Question from: 12/22/97

I am a 37 y.o. female. In the last few months (aprx 6) I have been having cycles two and three times a month. I know this is not normal but I do not want to go on birth control pills just to regulate myself. What are my other options if I plan on no more children.

Max C. Karrer, M.D.

Answer: I have surveyed the physicians of Women's Medical Group and the consensus answer to the question is as follows:

From the history given, we have to assume that the patient is having dysfunctional uterine bleeding on a hormonal basis, most likely anouvulatory ("without ovulating") cycles. Although the patient is resistant to the idea of birth control pills, the first thing we would try would be to place the patient on oral contraceptives for 2 to 3 cycles to break up the abnormal bleeding pattern and then stop them and observe the patient's menstrual cycle. (many patients will be straightened out by this simple conservative approach).

Next would be to do a D&C if pills did not work to rule out endometrial hyperplasia. A further more complicated treatment if the previous things failed would be to do an endometrial oblation procedure in order to destroy the endometrium so the patient would not bleed at all. (This procedure is done through a hysteroscope using a rollerball electrocoagulation device.)

As far as the patient not wanting any further children is concerned, tubal ligation alone could make the patient's bleeding problem worse unless an endometrial oblation was done first.

Of course the ultimate treatment could be hysterectomy. Based on the history given this would not be indicated unless conservative treatment modalities had failed.

Max C. Karrer, M.D.

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