1. ABNORMAL UTERINE BLEEDING Dr Rooma Sinha, MD, DNB Senior Consultant Gynecologist & Laparoscopic Surgeon Apollo Health City; HYDERABAD www.gynecologyhyderabad.comwww.gynecologyhyderabad.com, drroomasinha@hotmail.com 9550326662; 9849008180

2. Women have menstrual cycles from the age of 11- 12 years to about 50 years. In this time span of 40 years one is likely to have few episodes of bleeding which is not her usual cycle.

3. Characteristics of Normal Menstruation www.gynecologyhyderabad.com

4. Abnormal uterine bleeding can be as follows- One must be concerned and consult gynecologist Bleeding between periods Bleeding after sex Spotting anytime in the menstrual cycle Bleeding heavier or longer than normal - Passage of clots Absence of menstrual periods for 3 normal cycles or 6 month Severe pain associated with periods

5. Why Worry? Excessive bleeding can lead to anaemia, weakness Pain can affect daily activities Can be initial indication of a serious disorder www.gynecologyhyderabad.com

6. Abnormalities that cause abnormal bleeding Fibroid uterus/Adenomyosis Pelvic inflammatory disease Cancer of uterus Dysfunctional Uterine Bleeding Endometriosis PCOS Pregnancy complications www.gynecologyhyderabad.com

7. How We Evaluate Abnormal Bleeding? Pelvic USG Dilatation & curettage Hysteroscopy & directed Endometrial biopsy Thyroid profile www.gynecologyhyderabad.com Maintain a menstrual calendar - it gives a good insight into the problem if the bleeding pattern is available over 4-6 months for the doctor to evaluate

8. Ask Questions from your doctor Medical intervention? Surgical intervention? Era of minimally invasive surgery!! Look carefully for reasons for not going for key hole surgeries All Gynecological surgeries can be done with key hole www.gynecologyhyderabad.com

9. Medical treatment DEPENDS ON -cause, age, severity ; desire for future pregnancies Antifibrinolytic medication to reduce the blood loss during periods HORMONES- – Progesterone alone (for endometrial hyperplasia) – Combined pills – MIRENA- intrauterine device with impregnated hormone

10. Surgical method Removal of fibroid- Laparoscopy /Robotic / Hysteroscopy Hysterectomy—removal of the uterus—is another procedure that may be used to treat abnormal bleeding Thermal balloon ablation is a method to treat dysfunctional bleeding without removing the fibroid

11. Advantage of minimally invasive surgery- LAPAROSCOPY/ROBOTIC No Scar- beautiful body No pain Quick return to normal activity Less postoperative problems- as less tissue handling so less damage!! NO HERNIAS www.gynecologyhyderabad.com

12. Finally... If you notice that your cycles have become irregular, it is better to consult a gynecologist. Abnormal bleeding has a number of causes. There is no way of telling why your bleeding is abnormal until a gynecologist has made an assessment of your problems. Once the cause is found, abnormal bleeding often can be treated with success.