- Abnormal Uterine Bleeding
Pelvic Support Problems
Abnormal Uterine Bleeding
The menstrual cycle begins with the first day of your last period, and ends with the first day of your next period. The average cycle is 28 days, but can vary 21-35 days, and bleeding can last up to 7 days. When bleeding lasts longer, is heavier than usual, or bleeding patterns change, this is considered to be abnormal and can be from numerous causes. Abnormal bleeding also includes bleeding between periods and after intercourse.
If you notice any of these changes, you should document what your cycles are doing so you can review these changes with Dr. Haendiges. Again, there are several possible explanations for abnormal bleeding, and treatment varies from oral contraceptives, to surgical procedures.
Some causes of abnormal uterine bleeding can be:
• Ectopic pregnancy
• Some birth control methods
• Bleeding disorders
• Hormone related issues
Endometriosis occurs when the lining of the uterus, the endometrium, grows outside of the uterus onto other organs. This tissue still responds to changes in hormones associated with the menstrual cycle. It also breaks down and bleeds like your normal lining does. This process can also lead to scar tissue on the organs. Symptoms of endometriosis tend to worsen with time.
Endometriosis can occur in any female, and more often in women who have never had children. It also seems to be somewhat familial. 75% of the time, women with chronic pelvic pain are found to have endometriosis. The tissue most often appears on the ovaries, tubes, surface of the uterus, bowel, bladder, ureters, and rectum.
The main symptom of endometriosis is pain that may occur right before or during your period, with intercourse, bowel movements, or urination. Another sign would be bleeding between periods and infertility.
Endometriosis cannot be seen by ultrasound. Endometriosis can be diagnosed and treated with a laparoscopy. Other forms of treatment is using oral contraceptives, and a series of injections of Lupron Depot.
Uterine fibroids are benign growths from the muscle of the uterus. They may also be called leiomyomas or myomas. The vary greatly in number, size, and growth rate. This makes them difficult to treat. Fibroids occur in about 25% of women, and are most common in women age 30-40. Fibroids are more prevalent in African-americans. They often occur at a younger age and seem to grow more rapidly. Even though fibroids are common, the cause of them is little known, but estrogen seems to allow growth.
Symptoms vary from none to:
• Heavier, longer, more painful periods
• Pain in the pelvis, abdomen, or lower back
• Bleeding outside of the normal time of menstruation
• Pressure symptoms- trouble with or frequent urination, rectal pain, cramping
• Miscarriages and infertility
Fibroids that do not cause symptoms usually are not treated. Certain symptoms may require treatment. Fibroids can be removed with surgery (myomectomy), or again depending on severity, hysterectomy.
Ovarian cysts are very common in women during the childbearing years. They usually occur in response to hormonal changes throughout the menstrual cycle. Most cysts are non-cancerous, but have the potential to bleed, rupture, or twist. This can cause pain or discomfort. Ovarian cysts can range from pea-sized to softball-sized. There are also several types of ovarian cysts.
Functional cysts are the most common and occur with ovulation. One is a follice, and the other is a corpus luteum. A woman’s egg is stored in a follicle, or sac, and at the time of ovulation, the egg bursts from the sac, and the empty sac now becomes the corpus luteum. Symptoms, if any, are usually minor.
Dermoid cysts are made up of fat, teeth, skin, and hair. These also can lack any symptoms, however they can grow large and cause symptoms.
Cystadenomas develop from the cells on the outside of the ovary. These can grow large, cause pelvic pain, and depending on size, interfere with abdominal organs.
Endometriomas form when tissue from the uterus grows on the ovaries. The tissue responds to the same hormonal changes your uterine lining, or endometrium, does every month. Endometriomas are often associated with endometriosis.
Multiple Cysts occur primarily in women who do not ovulate regularly. This could be related to polycystic ovarian syndrome (PCOS).
Symptoms of ovarian cysts vary greatly. They may cause a dull ache in the pelvic region or pain during intercourse. Diagnosing ovarian cysts can be done via ultrasound or undergoing a diagnostic laparoscopy, which allows the doctor to view directly into the body. Laparoscopy can also treat the cyst.
Treatment of ovarian cysts can involve surgery or the use of oral contraceptives. Treatment is very patient-specific and will depend on the size and type of cyst, your age, symptoms, and desire to have children.
Most women have pelvic pain at some point in their lives. If you notice that it is disrupting your life, worsens over time, or suddenly becomes severe, you should make an appointment with Dr. Haendiges.
With sudden-onset pelvic pain, it may related to an infectious process, ovarian cyst, or ectopic pregnancy. Some women have chronic pelvic pain. This may be intermittent or constant. Some examples of this chronic pain are:
• Dysmenorrhea –occurs with menstrual cycles.
• Endometriosis –where the uterine lining (endometrium) grows outside of the uterus.
• Adenomyosis –occurs when the uterine lining connects to the muscle wall of the uterus.
• Ovulatory pain – varies from a pinch feeling to more severe. This may last minutes to a few days.
• Adhesions –scar tissue from previous surgeries or severe infection.
Many times it can be difficult for one to distinguish what the pain actually is. Pain can have a radiating effect sometimes; you may be truly having abdominal issues, but may feel the pain in more of the pelvic region. With that said, other reasons for “pelvic” pain could be:
• Diverticulitis (inflamed pouch in the wall of the colon)
• Irritable bowel syndrome
• Kidney stones
• Muscle strain
Diagnosing pain can also be difficult due to so many possibilities. Common testing done is blood samples, CT scans, ultrasounds, MRI, Laparoscopy, endoscopy, colonoscopy.
Pelvic Support Problems
As women age, they may begin to notice changes in the pelvic organs, and these problems may begin with childbirth. Pelvic organs are held in place with three different support systems; the fascia, ligaments, and muscles grouped along the sides of the organs.
During childbirth, the fascia and ligaments may be damaged. Also, when a woman goes through menopause, the loss of estrogen also affects the strength of the fascia and ligaments. They become weak and allow the organs to “drop”.
The symptoms include:
• Pelvic heaviness, or the sensation that something is coming out of the vagina.
• Lower back pain
• Aching/pulling sensation in lower back.
• Trouble urinating
• Difficulty holding urine (incontinence)
• Trouble having a bowel movement.
Cystocele: occurs when bladder drops into the vagina.
Enterocele: forms when the intestine bulges into the upper vagina.
Rectocele: occurs when the rectum bulges into or out of the vagina.
Uterine prolapse: This is when the uterus falls from it’s normal place, into the vagina.
Vaginal prolapse: The top portion of the vagina weakens. This happens sometimes after hysterectomy.
Depending on the degree of severity, treatment ranges from none, a special device called a pessary, estrogen therapy, or even corrective surgery.
Kegel exercises can be very beneficial. It helps to tone the muscles that surround your pelvic organs. If this exercise is done on a regular basis, women have noticed better control of urine in as little as 6 weeks.
How to do Kegel’s:
• Squeeze the muscles used to stop urine flow.
• Hold for about 10 seconds.
• It is recommended to do 10-20 repetitions at least 3 times a day.