Abnormal Uterine
Bleeding
The commonest cause of
Hysterectomy is abnormal uterine bleeding.
However, every women over 40 years of age will
have episodes of abnormal Uterine bleeding. This
abnormality is the result of less than normal
Ovarian function. As a women approaches
menopause , the lack of regular ovulatory
function results in irregular shedding of the
Endometrium. If the examining physician finds a
concomitant Uterine fibroid, then Hysterectomy
is the most frequently called for
solution.
The proper approach to the
women with abnormal Uterine bleeding is to
perform Endometrial biopsy as well as Ultrasound
examination to establish the proper diagnosis.
Often the hormonal irregularity can be resolved
with a short course of progesterone.
If
bleeding continues, then Endometrial Ablation
can be performed. This is a procedure in which
the lining of the Uterus is destroyed. There are
various techniques to accomplish this effect.
Ranging from transcervical Endometrial resection
with Roller Ball ablation to the newer
techniques, including Thermal balloon,
Microwave, Cryo, Bipolar technology and finally
Hydrothermal Ablation. Whichever technique the
physician chooses is not as important as his
dedication to performing Hysteroscopic
evaluation and attempting to solve the patient’s
problems without resorting to the alleged FINAL
SOLUTION of all women’s problems ,namely
HYSTERECTOMY.
When abnormal bleeding is
associated with Uterine Fibroids then I often
recommend the addition of Myolysis . Literature
review has shown the efficacy of combining both
procedures . These procedures are reserved for
those women who are post reproductive with
Fibroids of 10 cm or less and a desire to
preserve their Uterus.
Pelvic Pain. Many women suffer
from a condition called chronic pelvic pain
where there is no visible reason for a woman to
be experiencing pain.
Doctors used to
tell women that a lot of this pain was
psychosomatic or in their heads. This is not
widely believed to be true anymore. Chronic pain
ofthe pelvic organs has been linked to stress
and a tension filled lifestyle - just like
someone may get a neck ache due to tension.
Studies have also shown that women who have
experienced sexual traumas may experience pelvic
pain. More commonly Endometriosis, Uterine
Fibroids and the diagnosis of Interstitial
Cystitis is a cause of persistant
pain.
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