She looked at options like uterine myomectomy and uterine fibroid embolization, but she wanted kids one day. She feared the potential impact on her future fertility. She searched for an effective medication to treat her fibroids and reduce her heavy menstrual bleeding. She wanted to get her life back. 

For many years, women with fibroids have sought out menstrual cycle control options beyond oral contraceptives, Depo-Provera injections, and Progesterone IUDs. In May 2020, the U.S. Food and Drug Administration approved Oriahnn™ for the management of heavy menstrual bleeding associated with uterine fibroids in premenopausal women.

What is Oriahnn™?

Oriahnn™ is the only FDA-approved oral medication designed to improve and lighten heavy periods caused by uterine fibroids. Fibroids, also called leiomyomas, are benign uterine tumors that grow in the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime. 

Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth.

The addition of estradiol and norethindrone acetate adds back some of the female hormones to prevent side effects and help thin out the endometrial lining. 

Oriahnn™ is approved for use in premenopausal women to reduce the amount of bleeding caused by uterine fibroids.

Why would a woman want to try Oriahnn™?

Many women suffering from the effects of fibroids seek a non-surgical treatment to control heavy periods. Medial options allow her to reduce her symptoms without impacting her future fertility. An effective medication will enable her to keep her options open.

Older medications, such as Depo-Lupron (leuprolide acetate), are administered as an injection. This type of medication is costly, poorly covered by insurance companies, and often triggers menopausal symptoms such as hot flashes. 

Oriahnn™ comes packaged as a daily oral medication giving women the options to avoid surgery, procedure, or a birth control method. This pill is clinically proven to reduce heavy menstrual bleeding due to uterine fibroids within one month of taking it. 

Oriahnn™ is not birth control. Patients using this medication who do not want to get pregnant may want to consider a nonhormonal contraceptive option such as condoms, Phexxy, spermicide, copper IUDs, or a diaphragm. 

Does Oriahnn™ work? 

Oriahnn™ was studied in two 6-month clinical trials used for FDA approval. These studies included 591 premenopausal women aged 26–53 with heavy periods due to sonographically-confirmed uterine fibroids.

The participants measured menstrual blood loss (MBL) for two cycles before starting Oriahnn™ or a placebo. Only those with greater than 80 ml of MBL qualified for the study.

In the first study, 68.5% of patients who received Oriahnn showed a reduction in menstrual bleeding compared to 8.7% of patients who received a placebo. 

In the second study, 76.5% of patients who received Oriahnn showed an improvement in blood loss compared to 10.5% of patients who received a placebo.

Oriahnn™ was proven to lighten heavy periods in 70% of women with a 50% reduction in menstrual blood loss. During the 6-month clinical trials, only three women required surgery for their uterine fibroids.

What side effects for Oriahnn™?  

During the clinical trials, about 10% of patients stopped treatment because of any side effects. Of note,7% of women taking the placebo also stopped treatment due to side effects.

The most common reported side effects were hot flashes, headache, fatigue, and irregular uterine bleeding.

All products containing estrogen and progestin combinations increase the risk of thrombotic or thromboembolic disorders, including pulmonary embolism, deep vein thrombosis, stroke, and myocardial infarction. A doctor must evaluate a patient’s medical history to determine if these medications are an appropriate option. 

Oriahnn™ may increase the risk of bone loss so the FDA approval recommends limited its use to 24 months. 

A new medical option for fibroids

Gynecologists now have a new option to help women with fibroids. Women with fibroids who want to avoid surgery or birth control may want to consider Oriahnn™. 

This novel medication, back up by clinical evidence, gives women more choices to reduce menstrual bleeding caused by fibroids. 

The post Oriahnn; A Drug to Stop Heavy Periods for Women With Fibroids appeared first on Medika Life.

An endometrial biopsy is a simple office-based procedure where a doctor removes a small amount of tissue from inside the uterine cavity. This tissue is called the endometrium. To find out if any abnormal cells are present, the doctor must sample the endometrial tissue to be tested and evaluated under a microscope.

An endometrial biopsy is used to diagnose or rule out endometrial cancer or precancerous changes in the tissue called endometrial hyperplasia.

Women with postmenopausal bleeding, heavy periods, irregular periods, or abnormal findings on a sonogram may be candidates for this procedure. Most often, an endometrial biopsy is performed as part of the evaluation of abnormal uterine bleeding, but it also is used in cases of infertility.

What does this procedure involve?

The gynecologist inserts a thin, flexible tube called a pipelle into the uterine cavity through the cervix’s opening called the cervical os. Using negative pressure, the doctor pulls a small amount of endometrial tissue into the pipelle for sampling. The procedure takes only a few minutes and causes mild cramps.

Where is an endometrial biopsy procedure performed?

Gynecologists perform endometrial biopsy procedures in an office setting.

Can my family visit me?

Endometrial biopsies are performed in a medical office setting. The vast majority of patients will be able to drive themselves to and from the procedure. Some may prefer a trusted family member to bring them. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for an endometrial biopsy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally, gynecologists provide local anesthesia via a paracervical anesthetic.

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Some gynecologists recommend oral medication to reduce anxiety

What’s the procedure when I check in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because an endometrial biopsy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in position to allow visualization of the cervix, the procedure will attempt to pass a small pipelle through the cervix into the endometrial cavity. If the cervical os (opening) is too narrow, then the doctor will attach an instrument called a Tenaculum to the top of the cervix to stabilize the uterus. Then, they will use a small tool to dilate the cervix wide enough for the pipelle to enter. 

Once the pipelle is safely inside the uterus a small amount of endometrial tissue is pulled into the tube for sampling. 

These cells are sent to a pathologist for evaluation. 

After the biopsy, the speculum is removed and the procedure is complete. Some patients will experience mild bleeding, spotting or a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the procedure?

Once the patient enters the procedure room a series of safety steps must occur.

An endometrial biopsy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments

When can I go home?

After an office-based endometrial biopsy procedure, patients may go home after getting dressed as long as you are feeling normal.

Post-procedure recovery time will vary from person to person.

Endometrial biopsy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

• Some patients will require mild pain medication like NSAIDs.
• It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.
• You will be instructed to abide by pelvic rest for approximately 1–2 days. This includes no douching, no sex, and no tampons.
• You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 days.

You should not use tampons for 1–2 days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to review the pathology report findings. If any abnormalities are found on the biopsy, your doctor will discuss the next steps

Danger Signals to look out for after the procedure

After an endometrial biopsy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home?

Nothing special is required after an endometrial biopsy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for an Endometrial Biopsy appeared first on Medika Life.

Untreated heavy or prolonged bleeding can stop you from living your life to the fullest. It also can cause anemia. Anemia is a common blood problem that can leave you feeling tired or weak. If you have a bleeding problem, it could lead to other health problems. Sometimes treatments, such as dilation and curettage (D&C) or a hysterectomy might be done when these procedures could have been avoided with early treatment.

Causes

Possible causes fall into the following three areas:

1. Uterine-related problems
   1. Growths or tumors of the uterus that are not cancer; can be called uterine fibroids or polyps.
   2. Cervical and uterine cancer.
   3. Certain types of birth control—for example, an intrauterine device (IUD).
   4. Problems related to pregnancy, such as a miscarriage or ectopic pregnancy, can cause abnormal bleeding. A miscarriage is when an unborn baby (also called a fetus) dies in the uterus. An ectopic pregnancy is when a baby starts to grow outside the womb (uterus), which is not safe.
2. Hormone-related problems
3. Other illnesses or disorders
   1. Bleeding-related disorders, such as von Willebrand disease (VWD) or platelet function disorder.
   2. Nonbleeding-related disorders such as liver, kidney, or thyroid disease; pelvic inflammatory disease; and cancer.

In addition, certain drugs, such as aspirin, can cause increased bleeding. Doctors have not been able to find the cause in half of all women who have this problem. If you have bleeding such as this, and your gynecologist has not found any problems during your routine visit, you should be tested for a bleeding disorder.

You may exhibit the following symptoms

You might have menorrhagia if you:

• Have a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row.
• Need to double up on pads to control your menstrual flow.
• Need to change pads or tampons during the night.
• Have menstrual periods lasting more than 7 days.
• Have a menstrual flow with blood clots the size of a quarter or larger.
• Have a heavy menstrual flow that keeps you from doing the things you would do normally.
• Have constant pain in the lower part of the stomach during your periods.
• Are tired, lack energy, or are short of breath.

Diagnosing Menorrhagia

Finding out if a woman has heavy menstrual bleeding often is not easy because each person might think of “heavy bleeding” in a different way. Usually, menstrual bleeding lasts about 4 to 5 days and the amount of blood lost is small (2 to 3 tablespoons).

However, women who have menorrhagia usually bleed for more than 7 days and lose twice as much blood. If you have bleeding that lasts longer than 7 days per period, or is so heavy that you have to change your pad or tampon nearly every hour, you need to talk with your doctor.

To find out if you have menorrhagia, your doctor will ask you about your medical history and menstrual cycles.

He or she may ask you questions like the following:

• How old were you when you got your first period?
• How long is your menstrual cycle?
• How many days does your period usually last?
• How many days do you consider your period to be heavy?
• How do your periods affect your quality of life?

Your doctor may also ask if any of your family members have had heavy menstrual bleeding. He or she may also have you complete a questionnaire to help determine if you need to be tested for a possible bleeding disorder.

You might want to track your periods by writing down the dates of your periods and how heavy you think your flow is (maybe by counting how many pads or tampons you use). Do this before you visit the doctor so that you can give the doctor as much information as possible.

Possible Tests

Your doctor might tell you that one or more of the following tests will help find out if you have a bleeding problem:

• Blood test. In this test, your blood will be taken using a needle. It will then be looked at to check for anemia, problems with the thyroid, or problems with the way the blood clots.
• Pap test. For this test, cells from your cervix are removed and then looked at to find out if you have an infection, inflammation, or changes in your cells that might be cancer or might cause cancer.
• Endometrial biopsy. Tissue samples are taken from the inside lining of your uterus or “endometrium” to find out if you have cancer or other abnormal cells. You might feel as if you were having a bad menstrual cramp while this test is being done. But, it does not take long, and the pain usually goes away when the test ends.
• Ultrasound. This is a painless test using sound waves and a computer to show what your blood vessels, tissues, and organs look like. Your doctor then can see how they are working and check your blood flow.

Using the results of these first tests, the doctor might recommend more tests, including,

• Sonohysterogram. This ultrasound scan is done after fluid is injected through a tube into the uterus by way of your vagina and cervix. This lets your doctor look for problems in the lining of your uterus. Mild to moderate cramping or pressure can be felt during this procedure.
• Hysteroscopy. This is a procedure to look at the inside of the uterus using a tiny tool to see if you have fibroids, polyps, or other problems that might be causing bleeding. You might be given drugs to put you to sleep (this is known as “general anesthesia) or drugs simply to numb the area being looked at (this is called “local anesthesia”).
• Dilation and Curettage (D&C). This is a procedure (or test) that can be used to find and treat the cause of bleeding. During a D&C, the inside lining of your uterus is scraped and looked at to see what might be causing the bleeding. A D&C is a simple procedure. Most often it is done in an operating room, but you will not have to stay in the hospital afterward. You might be given drugs to make you sleep during the procedure, or you might be given something that will numb only the area to be worked on.

Treatment

The type of treatment you get will depend on the cause of your bleeding and how serious it is. Your doctor also will look at things such as your age, general health, and medical history; how well you respond to certain medicines, procedures, or therapies; and your wants and needs. For example, some women do not want to have a period, some want to know when they can usually expect to have their period, and some want just to reduce the amount of bleeding.

Some women want to make sure they can still have children in the future. Others want to lessen the pain more than they want to reduce the amount of bleeding. Some treatments are ongoing and others are done one time. You should discuss all of your options with your doctor to decide which is best for you. Following is a list of the more common treatments.

Drug Therapy

• Iron supplements. To get more iron into your blood to help it carry oxygen if you show signs of anemia.
• Ibuprofen (Advil). To help reduce pain, menstrual cramps, and the amount of bleeding. In some women, NSAIDS can increase the risk of bleeding.
• Birth control pills. To help make periods more regular and reduce the amount of bleeding.
• Intrauterine contraception (IUC). To help make periods more regular and reduce the amount of bleeding through drug-releasing devices placed into the uterus.
• Hormone therapy. To reduce the amount of bleeding.
• Desmopressin Nasal Spray (Stimate®). To stop bleeding in people who have certain bleeding disorders, such as von Willebrand disease and mild hemophilia, by releasing a clotting protein or “factor”, stored in the lining of the blood vessels that helps the blood to clot and temporarily increasing the level of these proteins in the blood.
• Antifibrinolytic medicines (tranexamic acid, aminocaproic acid). To reduce the amount of bleeding by stopping a clot from breaking down once it has formed.
• Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth.

Surgical Treatment

• Dilation and Curettage (D&C). A procedure in which the top layer of the uterus lining is removed to reduce menstrual bleeding. This procedure might need to be repeated over time.
• Operative hysteroscopy. A surgical procedure, using a special tool to view the inside of the uterus, that can be used to help remove polyps and fibroids, correct abnormalities of the uterus, and remove the lining of the uterus to manage the heavy menstrual flow.
• Endometrial ablation or resection. Two types of surgical procedures using different techniques in which all or part of the lining of the uterus is removed to control menstrual bleeding. While some patients will stop having menstrual periods altogether, others may continue to have periods but the menstrual flow will be lighter than before. Although the procedures do not remove the uterus, they can not be done on women who desire children in the future.
• Hysterectomy. A major operation requiring hospitalization that involves surgically removing the entire uterus. After having this procedure, a woman can no longer become pregnant and will stop having her period.

Menorrhagia is common among women. Many women do not know that they can get help for it. Others do not get help because they are too embarrassed to talk with a doctor about their problem. Talking openly with your doctor is very important in making sure you are diagnosed properly and get the right treatment.

Who is Affected

Heavy bleeding (menorrhagia) is one of the most common problems women report to their doctors. It affects more than 10 million American women each year. This means that about one out of every five women has it.

The post Menorrhagia or Heavy Menstrual Bleeding appeared first on Medika Life.