Irregular Periods: Treatment Options and Surgical Considerations

Treatment methods for irregular menstrual periods?

In the past, my menstrual cycles were normal, but three months ago, after trying to regulate my cycle, I suddenly experienced bleeding that lasted for a month.
I visited a local hospital where the physician prescribed hormones to help gradually stop the bleeding.
An ultrasound was performed, and everything appeared normal.
However, feeling uneasy, I went to a larger hospital for further evaluation, where I underwent two types of ultrasounds and a hysteroscopy.
The physician stated that the endometrium was 0.5 cm, which was acceptable, and there were no significant underlying issues.
They also mentioned that it seemed I had already tried the medications from the local hospital, and it appears that a dilation and curettage (D&C) might be the only option.

Q1: Given these circumstances, should I consider undergoing surgery?
Q2: Have you encountered similar situations before?

Miss Lin, 20~29 year old female. Ask Date: 2022/01/17

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Observation for 2-3 months or performing a hysteroscopy for biopsy.
2.
Hormonal therapy without the addition of uterotonics may lead to excessive menstrual bleeding and prolonged menstrual periods.

Reply Date: 2022/01/17

More Info

Irregular menstrual periods can be a source of concern for many women, especially when they experience significant changes in their menstrual cycle, such as prolonged bleeding. In your case, it seems that you have experienced a sudden change in your menstrual pattern, with a month-long bleeding episode following a period of normalcy. The hormonal treatment prescribed by your doctor was likely aimed at regulating your menstrual cycle and addressing the abnormal bleeding.

Understanding Irregular Periods
Irregular periods can result from various factors, including hormonal imbalances, stress, changes in weight, or underlying medical conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders. In your case, the ultrasound and hysteroscopy findings indicate that your endometrial lining is within normal limits, which is reassuring. The absence of significant findings suggests that there may not be an immediate structural issue causing your symptoms.

Treatment Options
1. Hormonal Therapy: As you have already started hormonal treatment, this is often the first line of management for irregular periods. Hormonal contraceptives can help regulate the menstrual cycle and reduce heavy bleeding.

2. Monitoring: If the bleeding resolves with hormonal treatment, your doctor may recommend monitoring your menstrual cycle over the next few months. This allows for observation of any further irregularities and helps determine if additional interventions are necessary.

3. Lifestyle Modifications: Stress management, regular exercise, and a balanced diet can also play a significant role in regulating menstrual cycles. If weight changes or stress are contributing factors, addressing these may help improve your symptoms.

4. Surgical Options: If hormonal treatments do not yield satisfactory results, or if you continue to experience prolonged bleeding, surgical options may be considered. These could include:
- D&C (Dilation and Curettage): This procedure involves scraping the uterine lining and can be diagnostic as well as therapeutic.

- Endometrial Ablation: This procedure destroys the uterine lining to reduce or eliminate bleeding. It is typically recommended for women who do not wish to preserve their fertility.

- Hysterectomy: In cases where other treatments fail and the bleeding is significantly impacting quality of life, a hysterectomy (removal of the uterus) may be considered. This is generally a last resort for women who have completed their families.

Surgical Considerations
Regarding your questions about surgery:
1. Should you undergo surgery?: The decision to proceed with surgery should be made collaboratively with your healthcare provider, considering your symptoms, the impact on your quality of life, and your future reproductive plans. If your bleeding is manageable and you are responding to hormonal treatment, surgery may not be necessary at this time.

2. Have I encountered similar cases?: Yes, many women experience irregular periods, and it is not uncommon for healthcare providers to see patients with similar symptoms. Each case is unique, and treatment is tailored to the individual's needs and circumstances.

Conclusion
In summary, while surgery is an option for managing irregular periods, it is essential to weigh the benefits and risks carefully. Given that your recent evaluations have not revealed any significant abnormalities, it may be prudent to continue with hormonal treatment and monitoring. If your symptoms persist or worsen, discussing surgical options with your healthcare provider would be the next step. Always ensure that you have open communication with your doctor about your concerns and treatment preferences.

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