Treatment of abnormal uterine bleeding is based on the underlying cause of bleeding. Patients with DUB are usually treated with medical therapy, since there is not a specific lesion (organic cause) amenable to surgical therapy. Those who fail medical therapy should consider surgical options. Patients with anatomic causes of abnormal bleeding such as fibroids, polyps, or cancer are managed with surgical therapy.
What medical treatment options are available?
Birth control pills which contain estrogen and progesterone are often used to treat abnormal uterine bleeding that is due to hormonal irregularities. Birth control pills have many benefits and are safe for long term use. Progesterone only pills and intrauterine device (IUD) are used in women with thickened uterine lining. Progesterone keeps the lining thin and can prevent the development of hyperplasia and uterine cancer.
Nonsteroidal Antiinflammatory Agents (NSAIDs) such as ibuprofen and naproxen, given for the duration of menstrual bleeding, have been shown to decrease blood loss during the menstrual period. NSAIDs are more effective when combined with birth control pills to control bleeding.
What surgical treatment options are there?
Dilatation and Curettage (D&C) is the fastest way to stop acute blood loss from the uterus. Those patients with severe bleeding not responsive to medical therapy should have the procedure done to stop the bleeding. D &C provides only short term relief from DUB. Medical therapy should be instituted after the bleeding has been controlled. Hysteroscopy at the time of D&C may help identify organic cause of bleeding such as uterine polyp or fibroid which can be removed during the same procedure.
Endometrial Ablation is the destruction of the endometrial lining with thermal energy and should be considered in patients with DUB who failed medical therapy. Energy delivering devices include cryotherapy, circulating hot fluid, thermal balloons, radiofrequency electrosurgery, microwave energy, and diode laser energy, as well as monopolar and bipolar devices. This can be performed in the office with local anesthesia and IV sedation or in the operating room with IV sedation or general anesthesia. Endometrial ablation should only be used in patients who do not desire fertility but desire to retain the uterus. Patients with multiple and/or large fibroids or patients with other organic causes of abnormal bleeding should not undergo this procedure. 80% success rate can be achieved in select patients. 20% of patients will require either another ablative procedure or hysterectomy.
Patients who are not candidates for endometrial ablation, who are not interested in future chld bearing, and who desire a guaranteed cure for their problem should undergo hysterectomy. Hysterectomy refers to removal of the uterus only, the ovaries are not removed. Since the ovaries are kept in place, they will continue to make estrogen, the female hormone. It is estrogen, not the uterus, that prevents patients from going into menopause, or change of life. For more details on the role of the uterus, ovaries, and hormones please see the Learning Center.
Myomectomy or removal of fibroids only with preservation of uterus is usually reserved for patients who desire to preserve fertility. For more information see Fibroid Treatment Options.