Abnormal Menstruation: Alternatives to a Hysterectomy

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Abnormal Menstruation:
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Alternatives to a Hysterectomy
By Henry Kaminski, M.D.
Obstetrics & Gynecology
Millions of women suffer from
ovulation. It is the rising of the FSH
abnormal menstruation and often
and LH levels and the misfiring of the
choose hysterectomy when these
ovulation cycle (occasionally not
problems become difficult to live
ovulating), that causes the
with. However, today there are other
premenopausal changes or what people
alternatives for women.
refer to as “change of life.”
Menstruation
Problem Periods
During a woman’s reproductive
Most abnormal bleeding can be
years, a normal menstrual cycle usually
divided into functional problems
lasts anywhere from 21 to 35 days,
(which are most common) or
with approximately seven to eight
Henry Kaminski, M.D.
pathological (disease-related) problems
ou Can U days of bleeding, and usually expelling
with the uterus. The uterus is a very
approximately two to three ounces of blood. For
simple organ. It is a very thick muscle that is lined in
Y the majority of women, the color of the blood or the inside by the replenishable lining called the
the amount of bleeding is not as important as how
endometrium. It produces no hormones and, as far
regular her menstrual periods are and whether there
as we know, has no other function than to hold a
is any bleeding between periods.
pregnancy. The ovaries produce all the hormones the
A female’s menstrual cycle is basically
woman needs in life.
controlled by four hormones. There are two
If a woman has a functional problem, it is
hormones in the brain: follicle stimulating
probably related to failure to ovulate. Pathological
hormone (FSH) and luteinizing hormone (LH),
problems usually consist of polyps, fibroids,
and two hormones in the ovaries: estrogen and
precancer or cancer.
ews progesterone. During a normal menstrual cycle, a
When we evaluate a woman for bleeding, we
woman produces estrogen during the first half of
usually try to find out if she is not ovulating and
her cycle. Estrogen is like a fertilizer to the uterus –
why. The majority of women who do not ovulate
it makes the lining (endometrium) grow. After
don’t due to stress or advancing age, but there are
ovulation, the ovary produces progesterone. Prior
some other causes including thyroid disease and a
to ovulation, the ovary produces almost no
high prolactin (a hormone that stimulates milk
progesterone. Progesterone’s purpose is to ripen the
production) level. Functional problems are usually
lining and get the lining ready for the fertilized egg
ruled out by either ultrasounds, biopsies or even a
that is going to implant. If no fertilized egg
D&C (hysteroscopy). A blood count is usually
implants, the progesterone level falls, causing the
obtained to determine if the patient is anemic.
lining to breakdown and a woman to have a
menstrual cycle. It is this alteration of estrogen and
Treatment
progesterone that produces a woman’s regular
Before treatment can begin, we need to
menstrual cycle. If a woman does not ovulate, she
determine if we are treating an acute or chronic
does not produce enough progesterone to ripen the
problem. Acute means that the woman is heavily
lining and cause this natural process. A woman will
flowing and needs to stop this heavy flow. Chronic
still menstruate without ovulating, but this
usually means a menstrual problem that has lasted
menstrual cycle will be more irregular because she
months or even years.
edical N is lacking progesterone.
For all intents and purposes, the only two
The brain of a woman produces FSH and LH
hormones that will
that drives the ovaries to ovulate. As a woman gets
affect the uterus are
older in her reproductive life cycle, the FSH and
estrogen and
M LH need to hit a higher level in order to create
progesterone. When a

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Abnormal Menstruation:
Alternatives to Hysterectomy continued...
woman is bleeding very heavily, estrogen is
uterus and burns the lining.
usually given to stop the bleeding. This is for
If the above treatment options fail, a hysterectomy
acute bleeding, not for a woman who is having
can be performed. Currently, hysterectomies can be
chronic abnormal menses. Another good
accomplished laparoscopically with a one- to two-day
treatment option is birth control pills for acute
hospital stay and two- to four-week recovery. The
bleeding. Usually giving three pills a day for
laparoscopic hysterectomy requires only three small
seven days will stop 99% of women who are
1/4-inch incisions in the abdomen with removal of the
having a heavy bleed. Acute heavy bleeding is
uterus through the vagina. Most of these hysterectomies
usually caused by failure to ovulate and having a
can be performed leaving the ovaries in place, and
very thick lining that is spontaneously bleeding.
therefore a woman does not need estrogen replacement
The treatment of chronic bleeding usually
therapy.
consists of either observation, estrogen/
In summary, most abnormal bleeding is caused by
progesterone, or surgery. Some women with
a functional problem of the uterus and is directly
heavy or regular bleeding will benefit with
attributable to not ovulating or what we call
ou Can U
Motrin-type products. This has been shown in
anovulation. A patient should see her physician for
studies to decrease the amount of bleeding. One
evaluation of abnormal bleeding. There are many
of the best drugs to cure abnormal bleeding is the
treatment options available. Medical treatment options
Y
birth control pill. In a nonsmoker, birth control
are always used before surgical treatment options.
pills can be given up to the age of menopause.
For more information call Advanced HealthLine at
Progesterone products, like Depo-Provera also
(262) 512-2880 or toll-free at 1-888-709-2080 outside
help, but tend not to regulate the cycle as well as
the Milwaukee metro area, or log on at www.ah.com.
birth control pills.
Henry M. Kaminski, M.D., is an Obstetrics and
A D&C (dilation and curettage in which the
Gynecology physician with Advanced Healthcare’s
cervix is dilated and a curet is used to scrape the
Germantown Clinic (N112 W17975 Mequon Road,
lining of the uterus) is good for evaluation of
Germantown, 262-532-7600) and Menomonee Falls
ews
abnormal bleeding, but does not help in
Clinic (N84 W16889 Menomonee Avenue, Menomonee
treatment. Studies have shown that within a
Falls, 262-251-7500).
month or two after a D&C, the patient will have
Dr. Kaminski and his colleagues at Advanced
the same heaviness of bleeding. If a patient has a
Healthcare are leading physicians in Obstetrics &
polyp, a hysteroscopy (a scope placed in the
Gynecology. His colleagues include:
uterus as an outpatient procedure) has been
Brian Bear, M.D.
Christine Berg, M.D.
shown to be successful in reducing a woman’s
Ann Cornell, M.D.
Curtis Cornella-Carlson, D.O.
heavy bleeding.
Francine Cosner, M.D.
Renee Coulter, M.D.
One of the newest procedures is endometrial
George Geanon, M.D.
Sandra Gottwald, M.D.
ablation. There are a few ways to do endometrial
Kathryn Kostic, M.D.
Paul Lucca, M.D.
ablation. The theory behind endometrial ablation
Francesca Lynd, M.D.
Tori Stephens, M.D.
is to burn and eliminate the lining of the uterus
Mary Swiderski, M.D.
Kathleen Szwalek, M.D.
and stop heavy periods. As stated before, the
Gerald Vitamvas, M.D.
Anna Marie Windsor, M.D.
uterus is a very simple organ. It is a big, thick
muscle with a replenishable lining. If one can
burn and scar this lining so it no longer exists,
the woman will no longer have periods.
Endometrial ablation has been shown to be 90
percent successful. It is an outpatient procedure
edical N
and women usually return to work in one to two
days. There is no cutting or suturing involved.
The physician just dilates the cervix as in a D&C
M
and then places a scope or balloon within the
AH 11/07

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