Treatment Options for Abnormal Bleeding

August 18, 2006

Recorded at the 34th Annual Clinical Meeting of the American Association of Gynecologic Laparoscopists (AAGL)held during November 2005 in Chicago, IL, USA

Hi, I am Dr. Ted Anderson, I am one of the gynecologists at Vanderbilt Medical Center. We are here to talk about abnormal bleeding. If you have bleeding that is excessive enough that it is interrupting the things you need to do or want to do, then it needs to be treated.

We have four ways of dealing with or treating abnormal bleeding. First of all, we can do conservative management, which is really kind of a euphemism for doing nothing. Sometimes it is good enough to know that the cause of your bleeding is not going to be harmful to your life or is not going to kill you and sometimes, it is okay with some people to know that. They really feel they can deal with the bleeding so long as it is not going to be a health threat. On the other hand, the complete opposite of the spectrum, we can do a hysterectomy. It will stop the bleeding, no matter why you are bleeding, hysterectomy will stop it.

Often there are two options in the middle that are a little more palatable and a little bit more attractive to women. One of those is hormonal therapy. Certainly hormonal therapy works for a lot of women. There are some problems with hormone therapy, however. One of those is medical complications. Sometimes women are taking other medications, have complicated medical histories or perhaps they are over 35 and smoke or have hypertension and these are people for whom the medication is actually more dangerous than the thing we are treating. The final option is something called an endometrial ablation.

Endometrial ablation is a technique where we actually destroy the lining of the uterus which is the part that bleeds. We now know that we do not always have to do a hysterectomy, we just have to remove the part that bleeds. The lining of the uterus is called the endometrium and when we destroy it, that is an endometrial ablation and there are many different ways to do that. A large percentage of women, in fact the majority of women, will have substantially decreased bleeding when we do an endometrial ablation and probably 8 out of 10 can avoid needing a hysterectomy. In fact, a large percentage of women, maybe 4 or 5 out of 10, will stop having periods altogether. That is a little dependent on the age of the woman who is having the procedure and the reason they are bleeding in the first place.

One really important feature of endometrial ablation is that it is an outpatient procedure, so you can have the procedure done and that night or the next day you are back to your normal activities and there is a shorter than 4 to 6 week recovery time like a hysterectomy.

If we can get physicians to understand the powerful nature of this intervention, this alternative to hysterectomy, there is a very real probability that we can reduce the number of hysterectomies in the United States by approximately 100,000 a year. A very, very powerful tool, very safe, very effective, very rapid return to work, minimally intrusive on your life, minimally invasive on your body and very effective for treating bleeding.