Abnormal Uterine Bleeding

Let's start by thinking about the causes using the mnemonic PALM COEIN: 

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 

Next, we will go through the treatments for several of the conditions above. 

Let's start with Polyps: 

• Polyps come in different sizes, shapes and locations. 
• A polyp that is causing your AUB may be cervical (arising from the cervix) or intrauterine (arising from the uterine mucosa or innermost lining). 
• Cervical polyps that are  easily seen on physical exam in the office can often be easily removed in a simple in-office procedure, called a polypectomy.  
• Uterine polyps are not typically seen on ultrasound. Therefore, you may undergo a procedure such as hysteroscopy which will allow the provider to visualize the polyp(s) and remove it/them at the same time. 

Adenomyosis: 

• As mentioned adenomyosis is a condition where endometrial ectopic implants are found in the muscular wall of the uterus. 
• You may wish to review my  endometriosis to understand what endometrial ectopic implants are. 
• Conservative treatment for adenomyosis would be the same as for endometriosis, such as Magnesium Glycinate and/or Ibuprofen to manage pain. 
• Other types of treatments that could be tried would include:  bioidentical progesterone, myo-inositol &  D-chiro inositol, NAC (N-acetyl-cysteine) and/or cervical mucus enhancers. 
• You can read more about these types of treatments here. 

***** Do not take unless under medical supervision *****

Leiomyomas (Fibroids)  

•  Uterine Embolization, I would recommend a specialist called an Interventional Radiologist. In my opinion, Penn Medicine has amazing physicians. 
• Hysterectomy, 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. 
• Note: Mainstream ObGyn doctors will almost always recommend hormonal contraception to medically treat fibroids. 
• NaPro Providers to not prescribe the birth control pill. We believe contraception is harmful to women physically, emotionally, and spiritually. 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. 

***** Do not take unless under medical supervision *****

Coagulopathy  

• Referral to Hematology/Oncology
• VWF concentrates
• DDAVP (desmopressin) leads to the release of  VWF from the inner lining of your blood vessels (endothelial cells) 
• Lysteda (tranexamic acid) is an antifibrinolytic agent that will stabilize clots, in other words, help you clot so you stop bleeding. 

***** Do not take unless under medical supervision *****

Ovulation Dysfunction: 

• See respective treatments on my other webpages here: Polycystic Ovarian Syndrome Amenorrhea/ Functional Hypothalamic Amenorrhea, and perimenopause.

Perimenopause & AUB: 

• For women who present with many days of very heavy (VH), heavy (H), and/or moderate (M) bleeding, using the bleeding key below, we may have to try to stop the bleeding so you don't become hypovolemic (low blood volume) and/or anemic, 
• A hemoglobin of < 7 or a patient who has symptoms of hypovolemia  ore severe anemia  may have to go to the hospital. 
• At the hospital you are able to receive a blood transfusion. 
• Some patients can receive iron infusions i on an out patient basis. 

Pharmacological Treatments for perimenopausal AUB: 

                ***** Do not take unless under medical supervision *****

• Megace (megestrol) 40 mg twice daily (usually used until a D&C procedure can be done. 
• Agyestin (norethindrone) taper: Take 5 mg three times daily for 2days. Then, take 5 mg twice daily x 2 days, then take 1 mg daily x 6days. 
• These medicines will do a great job to stop your bleeding. 
• Once you stop taking the medicine, you will have a 'withdrawal bleed" about 3-7 days later that will seem just like a period. 
• The first day of this bleed is your "new" cycle day 1. 
• We can then start bio-identical progesterone, which you will take on P+3 through P+12 if you are still cycling. For more information about bioidentical progesterone see below. 
• If you are having less than 3 periods a year, we can consider giving you progesterone to take once daily at bedtime for 10 days ever month. I will ask you start on the 1st day of every month and take your progesterone for 10 days.