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Understanding Abnormal Uterine Bleeding: Part 1

Posted Aug 24 2008 1:49pm 1 Comment
PAUL MONIZ: I'm Paul Moniz. Thank you for joining us on this webcast. Today we are discussing abnormal uterine bleeding and it's connection to fibroids. Fibroids are benign muscle tumors that usually grow in the uterus, but they can occur elsewhere, causing in some cases pain and infertility. As many as 20-50 percent of all women actually develop them. If you are suffering from abnormal bleeding, you may have what is known as a submucosal fibroid. Here to talk about that is a gynecologist and one of his patients.

To my left is Dr. Martin Goldstein. He is the Associate Clinical Professor of Obstetrics and Gynecology at Mt. Sinai Hospital. Next to him is Valerie. She is a 50-year-old mother of two who has agreed to join us. We are not showing her face because of the sensitive nature of this topic, but she is willing to share her story. Thank you very much for coming here Valerie. We appreciate it.

Dr. Goldstein, let's begin with you. What defines abnormal uterine bleeding?

MARTIN GOLDSTEIN, MD: Abnormal uterine bleeding can either take the form of irregular bleeding, which is other than at a regular time during the menstrual cycle, or profuse or heavy bleeding. Submucous fibroids usually cause profuse or heavy bleeding, which sometimes leads to anemia. If the anemia and heavy bleeding are distracting to the patient and interferes with the patient's lifestyle, a woman will go to her gynecologist and make a complaint about this. Irregular bleeding can be either on a functional basis, meaning due to a polyp or due to a fibroid. Or, it can be on a dysfunctional basis, due to a hormonal irregularity.

PAUL MONIZ: What's interesting about Valerie's story is that women sometimes don't realize that they are bleeding abnormally. Is that right? Let's first start with you doctor.

MARTIN GOLDSTEIN, MD: That is correct. A woman begins menstruating probably at about age 13 to 14. Most women develop a menstrual pattern and accept that pattern as "normal." In some circumstances, the amount of bleeding that a woman will have is heavier than normal, and it can lead to anemia.

PAUL MONIZ: Valerie, just to share your story. About a year ago in May you had some difficulty. You were tired. Did you notice that you were bleeding excessively?

VALERIE: I hadn't noticed that I was bleeding any more excessively in the last seven or eight months prior to feeling so tired.

PAUL MONIZ: What kinds of symptoms were you experiencing at the time?

VALERIE: I felt very weak and tired. Since I'm a psychoanalyst, I knew that it wasn't depression. I knew there was something physically wrong with me, so I needed to get it checked out.

PAUL MONIZ: How common are the symptoms that Valerie just mentioned doctor?

MARTIN GOLDSTEIN, MD: Usually, a woman who comes to see me complaining of heavy bleeding will be aware that she's bleeding heavily. Instead of using one pad lasting overnight, a woman may use two or three pads at night, requiring multiple pad changes. In the most dramatic circumstance, a patient may come in to tell me "I'm passing huge clots. I have to wear diapers at night." The story of the bleeding is extremely dramatic.

PAUL MONIZ: But in Valerie's case it wasn't?

MARTIN GOLDSTEIN, MD: No. Valerie, by her story, had what she considered normal bleeding for most of her life. In actuality, when we got down to history taking and figuring out what was happening, Valerie was actually passing moderate-sized clots.

PAUL MONIZ: Valerie, you were aware from your gynecologist, who initially was not Dr. Goldstein, that you had a fibroid. What did your gynecologist tell you about that fibroid? Were you concerned about it prior to developing these symptoms last year?

VALERIE: I was not concerned about it. I read up on it that women can have fibroids, and you can be asymptomatic. There doesn't have to necessarily be any difficulty in terms of weakness or tiredness. But, in the last seven months, now that I was aware of this, the bleeding was pronounced.

PAUL MONIZ: Initially, you were misdiagnosed. From the story that we talked about before the show, it sounds as if it was really a hellacious experience for you based on that you didn't know what was happening, and that initially even some of your doctors weren't sure. Can you tell us in short order what was happening?

VALERIE: I don't know if I was really misdiagnosed. It was that my symptoms were that I was tired and weak, and had not had any type of blood workup. So early one morning, I went to a doctor I trusted, who happened to be my children's pediatrician. She checked my heart and my lungs, and said, "Let's just check your blood." So, she checked my blood and called me at 6:00 AM the next morning and told me to meet her in the hospital, that my hemoglobin was extraordinarily low.

PAUL MONIZ: You had a hemoglobin of five. Doctor, what does that mean?

MARTIN GOLDSTEIN, MD: The normal hemoglobin for a woman is somewhere between 13 and 15 grams. A hemoglobin of five is a very marked level of anemia; almost life threatening.

PAUL MONIZ: Calling for drastic measures, which is, in fact, what happened to Valerie. Valerie, you had to go three transfusions?

VALERIE: I needed to be hospitalized and have three transfusions immediately.

PAUL MONIZ: And subsequent to that, more tests were taken?

VALERIE: More tests needed to taken to find out diagnostically where the bleeding was coming from.

PAUL MONIZ: Another doctor told you that the solution should be hysterectomy. Is that correct?

VALERIE: Right. First, I went to several doctors. I went to a hematologist to find out that my blood production was fine, and I was healthy. I went to a gynecologist who recommended, from this bleeding, that I needed a hysterectomy. Then I, of course, spoke to friends and was referred to Dr. Goldstein.

PAUL MONIZ: Dr. Goldstein, when Valerie came to see you, based on what you had looked at before you started doing additional testing, did you think it was a submucosal fibroid?

MARTIN GOLDSTEIN, MD: By the history of the heavy bleeding, enough to create this level of anemia, my feeling was that there was a submucous fibroid. Valerie had had a previous ultrasound, which demonstrated that there was a fibroid in the uterus.

PAUL MONIZ: Let's talk about the fibroid. We have a diagram of what a fibroid looks like. Maybe you could walk us through and explain exactly what a fibroid is and what we're seeing here.

MARTIN GOLDSTEIN, MD: You're seeing a picture here on the left of a uterus, which contains several fibroids. Fibroids can be within the muscle wall of the uterus. These are called intramural fibroids. They usually don't create any bleeding problem. Fibroids that push into the cavity of the uterus, as you see in the center of the picture, are called submucous fibroids. Submucous fibroids have large blood vessels on their surface. They interfere with the contractile mechanism of the muscle of the uterus, which doesn't allow the uterus to squeeze its blood vessels shut so that it decreases bleeding.

Submucous fibroids will cause this type of bleeding. In order to correct this, you have to remove the submucous fibroid. The options are either to remove the fibroid locally; a procedure called a myomectomy, or remove the fibroid with the uterus, which is a hysterectomy.

PAUL MONIZ: Dr. Martin Goldstein thank you very much for joining us and that important information. Valerie, thank you for sharing your story, as well.

I'm Paul Moniz. We are talking about hysteroscopy today. If you have any questions, you should ask your doctor. Thanks for joining us.

Comments (1)
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I had a hysterectomy in 93 and therefore no longer have a period. I got to keep my ovaries. I had suffered for years with endremitriosis and fibrous cysts so this was a relief. Now in 2008 I am having major fatigue, bleeding when I have sex and aching inside the vagina. I recently was treated for diverticulitis and just had a colonoscopy which showed no perferation or growths in the colon. I need to get an appt with a gyn to see why I have this bleeding but I am trying to understand today why I have this bleeding if I don't have my tubes, or my uterus anymore. Kathy
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