DR. LISA GIBBONS: Hi. My name is Lisa Gibbons and I'm an obstetrician/gynecologist working with Cascadia Clinic in Vancouver, Washington. I'd like to talk with you today about menstrual disorders and this is somewhat of a broad topic, so I'd like to pare it down to abnormal uretal bleeding in the perimenopausal patient. We see these ladies coming quite often to our office complaining of symptoms of heavy bleeding, soaking through pads, tampons, clothing, and ultimately affecting their quality of life. It can also present as infrequent and sporadic periods where a lady thinks that she's completely done with her periods, and then two months later a surprise or four months later a surprise. So, it can be any manner of irregularity to their period cycle. The diagnosis is made by doing a physical exam excluding any other abnormalities that may be going on that could be affecting the menstrual cycle as well and ruling out anything cancerous or precancerous or structural. We do this by a physical exam and a pap smear and also ordering an ultrasound. On the ultrasound, we're looking for structural defects like fibroids of the uterus, adenomyosis or polyps, things within the lining of the uterus and also thickened lining of the uterus that could potentially be a cancerous or precancerous lining. The lining is further assessed by an endometrial biopsy. This is done by a speculum exam much like a pap smear, but we actually thread a catheter through the cervix and obtain a very small amount of tissue that is sent to be evaluated by a pathologist. If all of these things return normal, then our diagnosis is typically made in that it's a hormonal problem and an imbalance of those hormones, the brain talking to the ovaries trying to recruit an egg to be ovulated. And, with that, the treatment then becomes either replacing those abnormal levels or hormones, most commonly by a low-dose birth control pill or a patch or a ring. Also, a Mirena IUD that has a progesterone lining to the IUD will affect the lining of the uterus by thinning that out and helping with abnormal bleeding. If the hormonal options don't work or not an option for the patient from a medical standpoint, then other options include surgery. One of the most exciting newer things within the last 10 years has been an ablative-type procedure, where we cauterized the lining of the uterus so that decreases the amount of bleeding significantly, decreasing the bleeding by 85% to a point where ladies are quite comfortable with the amount that they're having, typically more like end of period sort of bleeding, spotting for a couple of days, and approximately 35% of ladies become amenorrheic or have no periods whatsoever; these ladies are quite happy. If these things fail, then the last resort would be something more definitive like the hysterectomy and this are quite successful in reducing the amount of bleeding because we remove the uterus, but also have a longer recovery. So, talk with you physician about different options and what's best for you, but there definitely is no reason to have these horrible cycles and affecting your quality of life.
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