Treatments for abnormal uterine bleeding (AUB)
- illustrations yet to come/GN
Here we will address the spectrum of treatments for various forms of abnormal uterine bleeding.
As a general rule, if we can, we try medical treatments first. This is because they are less invasive and less expensive.
Beyond such general rules of thumb we offer treatments that are " evidence based. " That is, we go beyond common sense, and offer something that has actually has been scientifically tested and compared with other treatments. Each specific condition has a an appropriate treatment or treatments which is indicated. In my specialty, Obstetrics and Gynecology, such research data, recommendations and standards of care have been very nicely collected and made accessible to us by our governing bodies, the American College of Obstetricians and Gynecologists ( ACOG) and the American Board of Obstetricians and Gynecologists (ABOG) . ACOG deals more with the science, and ABOG the testing and certification which we have to (continually) do.
This may sound like " cookbook medicine ". On the contrary, try as we may to have each patient's condition be typical, and the treatments ideal, a significant amount of individualization is required. This is where the art of medicine and good old fashioned experience also come into play. We have a saying about certain patient's cases which become very atypical : " She just didn't read the book " .
Be that as it is, I will share some pages from " the book" that not every patient reads. . This list is by no means comprehensive.
Treatments for Hormonal causes of AUB
This a often a case of fighting fire with fire.
1. Anovulation (not ovulating) - If a patient is found to be anovulatory and has irregular periods, and desires fertility, we may give medications, often hormones, and take other measures to help her ovulate. Once ovulation is back on track, the periods will be too. See Menstrual cycle 101. If the patient does not desire fertility, we might regulate the cycle with a birth control pill, again hormones. The pill is just one of many hormone treatment options. If she is anovulatory in the setting of the larger disorder Chronic Estrogenized Anovulation ( CEA ) then we will certainly take additional measures to correct this. See CEA.
2. Abnormal thyroid or prolactin - If these blood test results are abnormal, we may search further for a cause of the abnormalities and then take measures to correct them, for example, by giving thyroid supplementation.
Sometimes, even though no anatomic lesion is found and hormonal causes are to blame, medical treatments are tried that simply do not work well enough. These patients occasionally opt to have their uterine lining destroyed using a variety of techniques. Of course this is not for those wishing to retain fertility. It can reduce bleeding for a time, and has the disadvantage of making uterine monitoring more difficult in the future. Many patients who fail medical therapy opt for a hysterectomy.
Treatments for Anatomic causes of AUB
" A chance to cut is chance to cure ." old surgical proverb.
1. Polyps- If a few smaller polyps are discovered to be the likely culprit, then a scope, a hysteroscope in particular, can be inserted, and a tool besides, to remove them, often ending the AUB. This is a day, or outpatient surgery. A whole uterus full of polyps is more challenging.
2. Fibroids- Likewise if there is a fibroid impinging on the lining of the uterus, and it is accessible from inside with a hysteroscope, whole or partial resection may be beneficial to the bleeding pattern. A whole uterus full of fibroids is more challenging.
3. Abnormal cells- There are abnormal cells which are precancerous and those which are not. Any precancerous cells warrant a hysterectomy unless it is medically contraindicated, such as in the case of a very ill patient. Abnormal non-precancerous cells such as hyperplastic cells may be addressed by strong hormones or a dilation and curettage. If the abnormal cells persist, or there is concern the sampling is incomplete, a hysterectomy may be done.