Uterine Bleeding

Hi,

I am Dr. Nupur Gupta, Gynaecologist. Today I will talk about uterine bleeding. This always happens once in your lifetime and you might need to visit OPD. Its symptoms are irregular bleeding, scanty smell, bleeding during periods, bleeding after menopause and it affects women of all age group. Almost 80% of women in India suffer from abnormal uterine bleeding. As regards to management, there are a lot of medications are available depending upon your age. The medical options are available for pain and bleeding. Medicines are also given with the combination of estrogen and progesterone. If medications are not working properly then surgical options are available. Earlier the most popular once were endometrial ablation, transcervical resection but they have their own limitations. Another major surgery is a hysterectomy, it can be laparoscopic, or it can be an abdominal or vaginal hysterectomy. Other than that the conservative surgical options which have become very popular nowadays in insection of intrauterine device which contains progesterone and it has come to the world over as a magic for the woman who has abnormal uterine bleeding and that is called viremia. It is not only used for abnormal uterine bleeding but also it has a very good contraceptive method.

It is also being used for the woman who has endometriosis. It has been found very useful in women who have heavy bleeding or dysmenorrhea as a contraceptive and women with fibroid who bleed heavily. In such conditions, pain is the biggest concern. As a hormonal contraceptive, it is very good. Because you don't need to take oral contraceptives. It has estrogen so no estrogen side-effects. It is reversible. We need to plan a pregnancy. It has a success rate of almost 90% within 4-6 months of its removal. There are hardly any failure rates associated with it. It thickens the cervical mucus and it also prevents fertilization of the egg with the sperm. As regards the management of menorrhea, it will reduce the lining of the endometrial i.e. thickening of the uterine wall is reduced. It can be done under local anesthesia. Sometimes, it needs to be done under ultrasound guidance. Sometimes there is stenosis of the cervical canal. It looks like a copperT. It has almost 52mg of the hormones progesterone. Sometimes, it is almost negligible as compare to oral hormones that we do for the management of heavy bleeding.

Sometimes, large doses of hormones are required to control the bleeding. In a few cases, low doses of hormones are given because it is active inside the uterine cavity. Its life is almost 5 years after that we need to renew it. There is hardly any pregnancy we have seen after the insertion of this device. In any case, it happens then it becomes ectopic pregnancy. But when it is copperT for 5-10 years, it is more effective. The women who cannot tolerate cooperT, they will have an infection, bleeding, anemia and pain are also concerned and there is the increased risk of infection when we use copperT. The comparison also has been done with hysterectomy which is better technology and which is better for women who have abnormal uterine bleeding. The results for both are almost same. The cost effect is much less as compared to the cost where hysterectomy needs to be done at the same time as the major surgery.

So, it is very good at the age of reproductive not only for contraception but also for managing abnormally uterine bleeding. But we need to keep in mind that its effect will come within 3-6 months of its insertion. You may have an absence of periods for almost 1 year. There might be excess vaginal discharge for some time but all this can be managed. The reduction in pain is almost 80% at the end of 2 years. The satisfaction rate is very high. Sometimes expansion rate is very high for the women who have a uterine cavity. So, we have to be very choosy who is the right candidate for this insertion. It is usually a painless procedure we operate in our OPD. So to conclude, I would like to say you must give it an option and you must find out whether it will suit you or not. Your life will become very easy. For any further query, you can consult me through Lybrate.

Thank You.