Abnormal Uterine Bleeding – Definition, Causes, and Treatment

Keith Reisler, MD, is an accomplished board-certified OBGYN physician with over three decades of experience. Since 1988, Dr. Keith Reisler has served North Texas women from his practice in Plano, TX. Emphasizing a personalized approach and preventative care, Keith Reisler, MD, and his team provide comprehensive OBGYN services, ranging from regular preventative Pap smears and pregnancy monitoring to diagnosis and treatment of various gynecological conditions, including ovarian cysts, uterine fibroids, and abnormal uterine bleeding (AUB).

AUB refers to irregular or heavier- or longer-than-normal bleeding from the uterus. The frequency of a normal menstrual cycle can be anywhere between every 21 to 35 days, with menstrual bleeding lasting between 3 to 5 days. Spotting or bleeding between a woman’s periods, after sexual intercourse, or after menopause; bleeding lasting more than 7 days, and heavy bleeding that requires changing one or more pads or tampons every hour all qualify as AUB.

AUB can affect women of all ages, but it is most common when menstruation starts (about the ages of 9 and 14) and in the years leading up to menopause (around 50). Causes vary widely and can include hormonal imbalances (lower or higher than normal levels of the female hormones estrogen and progesterone, thyroid issues, hypophysis issues), medications (blood thinners, hormonal replacement therapy), and extreme weight loss or gain. In addition, structural abnormalities, such as fibroids and polyps (non-cancerous growths in the uterus or cervix) and different types of cancer (cervical, uterine, ovarian, and vaginal) can also cause AUB.

Various treatment options exist for AUB. The best option depends on what has caused the issue, the patient’s age, and whether she wants to have children. Medications include birth control pills, hormonal injections, and nonsteroidal anti-inflammatory drugs. Hysteroscopy and myomectomy are examples of minimally invasive procedures, during which physicians remove potential AUB causes like fibroids and polyps but keep a patient’s uterus intact, thus preserving her ability to have children. Hysterectomy, on the other hand, is a surgical procedure typically used to treat cancer, during which a patient’s uterus gets removed.

A Look at Hysteroscopic Resection of Fibroids

An experienced OB/GYN with over 30 years of experience providing comprehensive care in Plano, TX, Keith Reisler, MD, is passionate about educating his patients on all available treatment options for their unique situation. With an emphasis on preventive women’s care, Dr. Keith Reisler specializes in minimally invasive procedures, including endometrial ablation, operative laparoscopy, and operative hysteroscopy.

Hysteroscopic resection for fibroid removal is a minimally invasive surgical procedure that enables the removal of fibroids that are located inside the uterus. Uterine fibroids are non-cancerous tumors that result from abnormal growth of the muscles and tissues lining the wall of the uterus.

During hysteroscopic resection, the surgeon directs an instrument called a hysteroscope through the vagina and the opening of the cervix, a narrow canal between the vagina and the uterus. For hysteroscopic resection of fibroid tissue, the hysteroscope holds a special camera around its tip. The camera helps visualize the interior of the uterus. By passing a small surgical device through the hysteroscope and maneuvering it, the surgeon removes the fibroid in fragments.

Typically, hysteroscopic resection completely removes the uterine fibroid in a single procedure. For large fibroids, doctors may perform the surgery twice, with a six to eight-week gap between the operations. A two-stage procedure is also the ideal option for removing fibroids that are partly embedded in the uterine wall, to mitigate the risk of injuring the wall. The uterus will contract over time, pushing the remaining fibroid into the cavity and enabling safe extraction during the second operation.

Non-Invasive, Same-Day Surgery for Uterine Polyps and Fibroids

Keith Reisler, MD, treats OB/GYN patients at his office in Plano, TX. An experienced physician, Dr. Keith Reisler leverages his MD to perform non-invasive outpatient surgery for problems such as uterine polyps and fibroids. One of these procedures is called hysteroscopic resection (resection refers to removal of tissue).

Often used to treat women who are infertile, this operation involves the insertion of an instrument with a camera into the uterus. Looking at a monitor, the surgeon can identify polyps or fibroids and excise them with a wire loop. Performed under anesthesia and possibly a sedative, the procedure lets the patient go home the same day. It may cause minimal vaginal bleeding or spotting for some time, but most patients resume their usual activities within 2 days.

Ranging in size from a sesame seed to a golf ball, uterine polyps occur on the inner uterine lining. Most are benign, but a few (less than 5 percent) can be cancerous. The risk is low in women under 20 and peaks in the 40s, although older women are not immune. Causes include elevated levels of estrogen caused by overeating or the use of tamoxifen. Symptoms range from heavy vaginal bleeding after menopause to irregular or unpredictable periods. Polyps can also lead to infertility.

Fibroids can be larger, up to five or six inches in diameter, and may appear in other parts of the uterus, such as the outer lining or the wall. Like polyps, they can occur in multiples and are also related to hormone levels. Fibroids can develop at any age, but mostly strike between the ages of 30 and 40. They develop more often in Black women than White women, often appearing earlier and growing faster.

Symptoms of fibroids affect more areas of the body than polyps. They may be related directly to the pelvis (menstrual pain, vaginal bleeding, or unusual periods) or elsewhere (pain in the back and abdomen, difficulty in elimination), or involve infertility or pain during sex.

FDA Links Medical Device to Increased Cancer Risk

Keith Reisler, MD, is an Ob/Gyn physician and a fellow of the American College of Obstetrics and Gynecology, where he researches treatment for fibroid tumors. Dr. Keith Reisler advocates for minimally-invasive procedures for cancer patients and is part of an ongoing discussion of which tools and practices are safest.

The Food and Drug Administration (FDA) has issued statements about laparoscopic power morcellators, which are medical devices used during typically minimally invasive surgeries to remove unwanted or cancerous tissues. The device uses a small blade to cut unwanted tissue into small pieces which is then removed via a small incision site – the low impact of this surgery is such that recovery time is typically short and there is little risk of infection.

However, the FDA and other experts in the field are concerned about possible side-effects and unforeseen issues with these devices, especially in cases when cancerous cells and polyps are involved. Laparoscopic power morcellators are often used to remove non-cancerous growths or polyps from the uterus of the patient, but such patients often also have a small chance of undiagnosed cancer in the same area. The action of the device can spread cancerous cells beyond their initial growth site, making the patient’s odds of developing problematic cancer that is harder to treat greater. For this reason, the FDA and many Ob/Gyn physicians now refuse to use the device in case of doing more harm than good.

The 2019 Global Congress on Minimally Invasive Gynecologic Surgery

Dr Keith Reisler
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The holder of an MD from SUNY Downstate Medical School, Dr. Keith Reisler is an OBGYN with three decades of experience treating many gynecological conditions, including ovarian cysts and abnormal menstrual bleeding. Keith Reisler, MD, of Plano, TX, is also a member of the American Association of Gynecologic Laparoscopists (AAGL).

AAGL will hold its annual International Congress on Minimally Invasive Gynecologic Surgery in Florence, Italy, May 8-11, 2019. A partnership between AAGL and the Italian Society of Gynecologic Endoscopy, the conference will feature a live surgery demonstration.

Other opportunities will be available for attendees to obtain continuing education in topics such as endometriosis, laser surgery in gynecology, and vaginal access in minimally invasive surgery. A pre-conference curriculum will be available in Siena on May 7th and in Florence on May 8th. To learn more about the event or to register, visit www.aagl.org.

An Overview of High-Risk Pregnancies

 

High-Risk Pregnancies
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Keith Reisler, MD, has served patients in and around Plano, TX, as a private practice obstetrician and gynecologist since 1988. In this position, Keith Reisler, MD, provides a number of medical services, from annual Pap smears to support with both routine and high-risk pregnancies.

High-risk pregnancy is a term used to describe any pregnancy that poses a higher than average threat to the well-being of the mother, child, or both. In some cases, a routine pregnancy may develop into a high-risk pregnancy over time. In other scenarios, a woman may be a candidate for a high-risk pregnancy due to a variety of factors.

Existing health conditions are one of the most common influencing factors when it comes to high-risk pregnancies. High blood pressure, diabetes, and HIV are all health conditions that can complicate the delivery process. Similarly, obesity has been linked to a number of birth complications, including a 15 percent increase in a child’s likelihood for heart problems at birth.

Additional factors that may result in a high-risk pregnancy include the age of the mother and the number of expected births. Teens and women over the age of 35 are at elevated risk for gestational high blood pressure, among other conditions, while twins and higher order multiples often lead to premature labor. In fact, over 50 percent of twins and in excess of 90 percent of triples are born at less than 37 weeks.

What to Expect at a First Pelvic Exam

 

Pelvic Exam
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An obstetrician-gynecologist, Dr. Keith Reisler, who earned his MD from the State University of New York, has been in private practice for over 25 years. At his Plano, TX practice, Keith Reisler, MD, performs routine pelvic exams on patients.

For young patients, anticipating a first-time pelvic exam can be nerve-wracking. However, the exam is generally not painful and typically lasts only about five minutes. This diagnostic tool is used to examine the female organs and identify any problems.

Many practitioners agree that young women should have their first pelvic exam when they turn 21 or when they become sexually active, whichever comes first. However, a patient is encouraged to have a pelvic exam earlier if she has symptoms such as pain in the pelvis or lower abdomen, vaginal burning or itching, periods that last longer than a week, and menstrual cramps that are debilitating.

At the pelvic exam, a first-time patient can expect to be weighed and have her blood pressure taken. Afterward, she will be asked to remove all her clothing, wear a hospital gown, lie down on an exam table with her stomach up, bend her knees, and spread her legs apart.

The doctor will gently examine the external portion of the vaginal area. He or she will then use an instrument called a speculum to examine the inner parts of the vagina including the cervix, uterus, and fallopian tubes. Any abnormalities will be identified and communicated to the patient. It is important for the patient to be open with the doctor about any discomfort.

ACOG and Abt Associates Team Up to Fight Cervical Cancer

 

American College of Obstetrics and Gynecology
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An experienced obstetrician based in Plano, TX, Dr. Keith Reisler has been serving patients through his own practice for three decades. In addition to his everyday clinical work, Keith Reisler, MD, is recognized for his expertise as a fellow of the American College of Obstetrics and Gynecology (ACOG).

In September 2018, ACOG announced a new partnership with Abt Associates to jointly develop programs to eliminate cervical cancer, particularly in lower and middle-income countries. The move comes as the World Health Organization has put a global focus on fighting the disease in the coming years. In higher income countries, the HPV vaccine has been an effective tool in preventing cervical cancer. Through their partnership, ACOG and Abt will work with medical staff and other key stakeholders in countries across the world to train them on how to administer the vaccine, as well as other practices and resources available to prevent and treat cervical cancer in their populations.

Categories of Risk in Pregnancy

 

Pregnancy
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Since 1988, Dr. Keith Reisler has served as an obstetrician and gynecologist in Plano, Texas (TX). Keith Reisler, MD, comes to his work with diverse experience in caring for women with both normal and high risk pregnancies.

A high-risk pregnancy involves one or more factors that may affect the health of the mother, her unborn child, or both. Some potential risk factors relate to the mother’s age, lifestyle, or health status, while others stem from conditions of the pregnancy itself. Women expecting multiple babies are at higher risk, as are those who develop pregnancy-related conditions such as gestational diabetes or preeclampsia.

Women with nongestational diabetes are also more prone to pregnancy complications, and so blood sugar control before pregnancy is essential. Women with kidney, thyroid, or autoimmune disease must also ensure that their conditions are well-controlled and that their pregnancies are closely monitored by an experienced gynecologist. The same holds true for women with HIV/AIDS, who require careful treatment and often a cesarean section to minimize the chances of transmitting the virus to the baby.

Teenage mothers and first-time mothers over the age of 35 are at higher risk as well. Younger mothers are more prone to high blood pressure, anemia, and early labor, while older mothers may have more trouble with labor and are statistically more likely to give birth to a child with a genetic condition.

Women of any age and any health status can reduce the risk to the baby by avoiding cigarettes and alcohol during pregnancy. Both increase the fetus’s chance of birth defects, while alcohol increases the risk of stillbirth and smoking predisposes a woman to preterm labor.

About Pelvic Exams

 

Dr Keith Reisler
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Dr. Keith Reisler has operated his own ob-gyn practice in Plano, TX, since 1988. Keith Reisler, MD, offers comprehensive women’s care at his clinic, including pelvic exams.

Any woman over the age of 21 should consider having a complete pelvic exam every year. Exams may be done at an earlier age in certain circumstances. Pelvic exams include a look at the vulva, cervix, uterus, fallopian tubes, ovaries, bladder, and rectum, as well as a pap smear to check for cervical cancer. Pap smears may be done less frequently depending on the circumstances.

Although a woman should have a pelvic exam during a routine annual physical, she should also have the exam if she becomes pregnant, suspects she is suffering from an infection, or is experiencing pain in the lower back or pelvic region. Women should attempt not to schedule a pelvic exam when they are having a period. Moreover, in the preceding 48 hours, the patient should not douche, engage in sex, use a tampon, use foam or jelly birth control products, or apply any medications to the vagina.