Abnormal uterine bleeding (AUB) is irregular bleeding from the uterus that is longer or heavier than usual or does not occur at your regular time. AUB sometimes is caused by changes in hormone levels or by problems such as growths in the uterus or clotting problems. In some cases, the cause of the bleeding isn’t known.
You can help treat it in many ways. Some return the menstrual cycle to normal. Others reduce bleeding or stop monthly periods. Each treatment works for some women but not others. Treatments include the following:
- Hormones, such as a progestin pill or daily birth control pill (progestin and estrogen). These hormones help control the menstrual cycle and reduce bleeding and cramping.
- Use of the IUD, which releases a progesterone-like hormone into the uterus. This reduces bleeding while preventing pregnancy.
- Hysteroscopy to remove polyps or fibroids.
- Surgery, such as endometrial ablation or hysterectomy.
Endometriosis is a common health condition that strikes women during their childbearing years and can lead to painful and heavy periods that interfere with daily living. If this disorder is not treated in the early stages, then it can progress until it causes problems with fertility along with intense pain. During a normal menstrual cycle, the tissue that lines the uterus is expelled each month during menstruation. However, with endometriosis, this tissue can grow outside of the uterus and begin to adhere to other organs within a woman’s body. All women are at risk for developing endometriosis, and there can be several different causes for the condition.
Several types of tests are performed that can diagnose endometriosis. A routine pelvic exam may reveal abnormalities that suggest endometriosis. Ultrasounds and laparoscopy may also be used to look for signs of endometrial tissue outside the uterus. Hormone therapy is the most common treatment used for mild cases of endometriosis in women who still desire to have children. Conservative surgery may also be used to remove endometrial tissue that interferes with fertility in women who are actively seeking to become pregnant. Women who have severe endometriosis and have completed their families may also be candidates for a hysterectomy.
Polycystic Ovary Syndrome (PCOS) is a metabolic disorder characterized by abnormal hormone levels. The syndrome may be associated with a wide range of afflictions ranging from severe acne, excessive hair on the face and/or body, and obesity to more severe disorders such as infertility, diabetes, and heart disease. It is not unusual for women to seek treatment for different PCOS symptoms without having the syndrome recognized. A diagnosis of PCOS is often made when a woman seeks medical help for infertility.
Because weight gain is common with PCOS, losing weight can help with the hormone changes and other disorders such as diabetes. Other treatments could include birth control pills to regulate irregular periods and additional remedies for the abnormal hair growth. With treatment, women usually can get pregnant.
Uterine fibroids are muscular tumors that grow in the wall of the uterus. Fibroids are almost always benign. Fibroids can grow as a single tumor, or there can be many of them in the uterus. Fibroids are most common in women in their forties and early fifties. Not all women with fibroids have symptoms. Some have pain and heavy menstrual bleeding. Fibroids also can put pressure on the bladder, causing frequent urination, or on the rectum, causing rectal pressure. No one knows for sure what causes fibroids.
Our providers can do imaging tests to confirm that you have fibroids. These tests might include the following:
- Ultrasound: Uses sound waves to produce a picture of the uterus. The ultrasound probe can be placed on the abdomen, or it can be placed inside the vagina to make the picture.
- Magnetic Resonance Imaging (MRI): Uses magnets and radio waves to make the picture.
- X-rays: Uses a form of radiation to see into the body and produce the picture.
- Cat Scan (CT): Takes many X-ray pictures of the body from different angles for a more complete image.
- Hysterosalpingogram (HSG) or sonohysterogram: An HSG involves injecting X-ray dye into the uterus and taking X-ray pictures. A sonohysterogram involves injecting water into the uterus and making ultrasound pictures.
In some cases, your healthcare practitioner may feel that surgical removal of the uterine fibroid will be best. He or she will either perform a laparoscopy or a hysteroscopy procedure to remove the fibroid.
Vaginitis is infection or inflammation of the vagina. It can cause itching and burning, a change in vaginal discharge, and sometimes pain during sex. A woman’s vagina normally produces a discharge that usually is described as clear or slightly cloudy, non-irritating, and odor free. During the normal menstrual cycle, the amount and consistency of discharge can vary. At one time of the month there may be a small amount of a thin or watery discharge; and at another time, a more extensive thicker discharge may appear. These descriptions could be considered normal.
A vaginal discharge that has an odor or that is irritating usually is considered an abnormal discharge. The irritation might be itching or burning, or both. The itching may be present at any time of the day, but it often is most bothersome at night. Sexual intercourse usually worsens these symptoms. See your healthcare practitioner if you notice any change in the amount, color, or smell of the discharge.
The three most common types of vaginitis and their causes are as follows:
- Yeast infection: A healthy vagina normally contains a small number of yeast cells, along with a certain number of bacteria. Normally there aren’t enough of the yeast cells to cause problems. But sometimes something happens to the vagina that lets the yeast cells multiply quickly and take over, causing symptoms. Taking antibiotics sometimes causes this. Being pregnant, taking birth control pills that contain estrogen, or having hormone therapy can also cause it. So can some health problems, like diabetes or HIV infection.
- Bacterial vaginosis: This happens when some of the bacteria normally found in the vagina can multiply quickly, causing symptoms. Experts are not sure what causes this, but certain things like having more than one sex partner, having a female sex partner, having a sexually transmitted infection, using an IUD for birth control, and douching can make it more likely.
- Trichomoniasis: This is a sexually transmitted infection, commonly called trich, caused by a parasite. You get it by having sex with someone who has it.
A Pap test, or Pap smear, is part of a woman’s annual wellness exam. The Pap test involves extracting a small sample of cells from the cervix. These cells are examined in a lab for abnormal cell changes. Your healthcare practitioner uses the Pap test in the screening for cervical cancer and human papilloma virus (HPV).
An abnormal Pap smear doesn’t necessarily indicate a condition like HPV or cervical cancer. Pap smears detect any changes within the cervical cells, not just cervical cancer. Abnormal Pap smear results may indicate other conditions such as inflammation or infection. False positives are also possible from Pap smears; however, further testing is recommended to protect your health whenever the Pap smear is abnormal.
Your healthcare practitioner will make recommendations for additional testing or treatment based upon the patient’s age and type of dysplasia, or abnormal cells that are found in the cervix. Some patients may require a repeat Pap smear every three to six months for follow-up until the Pap smear results return to normal.
Your healthcare practitioner may also recommend a colposcopy test if the Pap smear is abnormal. During the colposcopy, your healthcare practitioner uses a microscope to examine the cervix more closely and may take a biopsy from the cervix. The exam itself is like a Pap smear in that your healthcare practitioner inserts a speculum into the vagina so that the cervix is visible. After the biopsy results are received, your healthcare practitioner will recommend any treatment indicated to prevent cervical cancer.
Some patients will need an in-office procedure called loop electrosurgical excision procedure, also known as LEEP, to remove precancerous cells from the cervix. During the procedure, the abnormal cells are removed to prevent the development of cervical cancer. Wire loops attached to an electrosurgical generator remove the abnormal cells. The tissue removed is sent to a lab for further evaluation and to ensure that the abnormal area has been fully removed.
Ovarian cysts are a common condition in women during the childbearing years. They result when a cyst forms on the ovary. An ovarian cyst may or may not cause symptoms. Most ovarian cysts go away without treatment. In some cases, surgery may be necessary to remove large or ongoing cysts.
Ovarian cysts can result from the natural function of the menstrual cycle. A functional cyst may form if the follicle does not open to release an egg or if it seals after an egg is released. Ovarian cysts are not the same thing as cancerous ovarian tumors or polycystic ovarian disease. Functional cysts are more common during the childbearing years and rare after menopause. There are two types of functional cysts: follicular cysts and corpus luteum cysts.
An ovarian cyst may cause pelvic pain and may or may not produce symptoms. The pain is usually dull and may be constant or come and go. The pain may spread to your lower back and thighs. Your pain may increase during sexual intercourse, a bowel movement, or at the beginning or end of your menstrual period. You may experience abdominal bloating or swelling. Your periods may change and become longer, shorter, absent, or irregular.
Post-menopausal bleeding occurs in a woman’s vagina after she has undergone menopause. After a woman has gone twelve months without a period, she’s considered to be in menopause. Bleeding can occur in post-menopausal women for several reasons. Most of the time, postmenopausal bleeding is benign. However, it is recommended that all women with postmenopausal bleeding be evaluated with an exam, ultrasound, and possibly a biopsy to rule out uterine cancer.
Urinary incontinence, the leakage of urine, can be socially embarrassing to women; however, most of the time it can be cured, or at least treated. Behavioral techniques, exercise, lifestyle changes, and medical devices are often tried first. Surgical techniques are minimally invasive and can have quick recovery times. Here are some types of incontinence:
- Stress incontinence: Stress incontinence is the loss of urine during physical activity such as coughing, laughing, or lifting. The weakness of the muscles that help hold urine in the bladder cause it.
- Urge incontinence: Urge incontinence is a condition in which you lose urine with a strong sudden urge.
- Overflow incontinence: Overflow incontinence is many times a persistent dribble of urine, due to the inability to empty your bladder.
- Mixed incontinence: Mixed incontinence is when you experience more than one type of urinary incontinence, usually stress and urge incontinence.
Additional steps may reduce or eliminate your urinary incontinence. Strengthening your pelvic muscles by performing pelvic floor Kegel exercises every day, losing weight, smoking cessation, trying to identify foods that may irritate your bladder, and avoiding alcohol and caffeine may help. If exercise and behavioral therapies are not successful, your healthcare practitioner might combine these treatments with medication that relaxes the bladder and increases bladder capacity or may cause the muscles at the bladder neck to contract. Your healthcare practitioner may also try a pessary. A pessary is a rubber device that is inserted into the vagina and supports the urethra, thus helping to retain urine in the bladder. Stress incontinence that does not respond to other therapies is often treated with surgery. Surgery is typically not done for urge incontinence.