Before discussing about abnormal bleeding, we need to understand that a normal menstrual cycle lasts on an average about 28 days and lasts anywhere between 4 to 7 days.
What is DUB?
Abnormal bleeding is described as intermenstrual or irregular bleeding which occurs due to an underlying pathology (cause). Abnormal uterine bleeding is further classified into ovulatory and non ovulatory bleeding. When no particular pathology is detected, it is classified as dysfunctional uterine bleeding(DUB).
What might be the cause of abnormal bleeding?
It could be abnormalities associated with uterus, cervix or vagina. Conditions like fibroids, polyps, adenomyosis , polycystic ovarian disease , anorexia , infections in the uterus , endometrial hyperplasia or cancer can cause bleeding. Systemic imbalances like liver disease, bleeding disorders, high prolactin levels, thyroid issues, medications may also cause irregular bleeding patterns. Some anovulatory patterns are observed in adolescent and perimenopausal women.
What are the symptoms of abnormal bleeding?
· Inter menstrual bleeding
· Passage of large clots
· Heavy bleeding during menstruation
· Menstruation which lasts more than 7 days
· Post menopausal bleeding
· Bleeding during intercourse
How to diagnose abnormal bleeding?
A detailed history with examination coupled with a trans vaginal ultrasound in most instances would give a definitive diagnosis. A complete blood count, bHCG, hormone profile, coagulation studies and a pap test may help identify systemic imbalances. For patients who are in high risk for cancer, a hysteroscoic endometrial biopsy will be effective to identify any underlying cancer
How is abnormal bleeding treated?
Medical management with oral contraceptive pills, anti progestin, intrauterine devices are the first line of management for abnormal bleeding.
The final goal of treatment is to control further bleeding, correct the pathology (if diagnosed) and correct hemoglobin level.
What happens if medical management fails ?
In patients who have completed their family life , we suggest the patients to undergo a total laparoscopic hysterectomy .
What is Laparoscopic Hysterectomy ?
Laparoscopic Hysterectomy is a minimally invasive procedure that involves removing the uterus via tiny incisions in the abdomen. Most ob gyn specialists perform hysterectomy using laparoscopic assistance (LAVH), only part of the procedure is performed laparoscopically. At Indigo Womens Center we specialize in removing the uterus completely using laparoscopic approach, we are able to achieve this because our surgeons are highly experienced at suturing.
Do you remove the ovaries during a laparoscopic hysterectomy?
That depends on several factors- the patients age, her menopausal status and the condition of the ovaries while performing laparoscopy. Sometimes when the ovary looks suspicious or unhealthy we tend to remove them intraoperatively after consulting with the family members.
Does a hysterectomy affect bone density or cause heart problems?
A common misconception where many think the uterus is responsible for producing hormones in the body. The ovaries are responsible for hormone production, by conserving the ovaries we effectively avoid bone and heart issues. The sole purpose of the uterus is to carry the baby to term. When a woman has completed her family life, she can undergo hysterectomy if indicated.
Will a hysterectomy affect sexual function?
Removing the uterus has no effects on sexual function or satisfaction.
Why choose Indigo Womens Center for your surgery ?
At Indigo Womens Center we are pioneers in performing hysterectomy, our surgeons have developed their own novel techniques with over several years of experience. Using advanced energy sources we are able to give patients the benefits of the fastest recovery while making the surgery as “scar-less” and “pain-less” as possible.Our surgical techniques also help us reduce time of surgery, effectively reducing risks associated with anaesthesia.
For patients with severe adhesions (connections to other organs) due to previous surgery, we have "lateral window dissection" technique for the bladder, which helps us to separate the bladder from the uterus with no injury to the bladder whatsoever.
Patients with severe adhesions behind the uterus due to endometriosis or previous surgery, we perform retroperitoneal dissection to identify the ureters and separate them away from the surgical area. Very few ob gyn specialists are able to perform this dissection because it requires years of experience and good understanding of instrument ergonomics and anatomy to perform safely.
We are able to remove uteri of any size using our approach. These techniques are far less expensive than robotic surgery which most ob gyn may recommend for patients with large uteri.