The treatment of menstrual disorders depends on many variables. Regrettably, women and their physicians are generally unaware of the variety of management strategies available to them.
Fortunately, the vast majority of menstrual disorders are NOT the result of a serious underlying issue such as cancer. The sudden or even gradual appearance of a menstrual irregularity, heavy or painful periods or postmenopausal bleeding often fuels a woman’s worst fears. Fortunately, most menstrual changes are not the result of a life-threatening issue and there’s generally plenty of time to seek out information and opinions regarding the best form of therapy.
There are many variables that determine which of the following treatment options are best for you:
- Observation
- Medication & IUD’s
- Minimally Invasive Gynecologic Surgery (Endometrial Ablation, Endomyometrial Resection, Hysterectomy)
- Hysteroscopic Polypectomy
- Hysteroscopic Myomectomy with Ultrasound Guidance
Below are some—though by no means all–of the variables that need to be considered before recommending a treatment.
- Can the problem simply be observed? Is the problem of such significance that a “treatment” is necessary? Remember that not every “problem” needs a “solution.”
- Is there an underlying cancer? Remember this is much less common than most women believe. However, both you and your provider will want to address this issue if you are at risk.
- Do you have significant gynecologic issues such as uterine fibroids or polyps?
- Do you wish to have additional children?
- Are you strongly motivated to avoid hysterectomy?
- Are you or your provider strongly motivated to avoid hormones such as oral contraceptives, or other estrogen and progestin combinations?
- Are you strongly motivated to avoid the use of a Mirena Intrauterine Device (IUD)?
- Do you have an underlying clotting disturbance which puts you at greater risk for a deep vein thrombosis or a pulmonary embolus? An example of this is Factor V Leiden thrombophilia.
- Do you have an underlying bleeding disorder such as von Willebrand disease (VWD)?
- Do you have a history of multiple previous Cesarean sections?
- Do you have a history of multiple abdominal surgical procedures that caused a great deal of intra-abdominal scarring? Examples include appendectomy, cholecystectomy (gall bladder removal) gastric bypass procedures or bowel resection).
- Do you have a known history of proven or suspected pelvic endometriosis?
- Have you had a previous endometrial ablation procedures?
- Do you have a history of morbid obesity, severe asthma, severe diabetes or uncontrolled hypertension or some other equally debilitating chronic medical condition?
- Are you strongly motivated toward a particular form of therapy? For instance, some women were brought up in an environment – family members—who underwent a hysterectomy and have strong opinions regarding its helpfulness (one way or another).
- Do you have a high deductible insurance plan that may impact your decision?
- Is the length of recovery or time off from work a consideration for the type of intervention?
- Do you expect “perfect results”? Are you willing to accept “improvement” versus “perfection”?
- How do you feel about hospitals or outpatient departments?
- What are your thoughts on a procedure that can be performed in an accredited office-based surgery center?