• What are common symptoms of abnormal bleeding?
• What happens during an evaluation for abnormal bleeding?
• What are causes of abnormal uterine bleeding?
• What are treatment options for abnormal bleeding?

What are common symptoms of abnormal bleeding?
Most women have regular periods that occur about once a month and last up to seven days. But some women can have abnormal bleeding patterns, such as:

• Unpredictable bleeding patterns
  
• Bleeding between periods
  
• Very heavy periods
  
• Periods lasting longer than seven days

Any of these abnormal bleeding patterns or changes in typical bleeding pattern should be evaluated. 

What happens during an evaluation for abnormal bleeding?
During an evaluation, a complete history review and a physical exam will be performed.

Complete History:
The nurse and doctor get detailed information about medical history and symptoms.

Physical Exam:
Depending on what symptoms are present, a physical exam may be needed to complete the evaluation.

Evaluation may include an office ultrasound, diagnostic office hysteroscopy, endometrial biopsy or other testing.

Office Ultrasound:
At the MIGS Center, the doctor performs his or her own ultrasounds. Depending on symptoms, a transvaginal ultrasound may be done. This helps to identify what is contributing to bleeding symptoms (such as fibroids, polyps, a thickened lining of the uterus). The uterus and ovaries are evaluated using ultrasound.

The MIGS Center also offers 3-D ultrasound, which allows better visualization and evaluation of the uterus in some cases.

Diagnostic Office Hysteroscopy:
A hysteroscopy  is a minimally invasive procedure that uses a hysteroscope, or small camera, to look directly inside the uterus. Using advanced technology, we are able to perform this procedure in the office with minimal to no discomfort. A speculum is placed in the vagina in order to see the cervix (or opening to the uterus). The doctor guides a small camera (about the size of the tip of a pen) through the cervix and into the uterus while looking on a monitor. 

Using this technique, the doctor can directly see and evaluate the endometrial cavity (the lining and inside of your uterus) in order to identify any abnormalities that could be causing your symptoms.

Depending on the timing in the menstrual cycle and what symptoms are present, a diagnostic office hysteroscopy may be performed at the initial visit. Taking ibuprofen before the procedure can reduce the cramping with this procedure.

Endometrial Biopsy:
Depending on age and bleeding symptoms, the doctor may perform an endometrial biopsy.  An endometrial biopsy is a way of taking a sampling of the lining of the uterus (the endometrium). This is sent to a pathologist who examines it microscopically to make sure there are no pre-cancerous or cancerous cells.

Other Testing:
Sometimes the doctor may recommend blood work, or other imaging studies (such as an MRI or CT Scan).

At the MIGS center, much of the evaluation, such as ultrasounds and office hysteroscopy, can be completed during the initial visit. By completing many of the necessary steps at one visit, the doctor will have most, if not all, of the information needed to discuss the different management and treatment options.

What are causes of abnormal uterine bleeding?
There are many different reasons why women may have abnormal bleeding patterns. Some common causes are fibroids, polyps and adenomyosis. There are also other causes - therefore, it is important that a full evaluation is done to determine the reason for the bleeding.

What are treatment options for abnormal bleeding?
Treatment options for abnormal uterine bleeding depend on the cause of bleeding as well as personal preferences.

Some potential treatment options include:

• Medical treatment
• Surgical treatment
  • Laparoscopy
  • Hysteroscopy
  • Endometrial ablation
• Uterine artery embolization