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

Most women have regular periods that occur about once a month and last up to seven days. 

But some women can 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 your typical bleeding pattern should be evaluated. 

What happens during an evaluation for abnormal bleeding?

During an evaluation, you will have a complete history review and a physical exam.

Complete History Review:
Before your visit to the MIGS center, you will be asked to complete a questionnaire asking about your medical history and symptoms. At the time of your appointment, the nurse and doctor will review this information and talk to you in detail about your medical history and your symptoms.

Physical Exam:
Depending on what your symptoms are, you will also have a physical exam to complete the evaluation.

A physical exam 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 your symptoms, you may undergo a transvaginal ultrasound.  This helps to identify what is contributing to your 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 where you are in your menstrual cycle and what your symptoms are, a diagnostic office hysteroscopy is often performed at your initial visit. Taking ibuprofen before the procedure can reduce the cramping you might feel.

Endometrial Biopsy:
Depending on your age and your bleeding symptoms, your 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 your doctor may recommend blood work, or other imaging studies (such as an MRI or CT Scan).

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

What are the causes of abnormal uterine bleeding?

There are many different reasons why women may have abnormal bleeding patterns.  But some common causes can be fibroids, polyps and adenomyosis. There are also other causes so, therefore, it is important for you to have a full evaluation to help determine the reason for the bleeding.

Treatment options for abnormal uterine bleeding depend on the cause of bleeding as well as your personal preferences.

Some potential treatment options include:

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