If you experience heavy periods, there is no reason to suffer in silence. And if you've been told hysterectomy is your only solution, take hope. There are many options available to women today.
In the Cleveland Clinic Center for Menstrual Disorders Fibroids and Hysteroscopic Services, we use a streamlined, unified interdisciplinary approach to evaluate your problem and arrive at the best treatment for you. We have the state-of-the-art tools needed to evaluate your problems.
Our team includes physicians and advanced practice providers with extensive surgical experience and knowledge. Collaboration between multiple specialties is prioritized including Minimally Invasive Gynecologic Surgeons, Interventional Radiology, the Center for Integrative and Lifestyle Medicine and Center for Functional Medicine, Nutritionists, Reproduction and Infertility Specialists, Blood Management, and the Center for Weight Management.
Why choose Cleveland Clinic?
Cleveland Clinic is a teaching institution and incorporates medical students, residents, and fellows when appropriate to teach future generations how to manage menstrual disorders and uterine pathology. Our robust team of physicians routinely meet to discuss difficult cases to ensure the highest level of care is being delivered to our patients. The physicians at Cleveland Clinic serve as national leaders and routinely teach and coach others around the country and world through professional education seminars including conferences, didactics, video review, and live surgical teleconference.
We offer second opinions regarding diagnosis and treatment options to assist patients in understanding the full breadth of choices available. Virtual visits may also be an option to allow the flexibility of speaking with a physician from the comfort of your location. We support all backgrounds and beliefs and pride ourselves in offering bloodless medicine and surgery when elected.
Cleveland Clinic is ranked as one of the nation's top hospitals by U.S. News & World Report. We have established a center of excellence and experience for the women we serve.
Cleveland Clinic's Ob/Gyn & Women's Health Institute provides treatment outcomes that offer detailed information to help patients and their physicians make informed decisions about treatment for a wide-range of medical diseases and conditions related to women's health. This includes treatment for fibroids and menstrual disorders. Diagnostic evaluation are performed in the office or operating room by our gynecological staff. In addition to the above treatment, we also pride our clinics in offering additional services including saline infusion sonogram, transvaginal ultrasound including 3-D imaging, and magnetic resonance imaging.
Fibroids and Menstrual Disorders Treatment Guide
Dr. Linda Bradley is the Founder of Celebrate Sisterhood, a Cleveland Clinic-sponsored program dedicated to educating, energizing and empowering multicultural women to embrace self-care. We believe that women who care for their physical, mental and emotional health take charge of their destinies. They become stronger healthcare advocates for themselves, their families and their communities. They create positive change in the world.
What We Treat
Reasons for Problem Bleeding
A comprehensive workup in the Center for Menstrual Disorders, Fibroids and Hysteroscopic Services will shed light on the reason for a woman's bleeding problems. Possible causes include:
- Formed of muscle and tissue from the uterine wall, fibroids are the most common benign tumors in women of childbearing age. Women of the African diaspora are two to three times more likely to develop fibroids than Caucasian women.
- Fibroids only require treatment when they cause problems – such as heavy bleeding, pain, or "pressure symptoms" – constipation or frequent urination. This occurs in about half the cases.
- Today, fertility-sparing procedures are recommended for the treatment of uterine fibroids for those who desire fertility. This can often be performed through minimally invasive techniques.
- Uterine adenomyosis happens when cells that normally line the inside of the uterus grow in the walls of the uterus.
- Common symptoms include heavy periods, painful periods, or lower abdominal pain.
- Treatment can include both medical and surgical options.
Cesarean scar defect (isthmocele)
- A cesarean scar defect (“niche”) can occur when a previous cesarean section scar does not heal properly on the uterus and causes a pouch in the uterine lining. This area can fill with blood or fluid and cause abnormal menstruation or pelvic pain.
- This defect is often treated surgically through minimally invasive techniques including hysteroscopy or laparoscopy.
Retained products of conception
- Retained products of conception occurs when placental tissue or fetal tissue remains in the uterus after a delivery or a miscarriage.
- Symptoms may include uterine bleeding, pelvic pain, and occasionally fevers.
- An emerging treatment for some patients with retained products includes hysteroscopy, which uses a small camera inside your uterus to assess the uterine lining. This allows diagnosis as well as directed removal in one procedure. This directed removal under visual guidance may decrease future adhesion formation.
- In PCOS, many cysts (fluid-filled sacs) develop on the ovaries.This leads to imbalances in the female hormones estrogen and progesterone and the male hormone androgen.
- Many women with PCOS are also obese, which increases their estrogen levels.
- PCOS can produce irregular periods, infertility and may affect a woman’s physical appearance, including acne and excessive or thinning of hair.
- A detailed history, physical exam and laboratory testing can detect this disease.
- These involve thickening of the lining of the uterus
- Present throughout the person’s reproductive lifespan and menopause
- May cause abnormal bleeding
Inherited susceptibility to bleeding
- A tendency to bleed excessively can be passed down through families via faulty genes. Hemophilia and Von Willebrand disease (VWD) are two examples; in both cases, women may experience excessive bleeding when they have periods.
Sexually transmitted infections (STIs)
- Gonorrhea and Chlamydia are two sexually transmitted infections that can cause bleeding between periods.
- Chlamydia can also produce painful menstrual periods.
- A common vaginal infection—trichomonas—may be associated with vaginal discharge, vaginal odor, irregular bleeding, or bleeding after intercourse
- STIs are more commonly found in younger women.
- When vaginal bleeding occurs after menopause, it may be a sign of gynecologic cancer, although younger women can develop these cancers too.
- Ovarian cancer can cause abnormal vaginal bleeding, typically after age 50, but as early as age 20.
- Uterine cancer (endometrial cancer) can cause extremely long, heavy or frequent periods after age 40, with bleeding in between; after menopause, it may cause spotting.
- Cervical cancer can cause vaginal bleeding after intercourse or between periods, or menstrual flow may be heavier and last longer than usual. This cancer tends to occur between ages 35 and 55, and can develop after menopause.
- Vaginal cancer and vulvar cancer are rare gynecologic cancers. However, close inspection of the genitalia and vaginal examination can detect abnormalities.
- Leukemia, a cancer of the blood cells, can prolong menstrual periods.
- Menopause is defined as the time when menstrual cycles permanently stop secondary to decreased ovarian hormones
- This diagnosis is typically made when periods have stopped for 12 consecutive months.
- Uterine bleeding after the diagnosis of menopause is not normal and should be evaluated.
- The most concerning cause is endometrial cancer, but more commonly can be from atrophy (thinning of the uterine lining and vagina), polyps, fibroids, infection, or certain medications.
- Do not ignore this symptom! Please see your physician or advanced practice provider if you have unexpected bleeding after menopause.
Evaluation & Diagnosis
A careful evaluation is needed to determine if medical therapy, surgical intervention or a “wait and see” approach is indicated. An extensive "workup" can pinpoint the cause, location and/or extent of fibroids that may be associated with menstrual difficulties.
We begin with a detailed menstrual and health history, medication history, and a gynecologic exam. We then use one of the following imaging techniques to determine the health of your uterus before proceeding with treatment:
- Office Hysteroscopy: Use of a thin, flexible lighted tube, or endoscope, inserted through the vagina to examine the uterus. Cleveland Clinic specialists have performed more than 10,000 office hysteroscopies.
- Saline Infusion Sonography: This transvaginal ultrasound expands the uterus with salt water and uses sound waves to reveal fibroids, polyps or other abnormal structures.
- 3-D Ultrasound: Sends sound waves through transvaginal imaging to see detailed pictures of the inside of the uterus.
- MRI: Combining a powerful magnet, radio signals and a computer to obtain intricate pictures of the uterus and surrounding organs.
We also ask every woman we see whether or not she wants to preserve her fertility and/or her uterus. These considerations are very important in determining which treatments we will recommend. We aim for the best treatment outcome with the most minimal surgical procedure if indicated, in order to insure the highest patient satisfaction.
Following your evaluation, we will openly discuss all treatment options available to you. Treatments may involve medical management, non-surgical solutions, or minimally invasive or standard surgery.
Fibroids are rarely malignant. In fact, only 1 in 7500 women will have leiomyosarcoma, a cancer arising from fibroids. Therefore, medical therapy is typically used to treat bleeding associated with uterine fibroids. Many traditional medical therapies, such as birth control pills or hormone pills may be therapeutic and curative for fibroid-related bleeding.
An evolving therapeutic choice that has been used internationally for over 30 years is now available in the USA. Lysteda, or tranexamic acid, is an antifibrinolytic medication that decreases menstrual bleeding and passage of clots. It is non-hormonal and taken only during menses. An emerging medical treatment for menstrual disorders is progestin intrauterine devices (IUD). This progesterone IUD device is placed in the uterus during an office visit. It releases small amounts of progesterone hormone that can decrease menstrual bleeding, minimize menstrual cramps and, in 20-40% of women, improve menstrual bleeding for up to five years.
If periods are irregular due to obesity, a weight management specialist on our team can help you manage your weight, improve your nutrition and increase your exercise fitness.
Finally, we offer alternative treatments for problems such as severe cramping, to promote healing and relaxation and reduce stress. Alternative techniques include acupuncture, massage, reiki and yoga for stress reduction and healing. We make referrals for patients to Center for Integrative and Lifestyle Medicine and Functional Medicine to offer collaborative services.
If surgical intervention is warranted, our specialists are experts in many minimally invasive procedures. We routinely treat complex cases, and are experienced in performing surgery on women with complex medical problems.
For Women Who Plan to Have Children
To treat menstrual problems in women who want babies, we can preserve the uterus using hysteroscopic, laparoscopic, robotic or abdominal techniques.
Once we have examined the uterus with the hysteroscope, we can insert slender instruments through a separate channel to remove fibroids or other abnormal growths. These include fibroids and endometrial polyps (areas of overgrowth in the uterine lining).Tissue that remains after miscarriage can also trigger bleeding and may be removed hysteroscopically. Operative hysteroscopy is an outpatient procedure that is brief, requires only one to two days for recovery and is associated with minimal post-operative pain.
Minimally Invasive Myomectomy
Fibroid removal is known as myomectomy. Our gynecologists are highly skilled at removing difficult-to-access or large numbers of fibroids using minimally invasive methods. Robotic and laparoscopic approaches use small incisions on the abdomen. Instruments are placed through small trocars, tube-shaped medical devices, that permit safe removal of uterine fibroids. The benefits of minimally invasive techniques utilizing laparoscopic or robotic approaches is that you typically can go home the same day, have less physical scarring, require less pain medication, and return to work faster. In addition, when fibroids are more numerous and cannot be approached with a minimally invasive technology, they can often be removed through a small incision in the belly, a less invasive form of open surgery called mini-laparotomy.
When fibroids are too numerous or large, sometimes they must be removed in an open surgical procedure, through a bikini-line incision. With the training of our minimally invasive gynecologic surgeons, an abdominal approach is rarely required.
For Women Not Interested in Having Children
Other options can end excessive bleeding without removing the uterus in older women or in younger women who do not want children.
Minimally Invasive Hysterectomy
This procedure removes the uterus and any associated fibroids so you will no longer have periods. For women who are premenopausal, we typically recommend keeping your ovaries in place so you will not experience any hormonal changes. With the training of our minimally invasive gynecologic surgeons, even very large fibroids can typically be removed through minimally invasive techniques. These may include the use of conventional laparoscopic instruments, assistance of a robot, or vaginally. Most women can go home the same day as their surgery and return to work 2-4 weeks after surgery. If your physician informs you that you need a large incision for treatment, consider seeking a second opinion with our minimally invasive surgeons.
This procedure removes the uterus and any associated fibroids through a large incision. With benign pathology, an abdominal approach is very rarely indicated. If your physician informs you that you need a large incision for treatment, consider seeking a second opinion with our minimally invasive surgeons.
Uterine Artery Embolization (UAE)
Cleveland Clinic gynecologists collaborate with Cleveland Clinic interventional radiologists to offer uterine artery embolization. This procedure is ideal for women who do not desire future pregnancy. In this procedure, a small catheter is placed into the femoral artery in your groin or radial artery in your wrist. With the assistance of imaging, the catheter is inserted to the level of the uterine arteries and a material is placed in your arteries to decrease blood flow to the fibroids. This depletes the fibroids of oxygen and nutrients, and the fibroids shrink over a period of months.
MRI-focused Ultrasonic Ablation
This procedure is also called focused ultrasound or focused ultrasound ablation. This procedure utilizes the assistance of MRI imaging to accurately localize the fibroids while avoiding harm to adjacent tissue. A high energy ultrasound transducer is then used to heat the fibroids and destroy the tissue. The fibroids shrink over time.
The Acessa procedure is a minimally invasive procedure that uses radiofrequency ablation (heat) to destroy each fibroid. This procedure is performed using a laparoscopic camera and a laparoscopic ultrasound probe. Once ablated, the fibroid is then absorbed by the body over time. This should help relieve bleeding and bulk symptoms.
In this procedure, a thin layer of the uterine lining is destroyed utilizing bipolar energy. Generally, this is associated with decreased amount of menstrual bleeding and menstrual cramps. Approximately one-third of patients may cease having menstrual cycles. If you are <40 years old, this procedure does have a 40% risk of not working well. After an endometrial ablation, it is important to understand that your endometrial cavity can often not be evaluated again secondary to significant scar tissue. An endometrial ablation should only be considered after exhaustive evaluation and counseling.
Appointments & Locations
To see one of the specialists in our Center for Menstrual Disorders, Fibroids and Hysteroscopic Services, please call 216.444.6601 or 800.CCF.CARE (1.800.223.2273), ext. 46601.
If previous imaging tests and laboratory evaluations have been performed, please bring the records with you.
Menstrual disorders, fibroids and hysteroscopic services are available throughout northeastern Ohio. Our specialists see patients at our regional hospitals, medical office buildings and family health centers, as well as at our main campus.
Our office is located at Cleveland Clinic's main campus in the A Building - Crile Building:
Department of Obstetrics & Gynecology, Desk A81
2049 East 100th St.
Cleveland, Ohio 44195
View the videos below for more information about the treatment of fibroids and other menstrual disorders at Cleveland Clinic.
Listen to episodes of Cleveland Clinic's Health Essentials podcast about fibroids and other menstrual disorders:
- Women's Health: PCOS, Endometriosis and Periods featuring Linda Bradley, MD
- Navigating 'The Change': What Every Woman Should Know About Menopause featuring Pelin Batur, MD
Find helpful posts from Cleveland Clinic’s Health Essentials site. Discover the latest health and wellness information for fibroids and other menstrual disorders:
- What to Do When Menopause Comes Early
- Can Fibroids Affect Your Chances of Getting Pregnant or Having a Healthy Pregnancy?
- Why Is My Period Lasting So Long?
- PCOS: What You Should Know About Infertility’s Most Common Cause
- Is PCOS Preventable?
- I Have Fibroids. Could I Do Nothing — and Wait for Menopause?
- This Little-Known Gynecological Condition Can Cause Heavy, Painful Periods
- Menstrual Clots During Heavy Periods: What’s Normal & What’s Not?
- Bleeding Between Periods? How to Tell If It’s a Problem
- Fibroids: Are They Making Sex Painful for You?
- Women: Why You Shouldn’t Ignore a Heavy Period
- Treat Your Most Troublesome Fibroids — Without a Hysterectomy
Online Health Chat Transcripts
View transcripts from previously completed online health chats with our women's health experts:
Find helpful posts from Cleveland Clinic's site for physicians and healthcare professionals. Discover the latest liver cancer research insights, innovations, treatment trends and more:
- Study Looks at Ketogenic Diet to Treat PCOS and Infertility
- For Women Struggling to Conceive in the Face of Obesity and PCOS
- Number of Fibroids Removed May Impact Fertility After Myomectomy
- Medical Therapy for Uterine Fibroids Draws Nearer as Phase 2 Trial Brings Promising Results
- Fibroid Removal in Conjunction with Assisted Reproductive Technology
- Efforts Underway to Increase MIS in Gynecology
- Embracing Hysteroscopy
Research & Education
In the Center for Menstrual Disorders, Fibroids and Hysteroscopic Services, we are active in research, so our patients have access to clinical trials. Prior studies have explored new methods of endometrial ablation. We participated in a five-year federal research project comparing the long-term outcomes of myomectomy, hysterectomy and uterine fibroid embolization (UFE).
Education is also one of our missions. Our staff members are active in professional education seminars around the country and the world. They have performed live surgical teleconferences to help colleagues understand surgical procedures including hysteroscopy, laparoscopy, robotic and vaginal surgery.
Clinical trials (or research studies) help us create the medicine of tomorrow. They provide hope through offering testing of new drugs, new surgical techniques or other treatments before they are widely available.
We can help you access hundreds of clinical trials across all specialty areas. Our new searchable online trials tool makes identifying treatment opportunities easier than ever.