Chapter 32: Unusual Bleeding: Evaluation and Treatment

Hilgers TW

Menstrual Cycle · Cycle Disorders

Chapter 32: Unusual Bleeding: Evaluation and Treatment

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 387-406, 2004

RRM Academy Synopsis

Unusual bleeding had an organic cause in 57.4% of 148 Creighton users

Organic pathology turned up in 57.4% (85 of 148) of women who had a D&C for unusual bleeding. A NaProTECHNOLOGY textbook chapter reports 148 consecutive users of the Creighton Model System (CrMS) with bleeding abnormalities. All had a D&C, a uterine scraping. The chapter adds charted case examples.

Key Findings

Of 148 consecutive CrMS users with bleeding abnormalities who had a D&C, 85 (57.4%) showed organic pathology and 63 (42.6%) showed none.
Endometrial polyps were the most common organic finding (n=31), then hormone imbalance (n=18), endometrial hyperplasia without atypia (n=14) and chronic endometritis (n=10).
Four women had cystic hyperplasia and four had polypoid changes. Two had hyperplasia with atypia, one had adenocarcinoma and one had carcinosarcoma.
Of 23 women who described heavy periods, 20 changed pads, tampons or both every two hours or less.

RRM Context

The CrMS gives bleeding a standard chart vocabulary. A clinician reading the chart can sort a pattern as perimenstrual or intermenstrual. The chapter says standard practice puts women on oral contraceptives, which regulate bleeding without addressing the cause. The author adds that some women end up with hysterectomies because their bleeding goes undiagnosed.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes how the CREIGHTON MODEL System records bleeding and defines unusual bleeding as bleeding that is different from a normal menstrual period. The chapter sets out standard medical definitions and CREIGHTON MODEL definitions, including postmenstrual brown bleeding, premenstrual bleeding and excessively heavy menses, along with a menstrual scoring system developed at the Pope Paul VI Institute. Hilgers reports the histologic findings of 148 consecutive D&Cs in CREIGHTON MODEL users with bleeding abnormalities, in which endometrial polyps were the most common finding. Chart examples then illustrate bleeding associated with cervicitis, endometritis, suboptimal post-Peak hormone levels, endometrial polyps, submucous fibroids, endometrial hyperplasia, polycystic ovarian disease, thyroid dysfunction and adenomyosis, with the management used in each case.

Topics

Menstrual Cycle › Cycle Disorders › Unusual Bleeding · Reproductive Endocrinology › Luteal Phase › Luteal Phase Deficiency · Diagnostics › Cycle Biomarkers › Cervical Mucus Monitoring

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 32: Unusual Bleeding: Evaluation and Treatment

Unusual bleeding had an organic cause in 57.4% of 148 Creighton users

Key Findings

RRM Context

Abstract

Topics

By this author

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