Persistent Uterine Bleeding, Fibroids and Painful Periods
Fibroids (leiomyomas), Persistent Bleeding (menorhagia/metrorhagia), Painful Periods (dysmenorrhea)
Normal menstrual cycle (period) shouldn’t last more than three to four days or be painful and heavy (containing clots). Normal sized uterus shouldn’t exceed one to two ounces (50-75 grams) in weight and be bigger than a peach. Many women do experience persistent, heavy uterine bleeding, pelvic cramps and pressure. This may be caused by hormonal imbalance, fibroids, adenomyosis, endometrial hyperplasia (uterine pre-cancer) or even uterine cancer. Patients may complain of weakness (being anemic), may not be able to leave home for days or even stay in bed because of bleeding, cramps and pelvic pressure.
Possibly as many as 20-40% of all women have uterine fibroids. Fibroids are benign tumors originating from uterine tissue. The severity and impact of symptoms depend on location, number and size of the fibroids. While the majority of women usually have no symptoms, 1 in 4 women end up with symptoms severe enough to require treatment. Adenomyosis is a certain type of endometriosis (abnormal location of uterine lining cells) that develops inside the uterine walls. It causes pelvic pain and bleeding. Adenomyosis prevents effective uterine contractions during your period making it more painful and prolonged. In the majority of cases, adenomyosis and endometriosis are present and symptomatic at the same time.
Fibroids and Adenomyosis may coexist in the same uterus. This may exacerbate the already severe symptoms. After excluding cancer, conservative treatment should be attempted first by using a hormonal agent, if no contraindications exist. First-line hormonal agents may contain either a combination of an estrogen and a progestin medication or may contain a progestin-only compound; choices include birth control pills, vaginal rings, transdermal patches, intrauterine devices (IUDs), and injection progesterone. If this is not successful, then estrogen-eliminating treatment is offered in the form of Lupron injections (GnRH-a, gonadotropin releasing hormone agonist). Lupron treatments take several months and may produce severe side effects, especially menopause-like symptoms. Usually, the therapeutic impact lasts as long as these agents are given. If pelvic pain occurs with the abnormal bleeding, usually non-steroidal anti-inflammatory medications are given as well.
Uterine Cryoablation (freezing) is a minimally invasive, in-office procedure that is one of the most effective options for treating abnormal uterine bleeding, symptomatic small fibroids and adenomyosis. It only requires IM and/or PO (no IV) pain relief and relaxation medications and possible addition of local anesthesia.
Conservative minimally invasive out-patient procedures that are performed in the operating room include Hysteroscopic Myomectomy and Laparoscopic Myomectomy. Such an approach is recommended only if the patient wishes to preserve her fertility/pregnancy potential.
The definitive minimally invasive solution is provided by out-patient Laparoscopic Hysterectomy . Fibroids and adenomyosis are effectively eliminated by hysterectomy.
Uterine Fibroid Embolization (UFE) and Magnetic Resonance guided Focused Ultrasound (MRgFU) are additional options for treatment of symptomatic fibroids. UFE is performed by interventional radiologist, requires IV sedation and is associated with significant pain (days or weeks) after the procedure. UFE does not eliminate the fibroids. It blocks the blood supply and makes the fibroids inactive or less active and reduces the associated symptomatology. UFE is not recommended for patients desiring to preserve fertility. MRgFU is performed on a MRI table. The patient is lying on her abdomen for three hours with a catheter in her bladder. High frequency ultrasonic energy is applied on the fibroid causing it to become inactive or less active. MRgFU is associated with pain and requires sedation and pain medications.
Learn more about Laparoscopic Myomectomy and Laparoscopic Hysterectomy.