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UTERINE BLEEDING : Treatment, Procedure, Cost And Side Effects

Last Updated: Jun 10, 2024

What is Uterine Bleeding ?

Abnormal uterine bleeding, also known as dysfunctional uterine bleeding, is vaginal bleeding that cannot be related to pelvic injuries, miscarriage, pregnancy or menstrual cycle. It is a heavy flow of the blood between the periods of a women. Some of the symptoms of this disease are: the cycle changes and the bleeding of the uterine become heavier, if the bleeding lasts for 1 week or more, if there is tenderness or dryness of vagina, abnormal mood swings, hot flashes, nausea, menstrual cycles that are longer than 38 days or shorter than 24 days and if there is bleeding after menopause . Uterine bleeding may also occur due to hormonal imbalance.

The causes can vary from person to person. It can be caused due to fibroids, endometrial hyperplasia, due to bleeding disorders, due to miscarriages, due to ectopic pregnancy and due to cancer of uterus. It is also caused by endometrioses in women of the age group of above 50 years or those who have reached menopause.

There are various treatment options for abnormal uterine bleeding. The treatment depends on the cause of bleeding, woman’s age, and whether the woman want to get pregnant in the future. The doctor will help her decide which treatment is right for her. Or, if the doctor decides that a hormone imbalance is causing abnormal bleeding, woman and her doctor may decide to wait and see if the bleeding improves on its own. The diagnosis is done through the examination of the symptoms and through physical examination.

The doctors will also ask about the patient about overall health and give her a physical examination. The doctor may ask probably to get a pregnancy test, and others tests which may include:

  1. Blood work: Heavy bleeding can leave her body short of iron. A blood test can see if that’s a problem for her. It can also show if her hormones are out of balance or if she have a blood disorder or chronic disease.
  2. Ultrasound: This uses sound waves to make images of the inside of her uterus so her doctor can look for fibroids or polyps.
  3. Hysteroscopy: The doctor will look inside her uterus with a tiny lighted scope that they put in through her cervix.
  4. Biopsy: The doctor may take out a small piece of tissue so it can be checked under a microscope for abnormal cells.
  5. Magnetic resonance imaging scan: This uses radio waves and powerful magnets to make detailed pictures of her uterus.

What is the treatment for UTERINE BLEEDING?

Some of the treatments available to treat uterine bleeding are as follows:

  1. Medication: Hormone treatment, Gonadotropin-releasing hormone agonists and drugs like NSAIDs are given. Especially anti-inflammatories like ibuprofen or naproxen are given a few days before the period starts, which might help lighten the bleeding during the periods.
  2. Intrauterine device (IUD):-The doctor may suggest an IUD based treatment wherein an intrauterine device which is a small, plastic device is inserted into the patient uterus through her vagina to prevent pregnancy. One type of intrauterine device releases hormones, and this type can reduce abnormal bleeding. Like birth control pills, sometimes this device can actually cause abnormal bleeding. The doctor should be informed if this happens to the patient.
  3. Birth control pills:-This pills contain hormones that can stop the lining of the woman’s uterus from getting too thick. They also can help keep her menstrual cycle regular and reduce cramping. Some types of birth control pills, especially the progestin-only pill can actually cause abnormal bleeding for some women. The doctor should be informed if the pill taken doesn’t control abnormal bleeding.
  4. Dilatation and Curettage:-A dilatation and curettage is a procedure in which the opening of the woman’s cervix is stretched just enough so a surgical tool can be put into her uterus. The doctor uses this tool to scrape away the lining of her uterus. The removed lining is to be checked in a lab for abnormal tissue. A Dilatation and curettage is done under general anaesthesia. If she is having heavy bleeding, the doctor may perform a Dilatation and curettage both to find out the problem and to treat the bleeding. The Dilatation and curettage itself often makes heavy bleeding stop. Dilatation and curettage is performed to find out the cause of bleeding and also to address it in patients who suffer from heavy bleeding from the uterus.
  5. Hysterectomy:-In this type of surgery the uterus is removed. If she is done this hysterectomy treatment, she won’t have any more periods and she won’t be able to get pregnant. Hysterectomy is major surgery that requires general anaesthesia and a hospital stay. It may require a long period of recovery.
  6. Endometrial ablation:-It is a surgical procedure that destroys the lining of the uterus. In this uterus is not removed. This treatment may stop all menstrual bleeding in some women. However, some women still have light menstrual bleeding or spotting even after endometrial ablation. A few women may have regular menstrual periods after the procedure. Women who have this treatment still need to use some form of birth control even though, in most cases, pregnancy is not likely after the procedure.

The doctor can do endometrial ablation in several different ways. New types of endometrial ablation techniques do not require general anaesthesia or a hospital stay. The recovery time after this procedure is shorter than hysterectomy.

Who is eligible for the treatment? (When is the treatment done?)

A woman is eligible for treatment if she experiences some or all of the symptoms associated with abnormal uterine bleeding. Some of the symptoms are spotting or bleeding between periods from the vagina, irregular or frequent periods, and heavy bleeding due to large clots. A person may suffer from abnormal uterine bleeding if the bleeding lasts for more than seven days or for a period longer than what is normal. Uterine bleeding may also occur due to hormonal imbalance. The symptoms that are associated with hormonal imbalance include excessive growth of body hair, hot flashes, mood swings and tenderness and dryness of the vagina.

Who is not eligible for the treatment?

A woman is eligible for surgical procedures only if her condition is serious and if she has not experienced any tangible benefits from medicines. However, a person will only be eligible for treatment if she experiences some or all of the symptoms associated with abnormal uterine bleeding and has been properly diagnosed by a doctor.

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Are there any side-effects?

Some of the side effects of the treatment are as follows:

  1. Some types of birth control pills, especially the progestin-only pill can actually cause abnormal bleeding for some women. The doctor should be informed if the pill taken doesn’t control abnormal bleeding.
  2. The hormone and birth control pills may cause nauseas, headaches, itching, and vomiting in few patients.
  3. Dilation and Curettage is considered to be a safe procedure but in rare cases it can cause side effects like breathing problems, infection, bleeding, scarring, etc.
  4. Hysterectomy side effect may include vaginal dryness, mood swings etc.

What are the post-treatment guidelines?

The post treatment guideline after uternie bleeding treatment are that:

A woman will generally recover from the effects of endometrial ablation within a week or more. However, a doctor might advise her to refrain from activities that involves physical strength and also lifting any weights. She should also stop having sex and using sanitary napkins for the time being. A person requires at least 4 to 6 weeks to recover from hysterectomy. In this case too, a person is advised not to indulge in any activities that involves physical strength and not to lift any weights. Any type of treatment undertaken for abnormal uterine bleeding requires a regular follow-up with the doctor and the guidelines that are recommended by doctor should be followed. For some patients the doctor may advise to avoid having sex.

How long does it take to recover?

The recovery time for the patient shall vary from the treatment opted and the condition of the women. If the treatment is based on hormones pills and medication then the medication can be for 15 to 3 months and thus the patient shall see recovery from heavy flow within few weeks. It takes about 4 to 6 weeks for a woman to resume with her normal activities after the surgery. A person undergoing endometrial ablation will take 1 week to recover. If she has undergone the dilation and curettage treatment then she may take some time to recover.

What is the price of treatment in India?

The treatment costs varies from one city to another in the country. The cost of hysterectomy in India varies from Rs.180000 to Rs.220000. Installation cost of an intrauterine device is something around Rs.10000 in India. Endometrial dilation is more expensive and the average price of the procedure is close to Rs.200000. However, in some cases, it can goes up to more than Rs.350000.

Are the results of the treatment permanent?

The treatment of the uternie bleeding is promising in nature and has proven to provide relief to many womens. Endometrial ablation and Hysterectomy are surgical procedures that require the complete or partial removal of the uterus. These treatments may be a permanent solution for abnormal uterine bleeding problem. The dilation and curettage treatment cannot provide permanent results always. If there is any problem in the uterus the bleeding may start again. Birth control pills are also used to prevent the wall of the uterus from getting heavier. However, this is not a permanent solution as the bleeding might resume once a woman is off the pills.

What are the alternatives to the treatment?

Alternative treatments available for uterine bleeding are as follows:

  1. Diet: A person suffering from uterine bleeding should incorporate foods like whole grains, fresh fruits and fresh vegetables and fish like sardines and tuna so that her body receives the required nourishment. Adequate intake of foods rich in iron is to be taken to deal with this condition.
  2. Ginger has well-known healing properties and it also helps to deal with the excessive bleeding from the uterus.
  3. Furthermore, haemostat agent therapy can be used to treat people suffering from dysfunctional uterine bleeding.
  4. Danazol: It reduces menstrual blood loss by causing endometrial atrophy but also has many androgenic adverse effects, which may be lessened by using lower doses or a vaginal formulation. To be effective, danazol must be taken continuously, usually for about 3 months. It is usually used only when other forms of therapy are contradicted.

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Written ByDr. Sunita Singh MBBS,MS Obstetrics & GynaecologyGynaecology
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