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Gynecology - Menstrual Disorders
Mentrual disorders can be widely varied and occur in women of all ages. These can range from painful periods to heavy menses to irregular menses.
Painful periods can occur from the beginning of puberty to later in life. The age of onset and the type of painful menses dictates the evaluation and treatment.
Heavy menses are those that are specifically bothersome, namely that would cause the patient to miss work, have problems with severe anemia and extrememly heavy flow.
Irregular menses are those that occur in a noncyclic manner as expected on an
average 28-30 day cycle.
Treatment of Abnormal Periods
Treatment of abnormal menses depends on the type of problem that is encountered.
The following is a brief discussion of what could protentialy be a causative problem and their treatments.
Initial evaluation depends on the type of problem and could include a simple evaluation of the patient's history and physical.
Oftentimes no special diagnostic measures are necessary and the patient can be treated based on their specific symptoms. These treatments are most often conservative and would involve treatment with hormonal manipulation. Oral contraceptives, periodic progesterone derivatives and Depo-Provera or even progesterone based IUDs might be appropriate treatments for heavy or painful periods.
Minor surgical treatments are often recommended for abnormal menses. These might include evaluation of the lining of the uterus or the uterus itself with ultrasonography, hysteroscopy (video view of the interior of the uterus), hystersonography (ultrasound view of the internal cavity of the uterus), and even simple D&C (dilation and curettage of the uterus) for diagnosis. Other noninvasive treatments might include uterine artery ablation, uterine artery embolixation of fibroids, which would require referral to a specialist in that area.
Simple hysteroscopic evaluation and treatment of fibroids and polyps with their removal in outpatient surgery might be a possibility.
Endometrial ablation (destruction of the lining of the uterus with various methods such as cautery, balloon therapy, etc.) can be used.
Lastly, and most invasive, of course, would be hysterectomy. Multiple hysterectomy types are available through Brazos Valley Women's Center which include laparoscopic supracervical hysterectomy (LSH), total vaginal or abdominal hysterectomy with or without removal of the ovaries, and finally robotic hysterectomy for appropriate situations.
