may interfere with a woman’s sexual enjoyment.

Treatment for atrophic vaginitis after menopause may include hormone replacement therapy to restore estrogen levels. Hormonal creams, inserted vaginally, also alleviate local symptoms. Atrophic vaginitis during breast-feeding is only temporary and will correct itself in time. If the primary symptom is painful sexual intercourse, the use of a water-soluble lubricant may help. Regular sexual activity improves circulation in the vagina and helps to keep the tissues supple.

Bacterial Vaginosis 

The most common vaginal infection; inflammation of the vagina caused by bacteria. Symptoms include an unpleasant or fishy odor, increased vaginal discharge, or itching, burning, or redness in the vaginal area. Bacterial vaginosis is caused by an overgrowth of one or more types of bacteria, all of which interact and proliferate, destroying healthy organisms. Women who are sexually active are most likely to develop bacterial vaginosis, although it is not always a sexually transmitted disease.

Diagnosis requires a pelvic examination and microscopic laboratory analysis of the vaginal discharge. Treatment usually involves five to seven days of antibiotics taken orally or inserted into the vagina as a suppository. Many doctors also treat the woman’s sexual partner at the same time, to avoid re-infection after the couple resumes sexual intercourse, although this is controversial.

________________

Excerpted from: Complete Medical Encyclopedia, American Medical Association, 2003.

If you would like information about purchasing the Complete Medical Encyclopedia, click here.

Related Article

JAMA Patient Page: Vaginal Symptoms

© Copyright 2003 American Medical Association. All rights reserved.

 

Pap Test

The Pap test, sometimes called a Pap smear or cervical cytology screening, is an important part of women's health care. This test looks at cells taken from the cervix.

The cervix is the lower, narrow end of a woman's uterus. It opens into the vagina (the birth canal). The cervix is covered by a thin layer of tissue. This tissue is like the skin inside your mouth.

Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman's normal life, they are known as premenstrual syndrome (PMS).

Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can be managed in many women.

Symptoms

Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85 percent of women who menstruate have at least one premenstrual symptom.

Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social or work lives.

Abnormal Pap Test Results

The Pap test is a way to find cell changes on the cervix. If a Pap test shows these changes, the result will be called abnormal. In some cases, these abnormal cells may lead to cancer. You may need treatment. In most cases, the treatment will be performed in your doctor’s office with good results.

The Cervix 

The cervix is the lower, narrow end of a woman’s uterus. It opens into the vagina (the birth canal). The cervix is covered by a thin layer of tissue. This tissue is like the skin inside your mouth.

The Pap Test 

The Pap test, sometimes called a Pap smear or cervical cytology screening, is an important part of women’s health care. This test looks at cells taken from the cervix.

Most labs in the United States use the “Bethesda System” to describe Pap test results. With this system, your results will be placed in one of several groups:

Normal (negative): There are no signs of cancer or precancer.

Atypical squamous cells (ASC): Some abnormal cells are seen.

SIL (squamous intraepithelial lesion): Changes are seen in the cells that may show signs of precancer.

LSIL: Early, mild changes are seen in the cells.

HSIL: Moderate or severe cell changes are seen.

Atypical glandular cells: Cell changes show that further testing is needed because of an increased risk of precancer or cancer of the cervix, uterus or other female reproductive organs.

Cancer: Abnormal cells have spread deeper into the cervix or to other tissues.

Abnormal Results A Pap test result that is not normal usually is caused by an infection such as human papillomavirus (HPV) or types of vaginal irritation.

Squamous Intraepithelial Lesion

SIL is found in women of all ages. It can range from mild, moderate and severe to carcinoma in situ (CIS). CIS is not yet cancer.

Human Papillomavirus Infection

Human papillomavirus infection can cause abnormal Pap test results. However, most women infected with HPV have normal Pap test results. It is a very common infection that can be passed from person to person.

Certain types of HPV are linked to cancer in both women and men.

In some cases, an HPV test can be done to help clarify the Pap test results.

Further Testing A woman who receives an abnormal Pap test result may need further testing. Sometimes you may only need a repeat Pap test because many cell changes go away on their own.

Further testing methods, such as colposcopy and biopsy, can help identify the reason for the abnormal test result.

Colposcopy

Colposcopy lets your doctor look at the cervix through a special device similar to a microscope. It can detect problems of the cervix that cannot be seen with the eye alone.

Biopsy

If an area of abnormal cells is seen, your doctor may decide that a cervical biopsy is needed.

Treatment Treatment of cervical changes depends on the severity of the problem.

Electrosurgical Excision

Electrosurgical excision often is used for women with HSIL. This method is sometimes called a loop electrosurgical excision procedure (LEEP). LEEP often is done in the doctor’s office.

Cone Biopsy

Another technique used to obtain a tissue sample is a cone biopsy. In this procedure, a cone-shaped wedge of the cervix is removed. General or spinal anesthesia may be used for a cone biopsy.

Freezing and Laser Treatment

With cryotherapy, abnormal tissue is frozen and later sheds. Sometimes, laser treatment in which a beam of light destroys abnormal tissue is used.

Risks Although problems seldom occur after treatment for cervical changes, there are some risks. You may be at increased risk for preterm birth or infertility. There is also a risk of infection after the procedure.

Follow-up It may take a few weeks for your cervix to heal. While your cervix heals, you may have:

Vaginal bleeding (less than a normal menstrual flow)

Mild cramping

A brownish-black discharge

A watery discharge (with cryotherapy)

For a few weeks after the procedure, you should not have sex or use tampons or douches.

Finally … If you are concerned about abnormal Pap test results, talk to your doctor. Keep in mind that most problems that cause abnormal Pap test results, when found early, can be treated.

_________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © January 2004 The American College of Obstetricians and Gynecologistsost women in the United States give birth to healthy babies. Despite this, many women worry about birth defects.

About Birth Defects

About 3 percent of babies born in the United States have some type of major birth defect.

A baby may be born with more than one birth defect.

In most cases, there is no known reason for a birth defect. In some cases, birth defects are inherited. Others can occur if the fetus is exposed to certain drugs (including alcohol), chemicals or viruses during key stages of growth during pregnancy.

Genetic Problems

Genes are passed by parents to their newborn through tiny structures called chromosomes. Chromosomes are present in every human cell. The mother’s egg and the father’s sperm each contain 23 chromosomes. When the sperm joins the egg, the genes and chromosomes of both parents unite to form those of the fetus.

Thus, an error in a chromosome or a single gene may result in birth defects.

A birth defect can be passed from the parents to their baby through their genes. This is called a genetic disorder.

A defect also may result from problems with the number or structure of whole chromosomes. There may be too many or too few chromosomes. In Down syndrome, for instance, there is an extra (third) copy of one of the chromosomes.

Some genetic problems can be found in two ways:

Amniocentesis — studying the amniotic fluid that surrounds the fetus

CVS — studying the chorionic villi that make up the placenta

For these procedures, a sample is taken to be tested from either the amniotic fluid that surrounds the fetus or the placenta.

Who Should Be Tested?

Your doctor can tell you about your genetic risks and the tests you can have. Only you and your partner can decide whether to have a test.

Testing should be offered to:

Pregnant women who will be 35 or older on their due date

Couples who already have had a child with a birth defect or have a family history of certain birth defects

Pregnant women with other abnormal genetic test results

A normal test result on the fetus cannot ensure that the baby will be normal.

Amniocentesis Amniocentesis is the most common procedure used to test for birth defects. It is done at 16 to 18 weeks of pregnancy in most cases.

The Procedure

With amniocentesis, a sample of amniotic fluid is withdrawn through a needle from the sac that surrounds the fetus.

The amniotic fluid is sent to a lab. The cells are grown in a special fluid for several days. Then, tests are done.

Results

It may take about two weeks for enough cells to grow and tests to be performed.

Tests of the amniotic fluid itself are another way to find some defects. One such test is the alpha-fetoprotein (AFP) test. Too much AFP in the amniotic fluid can be a sign of fetal defects, such as open neural tube defects or openings in the fetal abdomen.

One type of AFP test is a blood test. It checks the levels of AFP in the woman’s blood.

Risks

Although amniocentesis is fairly safe, there is some risk involved. Side effects that may occur include:

Cramping

Bleeding

Infection

Leaking of amniotic fluid after the procedure

Miscarriage

Injury to the fetus from amniocentesis is rare.

Chorionic Villus Sampling

CVS can be done earlier in pregnancy than amniocentesis. In most cases, it is done about 10 to 12 weeks from the woman’s last menstrual period.

The Procedure

With CVS, a small sample of cells is taken from the placenta where it is attached to the wall of the uterus.

Results

CVS can detect most of the same defects as amniocentesis. One defect that cannot be detected by CVS is open neural tube defects.

The results of CVS can be obtained earlier in pregnancy and more quickly than with amniocentesis.

Risks

CVS may carry a slightly higher risk of miscarriage than amniocentesis.

Advantages of Each Method

Amniocentesis and CVS both have advantages. With amniocentesis:

It often is easier to have done because it is more widely available.

It offers a lower risk of miscarriage than CVS.

It can test for neural tube defects because it tests the amniotic fluid.

On the other hand, CVS can be done earlier in pregnancy.

Options

Most of the time, tests show normal results, which reduce patients’ fears and anxieties. If your tests diagnose a major birth defect, you have tough choices to make.

Before you decide, get as much information about the defect as you can — from doctors, counselors or parents of a child with the same type of defect. Ask friends or family for advice and support. Knowing as much as you can will help you to make the best choice.

Finally.. 

If you have certain risk factors, you may be offered amniocentesis or CVS to try to detect certain birth defects. Whether you have the test done is up to you. Some people choose not to get this information. Keep in mind that in most pregnancies, babies are born healthy.

___________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright December 1999 The American College of Obstetricians and GynecologistsThe birth control pill, injections, vaginal ring, skin patch, intrauterine device (IUD), diaphragm, Lea’s Shield, and cervical cap require a prescription. Condoms and spermicides do not.

More than one method may be used at the same time. For instance, a barrier method may be used with any other method.

Barrier Methods

Barrier methods include spermicides, condoms (male and female), the diaphragm, the cervical cap, and Lea’s Shield.

Barrier methods are effective when used the correct way every time you have sex. Even one act of sex without birth control can result in pregnancy.

Intrauterine Device

The IUD is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy. Although there have been several types of IUDs, currently only two are available in the United States: the hormonal IUD and the copper IUD.

Hormonal Contraception

With hormonal birth control, a woman takes hormones similar to those her body makes naturally. These hormones prevent ovulation. When there is no egg to be fertilized, pregnancy cannot occur.

Birth Control Pills

One of the most popular methods of hormonal birth control is the birth control pill (oral contraceptive). Most birth control pills are combination pills. They contain the hormones estrogen and progestin.

Injections

One type of injection of hormonal birth control, called depot-medroxyprogesterone acetate (DMPA), provides protection against pregnancy for three months. This means a woman needs only four injections each year.

Vaginal Ring

The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. The ring releases both estrogen and progestin continuously to prevent pregnancy. It is worn for 21 days, removed for 7 days, and then a new ring is inserted.

Skin Patch

The contraceptive skin patch is a small (1.75 square inch) adhesive patch that is worn on the skin to prevent pregnancy. It is a weekly method of hormonal birth control.

Natural Family Planning

Natural family planning used to be called the rhythm method or “safe period.” It also is called periodic abstinence or, more recently, fertility awareness. It isn’t a single method but a variety of methods.

Types of natural family planning include:

Basal body temperature method

Ovulation/cervical mucus method

Symptothermal method

Calendar method

Lactational amenorrhea

Withdrawal

The withdrawal method prevents pregnancy by not allowing sperm to be released in the woman’s vagina. This requires the man to take his penis out of the woman before he ejaculates. Drawbacks are that sperm can be present in the fluid produced by the penis before ejaculation and some men fail to withdraw completely or in time.

Sterilization

Sterilization for women and men works by permanently blocking the pathways of egg and sperm. This can be done by surgery.

Tubal sterilization is done by laparoscopy and minilaparotomy. The fallopian tubes are closed by tying, banding, clipping, blocking, or cutting them, or by sealing them with electric current.

Vasectomy involves cutting a man’s vas deferens so that sperm cannot mix with semen. The tubes that carry sperm to the penis are clamped, cut, or sealed so that the ends do not join again.

New Option for Sterilization

Women who want a permanent method of birth control now have an option that does not involve surgery. With this method, a tiny springlike device is inserted through the vagina into each fallopian tube. This device causes scar tissue to build up in the tubes. This build-up blocks the fallopian tubes and prevents the sperm from reaching the egg. It takes three months for the scar tissue to grow, so women should use another method of birth control during this period. This device can be inserted in a doctor’s office.

Choosing a Method At any given time, a couple may find one method of birth control suits their needs better than others. Most women and couples use many methods over their lifetime.

All methods have a chance of failure. When a method is used correctly each time, the failure rates are lower. Choose a method you will be able to use on a regular basis. If your method fails, you may want to consider emergency contraception.

Finally … No matter which method of birth control you choose, be sure that you know how it works, how to use it, and what side effects may occur. Even with methods that do not need a prescription, you need to learn how to use the method.

_________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © February 2003 The American College of Obstetricians and Gynecologists

Premenstrual Syndrome

Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman’s normal life, they are known as premenstrual syndrome (PMS).

Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can be managed in many women.

Symptoms 

Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85 percent of women who menstruate have at least one premenstrual symptom.

Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social or work lives.

Common symptoms of PMS are:

Emotional and behavioral symptoms

Physical Symptoms

Diagnosis To diagnose PMS, a doctor must confirm a pattern of symptoms. A woman’s symptoms must:

Be present in the five days before her period for at least three menstrual cycles in a row

End within four days after her period starts

Interfere with some of her normal activities

PMS or Something Else? Symptoms of other conditions can mimic PMS. For instance, premenstrual dysphoric disorder (PMDD) is a severe type of PMS. PMDD affects a small percentage of women with PMS.

Depressive and Anxiety Disorders

These disorders are the most common conditions confused with PMS. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. The symptoms of these disorders may worsen before or during a woman’s period. This makes some women think they have PMS.

Menopause

Women entering menopause may have PMS-like symptoms. These symptoms include mood changes and fatigue.

Other Conditions

Your doctor will want to rule out other conditions that share symptoms with PMS. These conditions include chronic fatigue syndrome, irritable bowel syndrome, and endocrine problems.

What You Can Do Lifestyle and dietary changes often can relieve some PMS symptoms. Talk with your doctor about your symptoms and treatment options.

Aerobic Exercise

For many women, aerobic exercise lessens PMS symptoms.

Relaxation

Finding ways to relax and reduce stress can help women who have PMS.

Dietary Changes

Simple changes in your diet may help relieve the symptoms of PMS.

Dietary Supplements

Dietary supplements help lessen the symptoms of PMS in many women.

Medications

Women with severe PMS may not feel relief with lifestyle or dietary changes alone. If these changes don’t reduce symptoms, your doctor may suggest medications.

Talk With Others

Talking with others about what you are going through can help. Sharing your feelings may help your family to support you more.

Finally … Many women with PMS find relief with exercise and lifestyle changes. Others may find dietary supplements or medicines to be helpful.

If you have PMS, talk with your doctor about ways to find relief. Simple changes may help improve your well-being, all month long.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © September 2003 The American College of Obstetricians and Gynecologists

Abnormal Uterine Bleeding

It is normal for a woman’s menstrual bleeding to last up to seven days. Abnormal bleeding can occur when the menstrual period is not regular, when bleeding lasts longer than normal, is heavier than normal, or when bleeding patterns change.

Causes 

There are many causes of abnormal bleeding. Your doctor may begin looking for the cause of abnormal bleeding by checking for problems most common in your age group.

Diagnosis 

To diagnose abnormal bleeding, your doctor will need to know your personal and family health history. You may be asked about:

Past or present illnesses

Use of medications

Use of birth control

Weight, eating, exercise habits and level of stress

You will have a physical exam. 

You also may have blood tests to check your blood count and hormone levels and a pregnancy test (to see if you are pregnant). One or more of the following tests also may be needed based on your symptoms:

Endometrial biopsy

Ultrasound

Sonohysterography

Hysteroscopy

Dilation and curettage (D&C)

Hysterosalpingography

Laparoscopy

Most of these tests can be done in your doctor’s office. Others may be done at a hospital or other facility.

Treatment 

Treatment for abnormal bleeding will depend on many factors, including the cause, your age, the severity of the bleeding, and whether you want to have children.

Hormones

Your doctor may prescribe birth control pills to help your periods to be more regular. They also may improve other symptoms. Progesterone can help prevent and treat endometrial hyperplasia.

Other Medications

Nonsteroidal antiinflammatory drugs, like ibuprofen, may help control heavy bleeding.

Surgery

Some women with abnormal uterine bleeding may need to have surgery to remove growths (such as polyps or fibroids) that are causing the bleeding.

Endometrial ablation also is used to treat abnormal uterine bleeding.

Hysterectomy — removal of the uterus — is another procedure that may be used to treat abnormal bleeding.

Hysterectomy is major surgery.

Finally … If you notice that your cycles have become irregular, see your doctor. Abnormal bleeding has a number of causes. There is no way of telling why your bleeding is abnormal until your doctor examines you. Once the cause is found, abnormal bleeding often can be treated with success.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © September 2003 The American College of Obstetricians and Gynecologists

Read More

Location
Heartfelt Obstetrics & Gynecology
2640 Biehn St, Suite 1
Klamath Falls, OR 97601
Phone: 541-204-1061
Fax: 541-205-6899
Office Hours

Get in touch

541-204-1061