Gynecologic Health

Understanding Abnormal Uterine Bleeding: Part 1

Summary & Participants

As many as 20 to 50 percent of all women develop fibroids. These benign muscle tumors usually grow in the uterus, and can cause pain, and in some cases, infertility. Join our panel as they discuss abnormal bleeding and fibroid concerns.

Medically Reviewed On: July 09, 2008

Webcast Transcript

MARTIN GOLDSTEIN, MD: Usually, a woman who comes to see me complaining of heavy bleeding will be aware that she's bleeding heavily. Instead of using one pad lasting overnight, a woman may use two or three pads at night, requiring multiple pad changes. In the most dramatic circumstance, a patient may come in to tell me "I'm passing huge clots. I have to wear diapers at night." The story of the bleeding is extremely dramatic.

PAUL MONIZ: But in Valerie's case it wasn't?

MARTIN GOLDSTEIN, MD: No. Valerie, by her story, had what she considered normal bleeding for most of her life. In actuality, when we got down to history taking and figuring out what was happening, Valerie was actually passing moderate-sized clots.

PAUL MONIZ: Valerie, you were aware from your gynecologist, who initially was not Dr. Goldstein, that you had a fibroid. What did your gynecologist tell you about that fibroid? Were you concerned about it prior to developing these symptoms last year?

VALERIE: I was not concerned about it. I read up on it that women can have fibroids, and you can be asymptomatic. There doesn't have to necessarily be any difficulty in terms of weakness or tiredness. But, in the last seven months, now that I was aware of this, the bleeding was pronounced.

PAUL MONIZ: Initially, you were misdiagnosed. From the story that we talked about before the show, it sounds as if it was really a hellacious experience for you based on that you didn't know what was happening, and that initially even some of your doctors weren't sure. Can you tell us in short order what was happening?

VALERIE: I don't know if I was really misdiagnosed. It was that my symptoms were that I was tired and weak, and had not had any type of blood workup. So early one morning, I went to a doctor I trusted, who happened to be my children's pediatrician. She checked my heart and my lungs, and said, "Let's just check your blood." So, she checked my blood and called me at 6:00 AM the next morning and told me to meet her in the hospital, that my hemoglobin was extraordinarily low.

PAUL MONIZ: You had a hemoglobin of five. Doctor, what does that mean?

MARTIN GOLDSTEIN, MD: The normal hemoglobin for a woman is somewhere between 13 and 15 grams. A hemoglobin of five is a very marked level of anemia; almost life threatening.

PAUL MONIZ: Calling for drastic measures, which is, in fact, what happened to Valerie. Valerie, you had to go three transfusions?

VALERIE: I needed to be hospitalized and have three transfusions immediately.

PAUL MONIZ: And subsequent to that, more tests were taken?

VALERIE: More tests needed to taken to find out diagnostically where the bleeding was coming from.

PAUL MONIZ: Another doctor told you that the solution should be hysterectomy. Is that correct?

VALERIE: Right. First, I went to several doctors. I went to a hematologist to find out that my blood production was fine, and I was healthy. I went to a gynecologist who recommended, from this bleeding, that I needed a hysterectomy. Then I, of course, spoke to friends and was referred to Dr. Goldstein.

PAUL MONIZ: Dr. Goldstein, when Valerie came to see you, based on what you had looked at before you started doing additional testing, did you think it was a submucosal fibroid?

MARTIN GOLDSTEIN, MD: By the history of the heavy bleeding, enough to create this level of anemia, my feeling was that there was a submucous fibroid. Valerie had had a previous ultrasound, which demonstrated that there was a fibroid in the uterus.

PAUL MONIZ: Let's talk about the fibroid. We have a diagram of what a fibroid looks like. Maybe you could walk us through and explain exactly what a fibroid is and what we're seeing here.

MARTIN GOLDSTEIN, MD: You're seeing a picture here on the left of a uterus, which contains several fibroids. Fibroids can be within the muscle wall of the uterus. These are called intramural fibroids. They usually don't create any bleeding problem. Fibroids that push into the cavity of the uterus, as you see in the center of the picture, are called submucous fibroids. Submucous fibroids have large blood vessels on their surface. They interfere with the contractile mechanism of the muscle of the uterus, which doesn't allow the uterus to squeeze its blood vessels shut so that it decreases bleeding.

Submucous fibroids will cause this type of bleeding. In order to correct this, you have to remove the submucous fibroid. The options are either to remove the fibroid locally; a procedure called a myomectomy, or remove the fibroid with the uterus, which is a hysterectomy.

PAUL MONIZ: Dr. Martin Goldstein thank you very much for joining us and that important information. Valerie, thank you for sharing your story, as well.

I'm Paul Moniz. We are talking about hysteroscopy today. If you have any questions, you should ask your doctor. Thanks for joining us.

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