To consider a woman’s menstrual cycle normal, many different factors have to be looked at. However, when heavy bleeding occurs unpredictably and at levels that keep her from daily activities such as school and work, it means that something is not going well.
So, is the solution in abnormal uterine bleeding the removal of the uterus? Assoc. Prof. Dr. Taner Usta, specialist in obstetrics and gynaecology, explained the answer to this question and more for us.
WHAT ARE THE CAUSES OF ABNORMAL UTERINE BLEEDING?
To take abnormal uterine bleeding into consideration, various causes have to be investigated. Signs such as cycles occurring at intervals shorter than 3 weeks or longer than 5 weeks, periods lasting less than 2 days or more than 10 days, heavy bleeding and bleeding after sexual intercourse can point to abnormal uterine bleeding. Hormones are among the main causes of abnormal uterine bleeding. Normally, after ovulation from the ovaries, if the egg does not meet a sperm, pregnancy does not occur. The endometrium layer in the innermost part of the uterus that has prepared for pregnancy is expelled from the uterus as menstrual bleeding if pregnancy does not occur. But sometimes the reproductive system falters and bleeding can be seen when it should not occur, due to organic causes (fibroid, polyp, excessive thickening of the endometrium, ectopic pregnancy, threatened miscarriage, infection, cancer of the uterus, cancer of the cervix, etc.) or hormonal causes.
Hormonal irregularity in adolescence and in the years close to the menopause can cause heavy bleeding and spotting-type bleeding in women. In addition, contraceptive pills and other medicines, rapid weight gain or loss, emotional or physical stress and the use of an intrauterine device can also be the cause of abnormal vaginal bleeding. Furthermore, structures occurring in the uterus such as fibroids (arising from the smooth muscle cells of the uterus and often benign) or polyps, as well as bleeding or clotting disorders, blood-thinning medicines, cancer of the uterus, cancer of the cervix, diseases affecting the kidneys, the liver, the thyroid and the adrenal glands, and infections of the uterus or the endometrium (pelvic inflammatory disease) can also lead to this condition.
TREATMENT METHODS
In situations where abnormal uterine bleeding arises as a result of a chronic condition or disorder, when the condition causing the heavy bleeding and the anaemia is treated, these problems also disappear. Treatment varies according to the patient’s situation and her wish to have children after treatment. In patients close to the menopause, the course of the disease is generally observed.
In situations where abnormal uterine bleeding arises as a result of very large fibroids or cancer of the uterus, removal of the uterus may be necessary. However, apart from such situations, hysterectomy is preferred only when the disease cannot be resolved with other treatment methods. In many situations removing the uterus is not a treatment option that is absolutely necessary, in other words the uterus can be preserved. Removal of the uterus is performed mostly in patients who are close to the menopause, who have had children and who have not responded to previous treatments. Hysterectomy is also frequently performed with minimally invasive surgery (robotic or laparoscopic). Patients often stay in hospital for only 1 day.