Abnormal Uterine Bleeding

Intro: This is Weekly Dose of Wellness brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and abnormal uterine bleeding is a very common cause of concern for women. Evaluation of abnormal uterine bleeding is important, as it could be a symptom of something very serious. Dr. Thomas Ruiz, OBGYN physician with MemorialCare Medical Group, is here to talk with us about what women should know about abnormal uterine bleeding, from causes and symptoms to treatment options. Welcome, Dr. Ruiz.

Thomas Ruiz, MD: Good morning.

Deborah Howell (Host): Can you tell us, in a nutshell, what is abnormal uterine bleeding?

Thomas Ruiz, MD: Abnormal uterine bleeding is any bleeding that can occur outside a woman's normal menstrual cycle, as well as problems with heavier than usual menstrual cycle bleeding.

Deborah Howell (Host): That's very concise. I appreciate that. Now, what are some of the causes of abnormal uterine bleeding?

Thomas Ruiz, MD: The most... there are two age groups that it typically happens. One is in teenagers where they haven't established their proper hormonal access because their body is maturing. And then the other age group is women in their 40s where again you can start to have various issues ranging from hormones to non-cancerous tumors.

Deborah Howell (Host): Are you talking fibroid tumors?

Thomas Ruiz, MD: Yes, fibroid tumors. And then there's another disorder that is called adenomyosis, which is changes in the muscle wall of the uterus that will lead to very heavy painful bleeding.

Deborah Howell (Host): Got it. Now what are some of the causes of all this abnormal uterine bleeding?

Thomas Ruiz, MD: Well in terms, the easiest one to deal with is the most common. It actually has to do with hormones. Your ovaries aren't in sync with the lining of your uterus. So the lining of your uterus kind of gets thick and an egg doesn't come out, in a nutshell, and then the lining of the uterus starts to break off and bleed very heavily and irregularly. That's a problem we usually fix with some kind of hormone treatment. Now tumors, like fibroids, we don't know what causes them. They're usually non-cancerous and they take up space in the uterus and can make the uterus very, very large and that will often cause heavy, irregular periods at irregular intervals. And there are several treatments for those. And the same issue with adenomyosis, only adenomyosis is just very, very heavy bleeding.

Deborah Howell (Host): Got it. What are some of the symptoms that women suffer?

Thomas Ruiz, MD: They will... some women will suffer premenstrual cramping and heavy menstrual bleeding with passage of large clots. Some of the pain will radiate to the lower back. Some women will also have pain radiating down to the front of the thighs. Depending on the size of the problem, some women will even have pain when they have sexual relations.

Deborah Howell (Host): Not fun in any case. So how is abnormal uterine bleeding diagnosed, doctor?

Thomas Ruiz, MD: It first starts with an office visit and a thorough history from your provider. Once we get a history, we will do a physical examination to assess the size and the mobility of the uterus. And it may also incorporate ordering studies such as a pelvic ultrasound or a pelvic MRI if we suspect some kind of large tumor.

Deborah Howell (Host): So we've been through the symptoms, the diagnosis. Now to the good part, what are some of the treatment options available for women?

Thomas Ruiz, MD: Now the... it all depends of course on what turns out, if there's a tumor or not. But most of the time we can use very conservative methods of treatment. Something as simple as putting a patient on birth control pills. We also have progesterone-only intrauterine devices, which work very well to slow down the flow of bleeding and make periods very light and at very prolonged intervals.

Deborah Howell (Host): Tell me more about the procedure of inserting that.

Thomas Ruiz, MD: That is a very simple office procedure. An IUD is a very small device with a small amount of progesterone. It's done at the time of a regular office visit and it takes me about two to three minutes to insert it into the uterus. And it'll typically have full effect after about three months.

Deborah Howell (Host): And will the woman feel it?

Thomas Ruiz, MD: She will feel a little bit of cramping when we put it in. But if a woman has a tendency toward having discomfort, we can also give a local anesthetic to the cervix to help block some of the cramping while inserting. But most women don't need any medication and afterwards they may take Tylenol or Advil for the cramping.

Deborah Howell (Host): So what you're saying is a woman could have really, really terrible symptoms and on her lunch hour get many of them solved in three minutes.

Thomas Ruiz, MD: That is true.

Deborah Howell (Host): That is great news for a lot of women. And I hope a lot of them are listening right now. Now the birth control, tell me how that controls bleeding for women.

Thomas Ruiz, MD: Birth control is really good for women whose ovaries and brain and uterus isn't quite in sync hormonally. So their abnormal bleeding is what I would call a cycle that's out of sync. And what the birth control pills do is they provide hormones in the pill form to help control and regulate the woman's bleeding. After about three months, again, you will, you should get very good cycle control with considerably lighter blood flow and less cramping than they would have otherwise had.

Deborah Howell (Host): There must be an emotional bonus as well.

Thomas Ruiz, MD: Um, there is. In terms of predictability, it is... when a woman is on a birth control pill, she knows exactly when her period is going to arrive and she can also expect that she's not going to be quite as uncomfortable prior to the start of the period or during the period. So it makes it very easy to plan your life around something that is very regularly scheduled as opposed to not knowing when it's going to be coming.

Deborah Howell (Host): It's a big sigh of relief, for sure. What else should our audience know about abnormal uterine bleeding?

Thomas Ruiz, MD: A woman above the age of 40, abnormal uterine bleeding can be a sign of an early cancer. So we will often do something called an endometrial biopsy to make sure that you don't have an early cancer. Some of the treatments, if the uterus is too big, you can't just put an IUD in. But we have minimally invasive operative techniques such as hysteroscopy with endometrial ablation. Or if the uterus is so big that ultimately we decide with the patient hysterectomy is the best treatment, most of the time we can remove the uterus with an outpatient hysterectomy using either robot-assisted laparoscopy or straight stick laparoscopy.

Deborah Howell (Host): And that is a pretty minimal downtime afterward.

Thomas Ruiz, MD: It is. Most of my patients after these hysterectomies are feeling pretty good after about two weeks. 90% of my patients do not spend the night in the hospital, they go home the same day of surgery. And depending on what type of work you do, you're typically ready to get back to work in two to four weeks. And the surgical scars are very small.

Deborah Howell (Host): And tell us a little bit about the ablation process.

Thomas Ruiz, MD: Yeah, the ablation process, you... we have a special telescope that we insert into the uterus. I evaluate the lining of the uterus, if everything looks relatively normal, if there's a small fibroid I can take it out. And then we can put in either a device which uses radio energy or you can use hot water and that'll basically burn the lining of the uterus so that 75% of women won't have periods after the procedure. And then you will have another 15 to 20% of women whose periods will be significantly lighter. So endometrial ablation is ideal for a woman who doesn't have a lot of downtime. The recovery is anywhere from one to three days. And again, it's an outpatient surgical procedure with a high success rate.

Deborah Howell (Host): Certainly worth trying if you're having these really severe complications and problems and pain. There are many, many more options these days for women than total hysterectomy, which used to be a major thing and, you know, a couple of months of your life back in the day.

Thomas Ruiz, MD: It, you know, that is very true. And we still have, you know, for women who qualify, vaginal hysterectomies, which is a hysterectomy removed through the vagina without any kind of abdominal scar, which some women may opt for. Again, that recovery is going to be about two to four weeks, with a one-day hospital stay.

Deborah Howell (Host): Well, thank you so much for the good news, Dr. Ruiz, and for coming on our show today and teaching us so much. We really do appreciate it.

Thomas Ruiz, MD: Thank you very much.

Deborah Howell (Host): For more info or to hear a podcast of this show, go to memorialcare.org. That's memorialcare.org. That's it for me, Deborah Howell. Thank you so much for listening and have yourself a fantastic day.