GynoFiles

Patients often ask, how much is too much bleeding? Or what is normal? As a doctor, we tell them that if they are bleeding through more than one pad an hour, they have 'heavy bleeding.' The picture on the right shows examples.

The formal definition has to do with exactly how much blood you lose, which is very difficult for a patient to evaluate. Instead your gyno will determine heavy bleeding by the following questions: Do you have a n eed for double protection to manage menstrual bleeding?   Does your menstrual cycle flow cause you a sensation of “gushing” or “flooding”? Do you ever thoroughly s oak one pad and/or tampon or more per hour for three or more consecutive hours? Do you need to arise at night r egularly during your menstrual period needing to change the tampon or sanitary pad at night or do you regularly soil your bedding? Does your menstrual bleeding ever get so h eavy that the it affects work, school, or social activities? The blood lost during a normal menstrual cycle is venous blood, it can clot, and usually appears dark in color. The amount of clotting may not be a very accurate sign of the amount of bleeding, but clotting can definitely cause pain as the clots passing the cerv...

We urge women with heavy menstrual bleeding to seek answers, get therapies and if interested, participate in a clinical research trial . Uterine fibroids, uterine polyps, and hormonal imbalance get so much talk on gyno blog, if we have a heavy menstrual period we assume it's one of those conditions. And it would be smart for your gyno to rule out that cause. But there are other, less common, and more hidden causes of bleeding. If you have had a normal pelvic exam, a normal endometrial biopsy, you seem to have hormones in balance considering you have regular periods, there may be other, actually medical conditions as the cause. Could it be a deficiency of Factor VIII needed for clotting? Von Willebrand factor which carries Factor VIII can be low. When this factor is low, it leads to Factor VIII to be low which can cause bleeding. It check for on a blood test about 1 percent of women will have this. Bleeding Bleeding Bleeding on your Period? Yes, VWF deficiency can be a ca...

Medical therapies for shrinking fibroids have been shown that fibroid tumors and hormonally responsive and could shrink without surgery although both hysterectomies and myomectomies can control the bleeding from fibroids/ Women no longer want a hysterectomy or a myomectomy to control uterine fibroid bleeding, but if you have fibroids and heavy periods, and anemia, or pelvic pain, or pain with intercourse you probably need to gab with your gyno as it's important to get them treated. The amount of menstrual bleeding women experienced when they have both bleeding uterine fibroids and anemia has been published in what is call the PEARL I  research study of the selective progesterone receptor modulator (SPRM), ulipristal acetate (UPA) . This medication can treat bleeding with fibroids, and is currently undergoing more research trials. In this first study, the fibroids were between 3 and 10 cm in size, and the uterus was no greater than a 16 week pregnant uterus. This first study d...

There is a condition that is called in lay terms miscarrying myoma. It is not common, but all gynos will see these cases. The fibroid may have once been inside the wall of the uterus or on a stalk within the uterus and it just begins to work it's way free. Often these cases create extremely heavy bleeding and need immediate attention. Here are pictures illustrating what is seen . Treatment is usually surgical and in many cases the fibroids can be removed and the uterus saved, in some cases it causes such profuse bleeding a hysterectomy has to be done. For information on uterine fibroid treatment options please refer to the Venus study site . Cervical Fibroid Cervical Fibroid Trying to Deliver Itself

Many techniques have furthered the technology of having uterine fibroids surgically treated. Vaginal hysterectomies are able to remove large fibroids, and a technique of manual morcellation or manual removal in pieces enhances the ability of the gyno surgeon to get quite a large fibroid removed without any abdominal incisions. Abdominal hysterectomies were then performed for even larger fibroids, and by those surgeons who felt that they couldn't safely perform a vaginal procedure. As laparoscopic hysterectomies became more popular, including the technique of preserving the cervix, called supracervical hysterectomies, gynos required a better way to remove the uterus. Power morcellators were then developed that could essentially remove the tissue in strips. When the tissue is removed in smaller pieces, or if any are inadvertently remain behind in the abdomen, this tissue can in fac...

A new Gallop poll says that almost 30% of women will put off getting testing and treatments when they have a medical complaint! Not only that, but the more serious the condition was, the more the woman is likely to not get it checked. And it's not getting better, a decade ago only 15% of women were putting off seeking medical care. So the number of women procrastinating has increased significantly! For instance: vaginal bleeding is the number one cause of gynecologic problems: both small and large. The bleeding could mean cancer, so irregular bleeding is not a reason to delay getting medical advice. If you are now having vaginal bleeding there is a tendency to think the bleeding is coming from the uterus itself, and most often you will be right. But there are many other causes of bleeding that you may not be considering. So when you see vaginal bleeding are you bleeding from the vaginal walls, the cervix, the rectum, from your bladder or from the vulvar area. All these types of ...

There are women who are bothered by their menstrual periods: and this complaint can be handled in a day. Women who are done having children should consider the option of stopping their heavy periods with the technique called endometrial ablation. For women with heavy menstrual bleeding the period can be here to day and literally gone tomorrow with this treatment. Once a woman has an endometrial ablation, she will almost be sure to never have a heavy period again, although she has to heal and will have some sort of light bleeding or discharge in the healing phase. Over 50% of women will have no periods at all after an endometrial ablation. Another 40% of women formerly with heavy periods will just have very light bleeding during their periods after having and endometrial ablation procedure. Office endometrial ablation is covered by most insurances with just your office copay. You can call today, get an appointment to have an ablation done, and find out what your insurance company wil...

Heat. Directly to the Abdomen. Although it did work faster if you also take a pain reliever. The heat studied is 40 degrees Celsius Vitamin B6. Many of the vitamin and herbal trials actually tried combinations of these vitamins and herbals therapies and this it’s not likely that this one vitamin alone would reduce your cramps. Vitamin B1 Fish Oil Vitamin E. Low Fat Diet Vegetarian Diet. Women with cramps were switched to a Vegetarian Diet for a couple of months and they found their cramps improved. What was even better is that they lost about 5 pounds! Exercise and yoga. It works if you are a regular exercise participant, but it’s not exactly studied whether it is necessary to exercise right when you have the cramps. Behavior Therapies. This can be hypnosis, or imagining, paced breathing, or distraction

Preventing Acne: three pills are approved for acne control, most all do work for this Treating PMS Preventing Endometriosis Preventing Ovarian Cysts Preventing Menstrual Cramps Preventing Heavy Menstrual Bleeding Preventing Menstrual Migraines Stopping Periods (if you don't want them! or just arrange them when you do!) Decreases Ovarian, Colon and Uterine Lining Cancer Makes periods predictable    11. Shrink Fibroids (not in every study, but in many they do)    12. Better Bones: this is for women over 40, for younger women the effect is probably neutral    13. Less Benign (non-cancerous) Breast Disease    14. Fewer Irregular Menstrual Periods

Many women have had an endometrial ablation that worked, and now the bleeding has returned. Womens will report that they may notice this quickly: within a few months of their procedure or it may occur over several months. It is more common to have light periods after a few years than no periods at all after an ablation was done. Many of the women who have had a recurrence of their menstrual woos are contemplating their second procedure. Usually a hysterectomy is not the first choice of treatment when the menstrual cycles recurr after an endometrial ablation, even if the new cycles are painful or have PMS. There are a number of choices of therapies and new ones being developed. For some women, it's time to move on to Mirena IUD, birth control pills, Lysteda or a hysteroscopy with Myosure. And yes, for a small percentage of women hysterectomy should be considered. All these have a roll for some women, and none are the solution for all. For many just repeating the prior NovaSure, o...

Supporting your menstrual cycle monetarily may mean that you are due for a menstrual makeover. Working off that large insurance deductible? Only have a set budgeted amount for your contraception? There is no reason you and your gyno cannot talk strategy about what is going to be the most cost=effective contraceptive alternative for you out there. And the factors that weigh into those treatments vary from woman to woman. If your periods are heavy, maybe you need to factor in the cost of tampons and pads as well! And maybe if you are going to try for a baby in 6 months to a year, that will be a factor as well, what is cost effective for a few months may not quite be the same as what is cost effective for the long haul. And what about method switching. It turns out this may be the most cost effective strategy of all! Who would have thought that! For instance, what about the woman with those terrible cramps and clots. If you are just going to treat your heavy periods for only one year i...

 Submucus Fibroid  Fibroid on Ultrasound Uterus Showing Fibroid Interiors These pictures are all of the round muscle knots called uterine fibroids. Usually your physician can feel the fibroids, that are either on the outside of the uterus or ones that make your uterus large, on a pelvic examination. Not every fibroid will need treatment, and we wonder should hysterectomies be done for heavy uterine bleeding with fibroids? Most gynos say most often no a uterine fibroid will not necessarily require surgery, definitely not initially. There are other things to try. And many women haven’t even heard of some of their alternatives for the treatment of these uterine muscle tumors, and there are new ones being developed. Uterine fibroids are the most common gynecologic tumor. And with over 500,000 hysterectomies being done in the USA each year for bleeding, we can actually save a lot of uteri and avoid complications with fewer days out of one’s life if alternatives are eval...

A reader asked several great questions regarding the findings of CIN, in her case I/II or mild to moderate dysplasia, on the pathology report of a D and C and then NovaSure done. NovaSure endometrial ablations are to treat heavy menstrual cycle bleeding which is the result of the shedding of the endometrium, or the lining of the uterus. CIN stands for Cervical Intraepithelial Neoplasia. This is a term for precancerous changes of the cervix itself. It is not likely the cause of any heavy menstrual bleeding. It is not likely the cause of any actual symptoms at all (spotting and discharge are sometimes associated, but not often). It is the result of an HPV infection, and it can lead to cancer. The chance that a woman will have cervical cancer after a CIN I diagnosis is probably about 1/100...after a more high grade diagnosis ...CIN II or CIN III....more like 10/100. Other tests are useful, like an HPV 16/18 test, or the actual pap smear. But bottom line, CIN cannot come from the lining...

Gals hate break through bleeding. It’s a worry from the standpoint of clean clothes and feeling as fresh, and it’s often worrisome to patients who wonder what the cause is and if it signals something more major. Although your gyno will likely reassure you that this is common, I always encourage my patients to get that extra gyno visit in to discuss their individual case, and to see if they need adjustment to their pills. This Gyno Gab Gal worries about unintended pregnancy for those having unscheduled bleeding, patients my only worry about the sheer annoyance of it! Usually those first three months are the worse, but about 10% of the time as you go forward with pill use you may have some breakthrough bleeding. Birth control pill users may experience breakthrough bleeding and failure. In the research world pill failure rates are less than 2% in the real world pill failure rates for pregnancy are about 8%. Lots of reasons have been proposed for this. Obesity, competing medications, s...

Decidual Cast Periods can be fairly easy, passing some tissue at a time, or off can come the whole lining in one piece called a decidual cast. Generally the lining of the uterus is only 6-8 mm thick at the time of the menstrual period, and it is shed gradually, a few cells at a time. The decidual cast is when the entire lining passes spontaneously.  It's not uncommon, but it usually both uncomfortable, and alarming to some. But us women are designed to have some sort of periods  Or Not? We have to pass tissue each month. Or Not? Are they good for us? Or Not? Do we want them? Or Not? Is this something that is individual? Or Not? It's a complex topic that I will be discussing a lot over my time in this blog. So lets start with basics: How much do we bleed and what are we loosing, and just what was this that the patient passed? And another basic: track your periods, and the Women's Health Practice site http://www.womenshealthpractice.com/media/pdf/menstrual_chart.pdf you...

Speculums For Lateral Wall Retraction In the March issue of the American Journal of Obstetrics and Gynecology Dr. JoAnn Pinkerton of the University of Virgina and co-workers wrote an article about what conditions are worsened by having one's menstrual period. Some were obvious: a pimple, PMS, and migraines, and some were suspected by not really discussed much with your physician: irritable bowel, diabetes, asthma, and rashes (uticaria). What was surprising to read was the good research that even conditions like acute appendicitis, and seizures, and glaucoma, and MS and Rheumatoid arthritis can be made worse during one's period. The immune system seems to be very hormone dependent, and which immune cells are both produced and functioning depends upon the phase of the menstrual cycle you are in. Hormones are also strong controlling factors over brain chemistry and bipolar disorders and anxiety related disorders like agoraphobia may become worse in the premenstrual time of th...