What is abnormal bleeding and what is a specialist who treats it?

Meet with Ulas Bozdogan, MD, FACOG

Endometriosis & Fibroids Specialist located in Hackensack, NJ and New York City, NY

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Abnormal Bleeding: Abnormal bleeding is any uterine (your womb) bleeding that differs in timing, amount, or duration from that of a normal period. A normal period is typically 3-7 days in length, comes every 24-32 days, and does not result in anemia. The bottom line is that any more bleeding than what the standard “cycle” entails is considered abnormal:

  • Periods that last longer than 7 days.
  • Periods that come more frequently than every 21 days.
  • Bleeding that causes debilitating cramps or pain.
  • Bleeding that is so heavy that hygiene becomes a problem.
  • Bleeding that is so heavy that it results in anemia.

Abnormal Bleeding Specialist: Dr. Ulas Bozdogan is a specialist in who diagnoses and manages abnormal uterine bleeding, as he is a gynecologist, board-certified by the American Congress of Obstetricians and Gynecologists. This is the highest achievement an OBGYN doctor can attain in the specialty. But Dr. Bozdogan uses the latest state-of-the-art technology and diagnostic—and if necessary, surgical—techniques, which sets him apart from other gynecologists. His vast experience (thousands) in performing hysteroscopy, laparoscopy, and other procedures using minimally invasive robotic procedures increase the safety, decrease the blood loss, and make complications of any diagnostic or therapeutic procedure less, should they be necessary, e.g., removing uterine fibroids; additionally his techniques also significantly decrease recovery time and postoperative pain. In fact, he even teaches procedures to other doctors who want to begin using the robot in their own practices.

FREQUENTLY ASKED QUESTIONS


What causes abnormal uterine bleeding?

There are many causes, some gynecological, others non-gynecological.

    1. Non-gynecological
    • Blood clotting disorders, from blood-thinners, genetic problems, vitamin deficiencies, or medication side effects.
    • Endocrine (glandular) problems, such as under- or over-active thyroid, diabetes, or a version of diabetes called insulin-resistance (polycystic ovarian syndrome—which is really more endocrine than gynecological in nature).
    • Medication side effects, which can interfere at many points in your menstrual cycle.
    • Malnutrition, “swing” and extreme diets, or starvation.
    • Extreme exercise.
    • Mental problems such as stress or anxiety.
    • Genetic (inherited) problems.
    1. Gynecological
    • Cervicitis, which is not a true uterine bleeding problem, but an inflammation of the cervix that can cause spotting and bleeding, but is otherwise harmless and easily treated.
    • Hormone imbalance in which the menstrual cycle is paused or prolonged in one of its two phases. Such imbalances can play an important role in causing infertility, and Dr. Bozdogan is very experienced in addressing this cause.
    • Adenomyosis, which is a glandular infiltration of the muscular wall of the uterus.
    • Fibroids, which interfere with the muscular contracting of your uterus’ muscular layer, preventing the bleeding from a period to be pinched off.
    • Polyps inside your uterus, which can erode and bleed.
    • Cancer of the inside layer of your uterus, which doesn’t follow the normal cycling pattern.

Does abnormal uterine bleeding mean it’s probably cancer?

No. In fact, the other causes are much more likely. Even in the rare case in which it is cancer, caught early with the diagnostics [BELOW] usually means it is curative. Dr. Bozdogan has much experience in diagnosing early uterine cancer and eradicating it.

Does abnormal uterine bleeding always mean surgery?

Not at all. In fact, the majority of the management for abnormal uterine bleeding is in the beginning, with blood work to rule out clotting disorders, hormone imbalances, and even unusual causes like thyroid disorders or medication side effects. Further management involves assessing your uterus (the source of the bleeding). This is done in three ways:

    1. Ultrasound
    2. Taking a sample of the inside of your uterus, by D&C (scraping tissue for study under a general anesthetic) or an endometrial biopsy (EMB) which is an office procedure that takes a sample, and when combined with ultrasound, can often eliminate the need for a D&C.
    3. Hysteroscopy

Each of these offer different capabilities and advantages. Ultrasound is done first, because it can help direct the way tissue sample retrieval or hysteroscopy can be used.

After the cause is determined, treating abnormal bleeding is based on what the diagnostics reveal, and they can range from conservative to aggressive, depending on whether pregnancy is desired,  to what degree pain is involved, or if there are pre-cancerous tissues.

What is hysteroscopy?

Hysteroscopy is a procedure that uses a small lighted scope to look through the mouth of your womb (cervix) to examine internally. As such, there are no incisions. Technically it is a “surgical” procedure, but there is no actual surgery per se, unless Dr. Bozdogan takes advantage of it to remove a polyp or internal fibroid through the hysteroscope tube.

What are the options in treating abnormal uterine bleeding?

Again, this depends on the cause. Dr. Bozdogan can treat hormonal causes using birth control pills, IUD, or time-released hormone shots. Endometrial ablation is the burning or freezing of the lining of your uterus which bleeds and is done via a vaginal approach (no incisions).

Polyps can be easily removed with a hysteroscope, as can fibroids that hang into the uterine canal, and Dr. Bozdogan uses such technology to prevent larger procedures.

When pregnancy is no longer desired, the pain and cramping of heavy bleeding can make hysterectomy (removal of your uterus) a better choice than trial-and-error involving hormones or other more conservative measures. This is also true with adenomyosis, fibroids, and pre-cancerous tissue.

When hysterectomy is chosen, the procedure as done by Dr. Bozdogan using the da Vinci® robot offers the best approach for minimal pain and shortest recovery.

How is a hysterectomy done with the robotic technique?

Using the advantages of the robotic approach minimizes the complications drastically compared to more invasive surgeries other doctors do, such as laparoscope-assisted, open, and vaginal hysterectomy. This is because the robot’s advantages over the others is stereoscopic visibility, 2-hand dexterity that electronically couples with advanced instrumentation for meticulous dissection, and visibility from any angle within your pelvis. The precise technique allows for meticulous handling of tissue, which also means reduced inflammation, decreasing postoperative pain and speeding up recovery tremendously.

Summary

Abnormal uterine bleeding is a far-reaching simplistic label that can represent any one of a vast number of problems. Each woman who suffers abnormal bleeding is unique and Dr. Bozdogan insists on an individualized treatment plan that takes into account her age, fertility and pregnancy plans, quality of life, and personal choices.

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