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.

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 MyCatholicDoctor 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.

I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. 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.

Please consider joining me as I pray for you here.

Fertility Care Practitioners webpage

Second Appt: You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis.

Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal.

Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you.

During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels.

Hormone Panels:

Peri ovulatory estradiol panel: start on CD8, go to the lab EOD for an estradiol draw, until you have one draw post-peak.
post-Peak estradiol and progesterone panel: P+3, 5, 7, 9, and 11. See Handout #3 on the the Patient Handout webpage
Hormone panels require 2 mos of CrMS charting AND the patient must be able to confidently identify her Peak day.

Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a a primary care-mental health appt to help with anxiety, depression and or disordered eating habits.

Primary Care-Mental Health Appointments

Third Appt: You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented.

Follow Up Appts: You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging.

After 6-9 months: If medical management has not been successful AND we have not identified yet any other root cause for your problem, you may wish to move forward with a diagnostic laparoscopy. However, this would be your personal decision after we discussed benefits vs risks for your individual case. All surgeries present risks, which can sometimes be serious. Oftentimes, we will have identified additional medical conditions which are treatable with supplements and/or medications. On occasion, I may come to know a surgical evaluation will be of benefit to you earlier on in this process, and an expedited surgical referral will have been recommended. NaPro surgeons typically book out 5 mos to 18 mos. At any time, if you feel you would like an expedited surgical referral, please feel free to discuss this with me.

Please review my laparoscopy page. You will notice NaPro surgeries are done very differently as compared to laparoscopies done by mainstream medicine surgeons. We use a near contact approach and a near adhesion-free technique", which has been described as pelvic surgery of the pelvis.

At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice.

BLEEDING KEY: How do I Measure of Period Flow on My CrMS Cha

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.

Queen of Hearts Fertility Care & NaProTechnology

Abnormal Uterine Bleeding