THE MOST FREQUENT CAUSE OF HEAVY BLEEDING.
Dr Steven R. Goldstein, a NYC Gyn regularly sees patients presenting with abnormal uterine bleeding conditions.
You can have very heavy, very scary bleeding from nothing more than a hormonal imbalance. Without progesterone, unopposed estrogen in your system may cause heavy, clotty bleeding that is different from the menstrual periods you’ve experienced before.
It is also true that you can have abnormal bleeding – heavy or at the wrong time or both – from cancer, hyperplasia (precancer), polyps or fibroids.
If you are twenty five years old and bleeding twice a month, this is invariably a hormone imbalance (dysfunctional uterine bleeding). You will usually be treated with birth control pills or simply some reassurance about why this is happening.
If you are thirty five with the same scenario, it is still almost always dysfunctional uterine bleeding. But if you are forty five, modern gynecology has always felt a need to rule out any serious organic causes of bleeding (polyps, fibroids, hyperplasia, or cancer). Abnormal bleeding in this age group has always triggered some sort of sampling of the lining of the uterus, usually through Dilation and Curettage (D&C), an invasive painful procedure.
The problem is the vast majority of D&C’s never turn up any abnormalities, and the bleeding is attributed to hormonal causes. Although some doctors recommend endometrial biopsy instead of D&C, it is of extremely limited value.
In a study of 433 perimenopausal patients with abnormal uterine bleeding, it was demonstrated that an office biopsy alone would have potentially missed polyps, submucosal myomas, and hyperplasia in up to eighty patients, or 18 percent of the time. That is because a biopsy, in which an instrument is passed into the uterus and a small piece of the lining removed, samples such a small area of the uterus. If the abnormality involves only a portion of the lining, as polyps and many hyperplasias and cancers do, it is totally a hit or miss as to whether a biopsy done blindly will reveal it.
Transvaginal ultrasound and fluid enhanced sonohysterography can eliminate the need for almost all diagnostic D&C’s, hysteroscopy, and blind endometrial biopsies. Thousands of doctors across the country have now embraced these techniques. With a fluid enhanced sonohysterography, the detail is phenomenal. A doctor can see the uterine lining as if he or she were looking at it under a low power microscope. If nothing turns up on the sonogram, no surgery is necessary. If something turns up, the doctor knows what to expect during a surgical procedure.
As it turns out, the most frequent cause of heavy bleeding is hormonal. Transvaginal ultrasounds tell not only about the anatomy of the uterus, fallopian tubes, ovaries, but also their function by assessing the uterine
lining to tell if the hormonal function is normal. If it is not, then it may be the cause of the abnormal uterine bleeding.
A leading Gynecologist in NYC, Dr Steven R. Goldstein is a Professor of Obstetrics and Gynecology at New York University School of Medicine and a former Director of Gynecologic Ultrasound, NYU Langone Medical Center among many other positions. He is a tenured Professor of Obstetrics and Gynecology at New York University School of Medicine. He is one of the most highly regarded individuals in the field of gynecologic ultrasound.