Part One | Part Two
By: Jean Johnson for Uterus1
Otherwise healthy populations of women will experience heavy bleeding or menorrhagia at rates of 9 to 14 percent at some point during their reproductive lives. Consequently, an understanding of how physicians diagnose the problem can be useful for those interested in a basic understanding of their situation prior to consulting a healthcare professional.
|Maintaining good health can help you manage menorrhagia: |
Keep stress levels down with relaxing activities
Try to get enough rest
Eat a healthy diet and stay active
Seek the support of family and friends
Avoid aspirin that can interfere with clotting. Use Ibuprofen instead.
The cause of heavy bleeding can be difficult to determine. Physicians will generally take a complete medical history as well as one related to menstrual cycles, before doing a physical exam that includes a pelvic. If the last pap test is out of date, cells from the cervix will also be collected during the pelvic exam to check for cancer or precancerous tissue. Generally painless, ultrasound scans that provide real time visual images of the uterus might also be performed in the gynecologist’s office or at a later appointment. Blood samples are also often taken to screen for anemia and thyroid abnormalities among other possible problems.
From the initial screening, there are a number of procedures physicians can use to obtain more information to rule out other menstrual disorders and medical conditions:
• Endometrial Biopsy – An endometrial biopsy is an office procedure in which the physician uses a suction catheter that is inserted into the uterus through the vagina and cervix. By sweeping the wand around in the uterus, the physician collects a specimen of the lining or endometrium for laboratory analysis. To control pain and cramping associated with this common procedure, some physicians use intrauterine lidocaine, others recommend taking oral pain medications prior to the biopsy, and still others use no anesthesia.
• Sonohysterogram – Like an ultrasound, this test provides a real time image that can be copied onto paper to form a permanent part of a patient’s records. The difference is that a sonohysterogram uses a saline solution that is introduced into the uterus via a small catheter passed through the vagina and cervix. Once the uterus is sufficiently dilated or enlarged with the solution, the radiologist uses what’s known as a transvaginal ultrasound probe to evaluate the condition of the uterus. The test can generally be done in under a half hour and often takes just 10 minutes.
• Hysteroscopy – This procedure employs a slender tube with a tiny light affixed to the end that allows physicians to see the inside of the uterus. The tube is passed into the organ through the vagina and cervix. The hysteroscopy allows experts to spot any fibroids or polyps that might be causing heavy bleeding. It can also be used to obtain a biopsy sample if a cancerous malignancy is suspected.
• Dilation and curettage (D and C) – Dilation and curettage, or uterine scraping, can be used both as a diagnostic tool and a treatment for heavy bleeding. A relatively minor surgical procedure, a D and C is done either in a hospital with general anesthesia or right in a physician’s office with a local providing sufficient relief from pain and cramping.
A speculum holds the vagina open while the practitioner dilates, or enlarges, the cervix with a graduated series of sterile metal rods. Once the opening between the cervix and uterus is sufficiently dilated, a curette or long-handled instrument with loop on the end is inserted into the cavity of the uterus. The practitioner uses the loop to scrape the lining of the uterus either in part for a specimen or in its entirety to actually treat the heavy bleeding.
Diagnosis is only half the battle, of course, so we’ll deal with treatment of heavy bleeding in our final installment of this primer series. Check back next week if you’re finding the information helpful. And feel free to let us know if there’s something you’re interested in that we’re missing. It’s all part of the solidarity effort focused on empowering women so that when they do consult their professionals of choice, they have a base of reliable knowledge from which they can draw. In that way they can participate in the conversation that has critical consequences for their health and well being. We think you’ll agree that it’s a proactive and intelligent way to proceed.
Concluded in Part Three
If you enjoyed this article, you might also be interested in the following:
Surgery and IUD Produce Similar Patient Results for Heavy Periods
IUD Device Doubles as Treatment for Heavy Periods
Women With Heavy Periods Express Concern About Symptoms, Treatment Options
Less Invasive Treatment for Excessive Uterine Bleeding