Treatment options for abnormal uterine bleeding and fibroids

Susie As-sanie: My name is Susie As-Sanie and I'm the Director of the Minimally Invasive Gynecologic Surgery Program at the University of Michigan. Today I'd like to talk a little bit about treatment options for abnormal uterine bleeding. Abnormal uterine bleeding is a common condition that affects many women and it's very important to see your doctor to determine the cause of bleeding. Once the cause of bleeding is identified you can discuss with your physician what treatment options might be best suited for your particular needs. One of the most common treatment options for abnormal bleeding is hormonal therapy, which is a very safe and effective therapy for many women. There are many different methods of using hormonal therapy and some can be as simple as taking a pill every day, using a patch once a week, there are various different types of injections, as well as local treatments within the vagina and or the uterus.

If a hormonal treatment option is not considered appropriate for you, or if that treatment option does not seem to be working for you, there are many different surgical options that might be best. There are three surgical approaches to the treatment of abnormal uterine bleeding and these include endometrial ablation, myomectomy, which is removal of uterine fibroids, as well as hysterectomy which is removal of the uterus. Endometrial ablation is a simple outpatient surgical technique that essentially destroys the lining of the uterus. There are many different methods of performing a endometrial ablation and you should talk to your physician about which method might be best for you.

Endometrial ablation can be done in the office or in an outpatient surgical center with very light anesthesia. Most patients go home the same day and can go back to work within two to three days. The risks of this procedure are generally minimal and its best used to treat patients with regular but heavy menstrual bleeding.

Some patients might also find that their uterine cramping associated with their heavy bleeding might also improve after this procedure. A second surgical approach to abnormal uterine bleeding is myomectomy which is surgical removal of uterine fibroids when they are considered the source of abnormal bleeding. There are many different approaches to myomectomy and this primary depends on the size and location of uterine fibroids. Uterine fibroids can be directly in the lining of the uterus and these can often be removed vaginally through a procedure called hysteroscopic myomectomy.

If this treatment option is thought to be appropriate for you, this is an outpatient surgery option in which the patient can often go home the same day and back to work within two to three days. When uterine fibroids are more deeply infiltrating into the muscle of the uterus or the surface of the uterus, hysteroscopic myomectomy may not be an option, but patients might still be a candidate for a minimally invasive approach through a laparoscopic myomectomy. At the University of Michigan, we perform many robotic myomectomy's for the patients with abnormal uterine bleeding and or infertility related to uterine fibroids. This procedure is an excellent treatment option for many patients because it is a minimally invasive approach, in which patients can go home the same day, and usually back to work within ten to fourteen days.

Small incisions are made on the abdomen, and the uterine fibroids are removed, and the uterus is repaired to restore its normal anatomy. Again, many patients go home the same day and are back to work within ten to fourteen days. This option is an excellent option for women who wish to preserve their fertility as pregnancy can still be a choice after this surgical approach. The final surgical approach for abnormal uterine bleeding is hysterectomy. Hysterectomy is a surgical removal of the uterus and possibly the cervix and does not necessarily mean that the ovaries will be removed. As long as the ovaries are retained, a patient would not be in menopause and may continue to produce her own hormones. If a patient chooses to undergo hysterectomy for the treatment of abnormal uterine bleeding, most women are actually candidates for a minimally invasive approach. Minimally invasive options include vaginal hysterectomy, laparoscopic hysterectomy, and robotic hysterectomy.

If a patient undergoes a minimally invasive approach to hysterectomy, she's usually in the hospital for less than twenty four hours and goes home for a four to six week recovery. Many patients can go back to all of their usual activities within that time period and have minimal pain, minimal bleeding and a low risk of infection and quick healing after this procedure. In most women undergoing hysterectomy, removal of the ovaries is not required, nor is it recommended. As long as a woman retains one or both ovaries, she's not menopausal, which means that she continues to ovulate and make her own hormones. What that means is that you would not need to be on hormonal therapy after this surgery. When choosing a physician for the treatment of abnormal bleeding, it's very important that you find a doctor that listens to you, listens to your specific concerns, and needs and is able to offer you a wide range of treatment options that are appropriate for you. At the University of Michigan Division of Minimally Invasive Gynecologic Surgery, we take pride in giving each of our patients a very specific treatment plan option that focuses on their individual needs. We have expertise in the medical as well as surgical options for the treatment of abnormal uterine bleeding, and have particular expertise in minimally invasive surgery options, such as microscopic myomectomy and hysterectomy, particularly with the use of the robotic assistive devices.

For more information, we encourage you to visit our website or to call us. We look forward to working with you to find the best treatment option for your particular needs.