Abnormal Uterine Bleeding

Important Definitions (coming soon!)

Anovulation: the absence of ovulation. You may wish to view normal healthy reproductive physiology on my education webpage.

Oligoovulation: a condition that causes irregular or infrequent periods.

Menorrhagia: period lasting > 7 days or very heavy, passing clots > than the size of a quarter. See "how do I measure volume of period flow" below.

Metrorrhagia: bleeding at irregular intervals, particularly between normal periods, ie: intermenstrual bleeding.

Perimenopause: the time period preceding menopause, which begins approximately 3-4 years prior to the woman's final menstrual period.

Menopause: defined as the permanent cessation of menstrual cycles, which is confirmed when the woman has not had a period for one full year. The average age is of menopause is 51.

Pre-malignant: a condition that may (or is likely to) become cancer.

Malignant: a cancerous condition.

Endometrial Hyperplasia: the inner lining of the uterus becomes too thick, which in some cases can be pre-malignant

Iron deficient anemia: anemia caused by a lack of iron. Heaving uterine bleeding can predispose a women to iron deficient anemia. Symptoms of iron-deficient anemia include: weakness, fatigue, dizziness, heart palpitations, shortness of breath on exertion.

Hypovolemia (hypo = low): low blood volume. Adequate blood volume is essential to keep your organs functioning normally. Symptoms of hypovolemia include: weakness, fatigue, dizziness, heart palpitations, shortness of breath on exertion.

Hypovolemic shock: a severe state of hypovolemia, in which the vital organs of the body (heart, lungs, kidneys, etc) are inadequately perfused and suffer damage, at times irreparable (unable to be repaired).

Blood Transfusion: is the process of transferring blood products directly into a persons' blood stream.

Intravenous (IV) iron infusion: the process of transferring iron directly into the bloodstream, which is a treatment offered to severely anemic patients.

Endometrial Ablation: a surgical procedure where the endometrium is "ablated" (removed), which is a treatment option for abnormal uterine bleeding.

Hysterectomy: removal of the uterus, which can be done transvaginally (through the vagina) or transabdominally (via an abdomenal incision). If the uterus is removed transabdominally, sometimes the cervix is left in place.

BLEEDING KEY: How do I Measure Volume of Period Flow?

I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B

TAMPON or PADS:

Very Heavy (VH): changing every 1-2 hours
Heavy (H): changing every 3-4 hours
Moderate (M): changing every 5-7 hours
Light (L): changing every 8-12 hours
Very Light (VL): changing less frequently than every 12 hours.

MENSTRUAL CUP MEASUREMENTS

Very Heavy (VH): 60 cc in a 24 hours
Heavy (H): 40 cc in 24 hours
Moderate (M): 20 cc in 24 hours
Light (L): 10 cc in 24 hours
Very Light (VL): 5 cc in 24 hours

**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc

Other important information about your flow:

Tail End Brown Bleeding (TEBB): brown bleeding at tail end of period.
Premenstrual bleeding: pink spotting or brown spotting at the prior to a full period starting.
Intermenstrual bleeding: bleeding between periods.

What Causes Abnormal Uterine Bleeding?

Start by clicking on the image to the left and listen to a great 7-minute video by Rhesus Medicine, which will teach both patients and new NaPro providers about common causes for abnormal uterine bleeding.

They use the mnemonic PALM COEIN to help you remember.

P: Polyp – an abnormal but benign growth of tissue

A: Adenomyosis – a condition where ectopic endometrial implants are found in the muscle layer of the uterus

L: Leiomyoma – a fibroid; a benign growth in the muscle layer of the uterus

M: Malignancy – a cancerous growth

C: Coagulopathy – a condition in which the blood's ability to coagulate (form clots) is impaired, such as as hemophilia and Von Willebrand disease.

O: Ovulation dysfunction – a condition in which a women does not ovulate normally, such as Polycystic Ovarian Syndrome Amenorrhea/ Functional Hypothalamic Amenorrhea, and perimenopause.

E: Endometrial – conditions that affect the endometrium, such as Endometriosis and Chronic endometritis

I: Iatrogenic – caused by medical procedure or treatment, eg: Tamoxifen,

N: Not Yet Classified

Please know NaPro Providers to not prescribe the birth control pill (mentioned briefly towards the end of this video).

To the contrary, we believe the birth control pill is harmful to women physically, emotionally, and spiritually. We pride ourselves on taking our patients OFF hormonal contraception, finding the root cause of their symptoms, making a proper diagnosis and providing superior treatments for all of the conditions we treat.

For more information about the spiritual harm brought into the relationship via contraception, visit my CrMS page, scroll to the bottom and read about SPICE.

What will the NaPro appointment be like?

Your appointments at Natural Women's Health with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model System (CrMS) is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate.

First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while.

Oftentimes, an ultrasound will be ordered which I will ask you to schedule on day 5-7 of your next menstrual cycle, and I will check blood levels for the three important reproductive hormones: FSH/LH and estradiol which must be timed to day 3 of your next menstrual cycle. Click the "laboratory tests" button below to learn more.

You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP) by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started.

Fertility Care Practitioners webpage

Second Appt: You will be asked to return to the office in one month for a follow-up appointment to review the results of your imaging and lab tests. Together we will review your Creighton Model Chart and your PMS Symptom Tracker. We will look for specific biomarkers in your menstrual cycle.

Please upload an image of your CrMS chart (and PMS tracker) two days prior to all follow up visits and send to me via the portal and ask your FCP to calculate your "mucus cycle score" for me as well.

Third Appt: You will return to the office one month later to review the results of your laboratory and imaging studies as well as your CrMS chart. At this time, we will consider ordering progesterone and estrogen panels specifically timed to your CrMS chart. Click the "Laboratory Tests" button below for more detail. You may be asked start medications and/or make an appointment with a specialist such as a dietician, a sleep specialist, or a counselor.

A full GYN physical examination will also be preformed during this visit, unless you have had a recent well-woman exam. Oftentimes, if your annual gyn exam is due, we can combine this follow-up appt can an annual gyn visit.

recommended Dietitians

Follow Up Appts: You will return to the office every two months to monitor and/or make adjustments to your medications and treatment plan.

Queen of Hearts Fertility Care & NaProTechnology

Abnormal Uterine Bleeding