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Fibroids & Abnormal Bleeding

The term "abnormal vaginal bleeding" can refer to abnormally heavy periods, bleeding in between periods, or bleeding after menopause. The cause of abnormal bleeding can be separated into two basic categories – anatomic and hormonal.

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Anatomic causes of abnormal bleeding include anything that physically should not be present, such as fibroids, endometrial polyps, adenomyosis, cervical polyps, endometrial cancer or precancerous, full-thickness vaginal endometriosis, cervical lesions, and potentially a tubal pregnancy or miscarriage.

Hormonal causes of abnormal bleeding include ovulation problems, endometriosis (especially with ovarian endometriomas), metabolic imbalance, insulin resistance, polycystic ovarian syndrome (PCOS), hypothyroidism, excess androgen production (male hormones), perimenopause, and the side-effects of hormone medications (such as birth control pills, Depo-Provera, etc).

A physician should collect a comprehensive patient history and conduct a physical exam to determine the best treatment for abnormal bleeding based on the diagnosis and cause of abnormal bleeding. This is usually completed with a sonogram (ultrasound) to look for fibroids (fibroid tumors, uterine fibroids, and other fibroid symptoms), ovarian endometriomas (chocolate cysts), adenomyosis, and the thickness of the uterine lining. A sonohysterogram can also be helpful. In this procedure, which is performed with the sonogram in the office, a small catheter is placed inside the uterus, which is filled with saline (salt water) to look at the inside of the uterus for polyps, etc. If needed, a hysteroscopy may be performed as well to actually look inside of the uterus. Blood tests also can help identify any hormonal causes of abnormal bleeding, and rule out the possibility of pregnancy if indicated.

It's very important to determine which type of fibroid treatment is best for you based on the type of fibroids that are present. Symptoms of fibroids can provide a clue – about one-third of women develop fibroid tumors within the wall of the uterus. If a fibroid tumor exists you may experience heavy menstrual bleeding along with the feeling of pressure in the pelvis which can cause frequent urination and pain during intercourse.

Usually, fibroids can be removed either laparoscopically or hysteroscopically with Minimally Invasive Surgery, especially if they are not so big that they fill the tummy higher than the belly button (although as a medical student I did see a 90-pound fibroid!). The most common procedure to remove a fibroid is called a myomectomy. In some cases, a woman may elect to have a laparoscopic (through the belly button) hysterectomy, either with or without the removal of her cervix. Removal of the ovaries (and thus, the loss of hormones) is not required. Thanks to Dr. Cook's advanced surgical skills, he is adept at removing fibroids with Minimally Invasive Surgery.

To learn more about symptoms of fibroids & abnormal bleeding or schedule a consult with Dr. Andrew Cook, please submit your information here: Request a Consult with Dr. Cook.

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