Abnormal uterine bleeding: Avoid the rush to hysterectomy
Patients with heavy bleeding may think hysterectomy is their only recourse, but research supports other alternatives.
Not all patients who undergo these procedures remain satisfied with the outcome, however. One study concluded that some patients undergoing hysterectomy were more satisfied after 4 years than those who had an endometrial ablation. Thus, you should counsel patients that they may need to return later for more definitive therapy.16 In addition, because the uterine environment after ablation is not hospitable to fetal development, you’ll want to caution patients that future childbearing is contraindicated and advise them to undergo some type of permanent sterilization procedure.
Uterine artery embolization (UAE). This interventional radiology technique uses embolic particles placed via the femoral artery to occlude the blood supply to the uterine arteries. The procedure is most commonly used to treat heavy bleeding from uterine fibroids, gynecologic malignancies, or postpartum hemorrhage. Although useful for treating heavy menstrual bleeding from uterine fibroids, this technique has not been fully evaluated as a treatment option for heavy menstrual bleeding caused by other disorders.17
Ms. M keeps her uterus
Because Ms. M is older than 35, your first step is a brief, office endometrial pipelle biopsy. The results indicate a benign, proliferative endometrium. You discuss the various treatment options with your patient, and she decides on an LNG-IUS. Her urine pregnancy test is negative, and you place the IUS uneventfully on the last day of her next menses.
Five months later she has amenorrhea, except for rare spotting, and is symptom-free. Her hemoglobin returns to normal levels using oral iron therapy. She is extremely pleased that she was finally able to get some relief without disrupting her busy schedule or undergoing major surgery.
Correspondence
D. Ashley Hill, MD, Associate Director, Dept. of Obstetrics and Gynecology, Florida Hospital Orlando & Loch Haven OB/Gyn Group, 235 Princeton Street, Suite 200, Orlando, FL 32804; d.ashley.hill.md.flhosp.org
