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.
Get Answers about Fibroids and Menstrual Disorders
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:
- 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.
- Leukemia, a cancer of the blood cells, can prolong menstrual periods.
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.
Polycystic ovary syndrome (PCOS)
- In PCOS, many cysts (fluid-filled sacs) develop on the ovaries.
- Many women with PCOS are also obese, which increases their estrogen levels.
- PCOS can produce irregular periods and infertility.
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.
- STIs are normally found in younger women.
- Formed of muscle and tissue from the uterine wall, fibroids are the most common benign tumors in women of childbearing age. African-American are two to three times more likely to develop fibroids than Caucasian women, and Hispanic women are also at increased risk. Asian women have the lowest risk of fibroids.
- One of the strongest risk factors for fibroids is obesity; extra fat cells produce too much male hormone and store too much female hormone.
- 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.
Evaluation & Diagnosis
A tailored evaluation
Careful preoperative evaluation is a must. An extensive "workup" can pinpoint the cause, location and/or extent of fibroids or menstrual difficulties. We begin with a detailed menstrual and health 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 lighted tube, or endoscope, inserted through the vagina to examine the uterus. (Cleveland Clinic specialists have performed more than 6,000 office hysteroscopies.)
- Saline infusion sonography: expanding the uterus with salt water and using sound waves to reveal fibroids, polyps or other abnormal structures.
- 3-D ultrasound: sending sound waves through the abdomen 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—and 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.
Current medications typically treat only the symptoms of fibroids. However, medications won't help when fibroids are too large or numerous. Medications being developed to permanently shrink fibroids are not yet approved.
An emerging medical treatment for menstrual disorders is Mirena(R). This estrogen-free IUD-like device, implanted in the lining of the uterus, sends out small amounts of hormone that can stop periods for up to five years.
If periods are irregular due to obesity, a bariatric specialist on our team can help you manage your weight and improve your nutrition.
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 offer group sessions for women in conjunction with our Wellness Institute.
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 who are obese, for whom surgery is risky.
For women who hope to have children
To treat menstrual problems in women who want babies, we can preserve the uterus using hysteroscopic, laparoscopic or abdominal techniques. Learn more:
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.
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. Fibroids may be removed hysteroscopically, through a scope inserted into the uterus; laparoscopically, through a scope inserted into the abdomen; or using a robotic laparoscope inserted into the abdomen (the robot streamlines suturing).
In addition, fibroids can be removed through a small incision in the belly, a less invasive form of open surgery called minilaparotomy.
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 but are not ready to enter menopause.
In this procedure, which can be done in the office or O.R., a thin layer of the uterine lining is destroyed using one of five equally effective devices. Heat, electrical current, laser energy or cold are applied to the inner walls of the uterus, halting periods.
Uterine fibroid embolization (UFE)
Cleveland Clinic gynecologists collaborate with Cleveland Clinic interventional radiologists on uterine fibroid embolization. This procedure is not for women who wish to conceive because its effects on the strength of the uterus are unknown. The radiologist guides a catheter to arteries that supply the fibroids, then inserts tiny plastic particles to block blood flow. This robs the fibroids of oxygen and nutrients, and the fibroids shrink over a period of months.
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 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 at the following locations:
Cleveland Clinic Main Campus
Department of Obstetrics & Gynecology, Desk A81
2049 East 100th St.
Cleveland, Ohio 44195
Toll-free: 800.CCF.CARE, extension 46601
Fairview Medical Office Building
18099 Lorain Ave.
Cleveland, Ohio 44111
Lakewood Medical Building
1450 Belle Ave.
Lakewood, Ohio 44107
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. For example, we are exploring new methods of endometrial ablation. And because fibroids can re-grow, we are participating in a five-year federal research project comparing the long-term outcomes of myomectomy, hysterectomy and uterine fibroid embolization or 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 brush up on hysteroscopic and laparoscopic skills. Director Linda Bradley, MD, collaborated with Cleveland Clinic interventional radiologists to hold the first interdisciplinary professional course on UFE.
View the videos below for more information about the surgical treatment of fibroids and menstrual disorders.