Abnormal But Not Uncommon:
A Briefing on Abnormal Uterine Bleeding
November 15, 2005
On November 15, the Jacobs Institute held a Capitol Hill briefing on abnormal uterine bleeding, a condition that affects approximately 22% of women ages 35 to 55 and can be debilitating. Abnormal uterine bleeding is bleeding that interferes with normal life, including regular cycles that are heavy (menorrhagia) or irregular menstrual cycles (at unusual times, light or heavy). Abnormal uterine bleeding (AUB) accounts for 10 to 20 percent of visits to gynecologists. But, surveys show that the many women suffer in silence, suggesting the need for greater public education about AUB and available treatment options.
Amy Niles, President and CEO of the National Women's Health Resource Center, opened the briefing with a presentation of survey results of 653 women ages 35 to 49 who suffer from menhorragia or heavy menstrual bleeding. The survey found that heavy periods have a negative impact on women's professional and personal lives, interfering in their daily lives and causing many women to miss out on work, sex, and athletic events. More than half of women also said that they had to make significant adjustments in their lives when they had their periods. The survey found that most women with abnormally heavy periods delay seeking medical attention, one reason being that they view their periods as just something they have to put up with. The survey found that Hispanic women are less likely than others to seek treatment.
Following the survey results, Elisabeth Quint, MD, from the University of Michigan, provided the audience with a thorough understanding of abnormal uterine bleeding, defining the problem and outlining causes, costs and treatment options. Dr. Quint stressed that abnormal uterine bleeding is a common problem that can interfere with women's lives and health. Causes for AUB are not always clear and they vary with age. Causes include an-ovulation, uterine structural abnormality, fibroids, STDs, bleeding disorders, and pregnancy complications. Treatments for AUB are available, but not all options are available to all women. Treatments include medications (anti-inflammatory drugs and hormones), endometrial ablation, uterine artery embolization and surgical procedures. Anti-inflammatories (such as Mafenemic acid, naproxen, and ibuprofen) can reduce flow and treat pain. Hormonal treatment (combined estrogen and progesterone, or progesterone only) can decrease flow and help with cramps. Endometrial ablation, removing the lining of the uterus by electrocautery or heat energy can reduce or eliminate bleeding. The progesterone interuterine system (a birth control product) is also used off label to address AUB. Uterine artery embolization to block the flow of blood to the uterus and fibroids, can shrink fibroids and reduce bleeding. And finally, surgery is also used to address AUB including both removal of fibroids and hysterectomy.
Joan LaRock completed the panel discussion by sharing her own experience with abnormal uterine bleeding, how it negatively affected her life, causing her to miss work and important events, and how she successfully sought treatment for the problem. As a midlife woman with two teenage daughters and a consulting business to run, Joan found abnormal uterine bleeding a great disruption and feared that she would have to undergo a hysterectomy, as her twin sister had to address AUB. Joan sought treatment and underwent endometrial ablation, which resolved her abnormal bleeding.
Overall, panelists stressed that women need not suffer in silence from abnormal uterine bleeding. If bleeding affects women's everyday lives, they should talk with their health care providers about treatment options.
Amy Niles, CEO and President, National Women's Health Resource Center
Elisabeth H. Quint, MD, FACOG, Clinical Professor of Obstetrics and Gynecology and Director of the Hysterectomy Alternatives Program, University of Michigan Medical Center
Joan LaRock, President, LaRock Associates, Inc., Patient Speaker