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 with extensive surgical experience and knowledge.
We are ranked fifth in the nation and first in the state of Ohio by U.S. News & World Report for gynecologic care. We have established a center of excellence and experience for the women we serve.
Get Answers about Fibroids and Menstrual Disorders
Dr. 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.
Polycystic ovary syndrome (PCOS)
- 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's disease are two examples; in both cases, women may hemorrhage 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 normally 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.
- 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.
Evaluation & Diagnosis
A Tailored Evaluation
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. Then we 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 using 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 350 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 anti-fibrinolytic 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 Mirena(R). 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, halt 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 Cleveland Clinic’s Wellness Institute, 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. Learn more and download a brochure about office hysteroscopy.
- Hysteroscopic surgery.
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 endometrial polyps, finger-like growths arising from the uterine lining that can become infected and bleed. 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 hospital stay is usually less than 23 hours, less physical scarring, less need for pain medication and quicker return to work. Fibroids may be removed hysteroscopically, through a scope inserted into the cervix to view the fibroids and remove them surgically, without abdominal incisions; laparoscopically or robotically through a scope inserted into the abdomen using small incisions. These minimally invasive techniques foster a quicker return to work, less need for pain medication, and fewer complications that traditional open laparotomy incisions. In addition, when fibroids are more numerous and cannot be approached with a minimally invasive technology, they can be removed through a small incision in the belly, a less invasive form of open surgery called open mini-laparotomy
- Abdominal myomectomy.
When fibroids are too numerous or large, sometimes they must be removed in an open surgical procedure, through a bikini-line incision. The advantage is that the uterus can be repaired in layers, making it as strong as possible for subsequent pregnancies.
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.
- Abdominal hysterectomy.
This procedure through which the uterus and cervix are removed through an incision in the lower abdomen. One or both ovaries and the fallopian tubes by also be removed.
- Endometrial ablation.
In this procedure, which can be done in the office or an operating room, a thin layer of the uterine lining is destroyed.Generally, this is associated with decreased amount of menstrual bleeding and menstrual cramps. Approximately one-third of patients may cease having menstrual cycles. This is an option with small fibroids that are located within the uterine muscular wall.
- Laparoscopic/robot-assisted hysterectomy.
In this procedure the uterus is removed done through small abdominal incisions using a thin, lighted scope with a camera on the end – the laparoscope. In robot-assisted laparoscopic hysterectomy, the surgeon uses a computer to control the surgical instruments.
- Uterine fibroid embolization (UFE).
Cleveland Clinic gynecologists collaborate with Cleveland Clinic interventional radiologists on uterine fibroid embolization. This procedure is ideal for women who have completed childbearing, but wish to avoid surgery. The radiologist guides a micro-catheter to arteries that supply the fibroids, then inserts tiny plastic particles to block blood flow. This decreases the fibroids of oxygen and nutrients, and the fibroids shrink over a period of months.
- Vaginal hysterectomy.
During the vaginal hysterectomy, the surgeon detached the uterus from the ovaries, fallopian tubes and upper vagina well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vagina.
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 (223.2273), ext. 46601.
If previous imaging tests and laboratory evaluations have been performed, please bring the records with you.
If traveling to Cleveland is an inconvenience for you, we offer an e-consult service. The Cleveland Clinic MyConsult remote second medical opinion service connects you to the specialty physician expertise you need when you are faced with a serious diagnosis. Following a thorough review of your medical records and diagnostic tests, Cleveland Clinic experts render a second medical opinion that includes treatment options or alternatives, as well as recommendations regarding your future therapeutic considerations.
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 on our Main campus. Use our Find a Doctor service to locate a Cleveland Clinic women's health specialist who has expertise in these services near you.
Cleveland Clinic Main Campus
Department of Obstetrics & Gynecology, Desk A81
2049 East 100th St.
Cleveland, Ohio 44195
Toll-free: 800.CCF.CARE, extension 46601
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.
View the videos below for more information about the surgical treatment of fibroids and menstrual disorders.