Improving Life with Gynecological Care [Larissa Bennis]

My name is Larissa Bennis. I was born and raised in Milbank, South Dakota. After I graduated from high school there, I did my undergraduate at Augustana College in Sioux Falls. I then did my medical school education at USD in Vermillion. I did my OB/GYN residency down at KU School of Medicine in Wichita, Kansas and I'm now an obstetrician and gynecologist here at the Avera Medical Group in Brookings.

What causes abnormal uterine bleeding?

Some of the more common things we can see polyps or kind of small benign growths that occur in the endometrium. There can be adenomyosis, which is kind of an in growth of the endometrial lining kind of into the muscular layer of the uterus. There can be problems with fibroids, what we call leiomyomas which are just kind of benign growths of the smooth muscle in the uterus. Those can not uncommonly cause abnormal bleeding.

There can be abnormalities with the actual cells that are in the endometrial layer that can lead to what we call endometrial cancer. So especially in postmenopausal patients, that's kind of the main thing that we want to try to rule out. Malignancies or cancer are definitely another option for things.

Aside from the actual physical changes that can occur in the uterus, you can also have problems with what we call coagulopathies or problems with bleeding disorders that can be either inherited or present since birth.

How can abnormal uterine bleeding impact a woman's life?

A lot of it depends on what age the woman is when she starts to have some of these problems, but in the younger years it can cause problems with having to miss days from work, school, those types of things. It can cause a lot of embarrassment, especially when we're talking about problems where people have heavy mensies or heavy periods because they can actually have accidents from those periods sometimes, which can be very embarrassing to the individual. In addition to that, there can be discomfort associated with heavy periods and it can cause just a lot of other problems.

How is abnormal uterine bleeding treated?

One of the most common things that we usually try is going to be something like an oral contraceptive pill. In some patients, that's not going to be an appropriate type of therapy especially in some of the patients that will have actual physical abnormalities with either the structure of the uterus or the lining of the uterus. So in some of those patients, we'll actually want to do a little bit more investigation of things, especially in the postmenopausal patient. Usually with those types of people we'll recommend doing what we call an endometrial biopsy, which is just kind of an in-office procedure that helps us sample just a limited portion of the endometrium or the lining of the uterus to make sure that there's not any concern for cancer.

And some of those patients we'll also recommend doing a transvaginal ultrasound so that we can take a look at the endometrial thickness. Sometimes when we find abnormalities either on those biopsies or in the ultrasounds, we'll recommend doing a little bit further surgical evaluation for things.

What procedures are used to treat abnormal uterine bleeding?

One of the more common procedures that we'll do with that is what's called a hysteroscopy and dilation and curettage. So what we do with that procedure is we actually will kind of dilate the cervix. We don't need to make any incisions on the abdomen or anything like that and it's usually just kind of a short same day procedure. But we'll kind of dilate the cervix up far enough to allow us to be able to pass a camera through the cervix. And then we can actually take a look at the endometrial lining of the uterus so we can actually look for structural abnormalities. We can look for fibroids, we can look for polyps, some of those types of things.

And then once we're able to get a look at those we'll do what is called a curettage. So we'll actually kind of scrape the very surface lining of that endometrial tissue off. We can send that to pathology to make sure that there's not any abnormalities that would be concerning for malignancy. And a lot of times if we have some of those little polyps we can actually kind of get rid of them, take care of that problem.

What is endometrial ablation?

When we look at trying to do an ablation, we will kind of still do the hysteroscopy and dilation and curettage portion of things. But then after we do that, we'll actually use one of a couple different devices to actually kind of cauterize or burn that very surface layer of the endometrium. And again, the thought being not that we're going to make the periods disappear, guaranteed. If it happens, it's great, but otherwise our main goal is to just kind of try to get those periods back to being a little bit more normal.

Who are candidates for endometrial ablation?

I would say candidates for endometrial ablation are going to be people who are having problems with abnormal bleeding. Usually people that are having either shorter cycle length, so they're having more frequent periods or they're having heavier periods than what they would normally do. But we also want them to be concluded with childbearing. So one of our main things that we want to make sure anytime we're considering doing an endometrial ablation is that the patient is not going to be planning on having any more children after that.

What are the benefits of endometrial ablation?

It ends up being a good procedure to kind of end up bridging them from that time where they're done with their childbearing to the time when they're going to hopefully be going through menopause.