When a patient asked, "I shouldn't be getting face slimming shots anymore?" I said, "If it worked for you, you can since V-line face is also something important!

" (opening song)
English subtitles written by Woori subtitles
*woori.subtitles.eng@gmail.com Dr. Hong: You are going to talk from there, Dr. Choo?

Dr. Kwon: We can do this! Dr. Kwon: Let's do this! OBGYNs that you, me, and people of all genders and ages should know (low tension)
Our neighborhood's OBGYN!

Wooridongsan Hoooray! What time is it now What time is it now!

Do you know what time is it now (Answer: 11 PM)
Dr. Choo: We just started a 10-minute live (which ended up to be 150 minute live) (Dr. Hong eager to go home)
Dr. Choo: but we did it for 100 minutes) We are going to talk about what many people are curious about which is very awkward that we haven't filmed about this until now.

The two main reasons that make people visit an OBGYN are (1) I am not having periods (1) I am not having periods
and
(2) I have bleeding not during periods We haven't filmed about amenorrhea and metrorrhagia.

So today, we would like to talk about the metrorrhagia.

First, what is the definition of the metrorrhagia? Definition is the most important in medicine. It's the first sentence of every chapter.

Q. What is metrorrhagia? Opposite from women's regular uterine bleeding, irregular bleeding from the uterus is called metrorrhagia.

In Korean, the word's pronunciation is the same as "bad," so some people think it's bad bleeding.

Dr. Kwon: Ah, so some may think there is good bleeding and bad bleeding. If there's bleeding other than menstruation, that is metrorrhagia.

Medical terms are abnormal uterine bleeding (AUB) and abnormal vaginal bleeding. Although normal menstrual bleeding differs between individuals, is there a range that can be considered as "normal"?

In terms of period, if there's menstruation every 24 to 38 days, we can consider it as a "normal period." If the period is shorter than 24 days or longer than 38 days, we can think the period is shorter or longer than the normal range.

Some people may be experiencing a delay of menstruation, but depending on the age, if the delay is within a week, it can be considered "normal." For example, if you had a menstruation period of 24 days until last month that changed to 31 days now, like if the interval between the last menstruation and this menstruation is 31 days, it is normal.

Menstrual bleeding at the beginning and end of the month is also normal. Since it's so-called "period," 28 days (4 weeks) is emphasized from the name.

However, only 15% of people have a 28-day period. Others (85%) have a period within 24 to 38 days.

Dr. Hong: I am amazed to see people who say that their menstruation is on the same date every month. Dr. Kwon: The interesting part is that Dr. Kwon: There are 31 days or 30 days in a month.

Dr. Choo: Maybe it's false recognition due to no recording of their period. Dr. Kwon: Those people are remembering by dates.

Within the first 2-5 years or before the age of 20, metrorrhagia is quite often. Do not worry too much and visit a doctor to get a consult about it.

People in the very early stage of menstruation, metrorrhagia does not necessarily mean huge problems unless they are pregnant.

HOWEVER, people having imperforate hymen with an imperfect hole, may misunderstand bleeding as menstrual bleeding. Therefore, if teenagers are experiencing abnormal bleeding, it's better to visit a doctor to check that there's no anatomical problem.

Q. What are the causes of metrorrhagia? Anatomical issues that cause metrorrhagia are: polyp, adenomyosis, uterine fibroid, endometrial cancer, cervical cancer, and endometrial hyperplasia.

Another cause is hormonal imbalance. Among the anatomical issues, a polyp can locate at the cervix and endometrium that can easily cause the metrorrhagia.

In the case of the endometrial polyp, its removal is not complicated.

For young people who have symptomless endometrial polyp can leave it untreated, but if there's related metrorrhagia every few months, you can simply get it removed with hysteroscopy just like the gastroscopy.

So, don't worry too much. It's better to get it treated.

It's too simple to be called a "surgery". Removal of a cervical polyp is much simpler. None of them hurts, so you should better get the polyps removed when there's accompanying metrorrhagia.

If the beginning and ending of menstruation is unclear, we can suspect that your polyp is the cause, although that's not always the case, if you have such symptom with actual polyp, we can try removing them.

Dr. Kwon: However, they may repeat again Dr. Hong: Yup Bleeding from a cervical polyp mostly occurs after a sexual intercourse.

So if you have bleeding after sex, it may be due to cervical polyp or cervical cancer that YOU MUST GET EXAMINED.

Regarding hormonal unbalance, the most common cause is the thyroid. You may feel it's weird to hear that the thyroid is related.

The thyroid hormone and the hormone that controls the ovulation (LH) partly have the identical molecular structure. Thus, when there's up and downs of the TSH (Thyroid-Stimulating Hormone) the period become irregular.

The common cause of metrorrhagia are hypothyroidism and hyperthyroidism.

Also, hormone imbalance can come from the prolactin. Women who delivered a baby will know that during breast feeding, there's no menstruation.

So if there's prolactin hormone imbalance, there may be either no period, or metrorrhagia. When you have visited an obgyn for metrorrhagia, you might have questioned "why are they examining my thyroid hormone and prolactin?

" It's because those two (TSH and prolactin) are the basic factors to check.

Along with the estrogen, we check your thyroid function and prolactin. The moment that I feel pity during outpatients' appointments is when they ask about their one-month-old bleeding.

Dr. Kwon: After the bleeding stopped Dr. Hong: Yeah. There are many moments like that Then, I ask "why didn't you come earlier?

" and they say "I felt sorry to show my blood to you" or "how can I come when I am bleeding?

" BUT! You should come when you are bleeding. You should visit a doctor when there's bleeding Secondly, in case of a polyp, it's difficult to see during bleeding because of adhesion of the polyp with the blood clot.

In such case, most OBGYNs will suggest you come back right after the next menstruation. Dr. Kwon: When I ask them to come after the next menstruation, many of them come later than I expected.

It's best to come when the bleeding changes to brown so that the doctors can examine more exactly.

Some may ask how transvaginal ultrasound is possible during bleeding, but it doesn't matter. We can do ultrasound during bleeding. In matter of fact, it's more important to capture the moment.

It's good to visit at the 5-7th day since menstruation. Small bleeding doesn't matter, so please visit an OBGYN at the right moment.

Especially, 5-7th day is the best to examine the endometrial polyp. Q. What are other possible causes of metrorrhagia?

One of the most common bleeding is: anovulatory dysfunctional uterine bleeding or anovulatory amenorrhea (absence of period).

Regardless of anovulation, the hormone system is running, which leads to incomplete menstruation cycle and collapse of hormone balance. That's most common.

Many polycystic ovary syndrome (PCOS) patients not only have amenorrhea but also metrorrhagia.

Stimulation from the estrogen weakens the endometrium. I had bad ovulation bleeding. Ovulation bleeding is one of the common metrorrhagia.

So, there are many people worrying about their potential infertility. However, ovulation bleeding does not directly imply infertility. You can consider the ovulation bleeding as one of the several symptoms.

It's important to confirm that it is really an ovulation bleeding and not to leave it as your personal guessing. Your guess of "Hmm, this seems to be ovulation bleeding" may not be true unless examined.

The best solution is to check from your periods. Many among people who have bleeding right after menstruation are experiencing ovulation bleeding.

Some people have similar amounts of bleeding during abnormal bleeding and menstruation. I tell my patients how to distinguish the two.

Not only the way of bleeding, but also the characteristic symptoms during menstruation like irritation, eagerness for sweets, headache, menstruation pain, and depression should be checked.

The bleeding while you have those characteristic symptoms is menstruation.

Whereas if it isn't, it's highly likely to be metrorrhagia. We often ask the patients to write a menstruation diary.

If you have metrorrhagia, you must Dr. Hong: Recently, smart phones are so convenient
Dr. Kwon: Yeah, nice applications.

record it regularly. Menstruation diary is convenient for the doctors too. Observing the application almost gives us answers.

Moreover, if you have taken medicines like Aspirin or steroids prescribed by the orthopedics, Dr. Choo: metrorrhagia happens often.
Dr. Hong: Also the face slimming shots.

If you have gotten any shot recently, or if you have eaten any special food before menopause like pomegranate, herbal extract, herbal medicine, it collapses the hormone balance.

Around the menopause, hormone is not balanced originally, but if you eat those food, it makes things worse like metrorrhagia.

If you are taking anything other than vitamins, you should tell us. A lot of bride-to-be get slim shots, and they come to me about metrorrhagia.

Such metrorrhagia does not last forever. Metrorrhagia caused by things like steroids does not last forever.

When my patients ask whether they should never get slim shots, I tell them to get shots if it was successful. I say, "Good shape is more important, right?" The shot does not last forever though, so they should get it constantly.

Drastic weight loss. Recently, many youngsters are on a diet.

It's important to retrieve the weight of regular periods. If you have gained or lost too much weight, you will be able to find a moment when you had regular periods if you have recorded well.

It's better to return back to that weight. Sudden increase or decrease of weight can cause metrorrhagia or amenorrhea.

It's better to change the weight in a long term. I feel bad for flight attendants because of constant jet lags.
Dr. Kwon: Also people with work shifts.

If someone lives day-night shifted, hormone balance cannot be established, so many of them experience either metrorrhagia or amenorrhea.

Extreme examples would be students preparing for university entrance exam and life like residents. Dr. Kwon: We rarely have menstruation during residency.

Dr. Hong: I had constant metrorrhagia. Dr. Kwon: And no menstruation. If you are doing a very harsh job metrorrhagia is very likely to occur.

As our subscribers tell us, is like a sunfish.
(Do you know the Survive! Mola mola! game?) Women after menopause experience abnormal bleeding during hormone therapy.

Also, the menopause itself can cause the bleeding.

Vaginal dryness easily makes scars, that lead to bleeding. However, three out of 10 menopause vaginal bleeding is related to cancer.

It's different from young people. Most of bleeding of young people are due to benign diseases. In contrast, bleeding of a woman after menopause is highly possible to be cancer.

You MUST visit a doctor to get examined exactly. I had such a patient. When I asked when did the bleeding start, she said it started six months ago.

Then I asked why didn't she come earlier. She said she felt younger. There are some who welcome the bleeding after their menopause.

As women after menopause tend to eat many hormone-breaking foods, if you visit a doctor for bleeding, please list up what you have been taking.

The most difficult case is bleeding during perimenopause when everything is irregular. Dr. Kwon: Because metrorrhagia is likely. Dr. Choo: And the amount can be huge.

When someone says, "I am having a period for the first time in six months, but it's lasting for two weeks," which I think is normal, but we cannot easily say it since we are not wizards.

We cannot exactly determine just by naked eyes.

Q. What is the most important thing that the metrorrhagia patients can do before visiting a doctor? It's the pregnancy test check.

Different from what people generally think, that there will be no bleeding after pregnancy, there can be bleeding like implantation bleeding. Hence, a pregnancy test check should be done first.

In case of extrauterine pregnancy, there can be bleeding like normal menstruation. So you must do the pregnancy check first.

Always use the pregnancy test kit whenever you don't have periods or whenever you have metrorrhagia. You should check unless you did not have any sex.

Put stars and underline. In our generation, we should put pig tails too. Q. What are the possible treatments for metrorrhagia?

If it is due to either adenomyosis, myoma, or polyp, we do treatments for those. Regardless of the cause, the simplest solution is injecting the hormone.

Using birth control pills is the most effective. If you feel uncomfortable about the hormone treatment, we can use a hemostat.

However, the contraceptive pill is the most used and the most effective method. NSAIDs also have hemostatic effect and we can try using it to stop the bleeding, but their effectiveness is less than the hormones.

Using two or three pills of contraceptives per day instead of one, and decrease the amount through time. If the patient wants contraception, we recommend taking the pills in a long term.

Or if the patient does not wish for contraception, we basically offer to take the pills for more than three months. In case of bleeding by uterine fibroids, the amount is huge, that they have severe anemia.

In that case, if we stimulate the menstruation, it's too much bleeding and it's better to control the menstruation (and anemia) throughout 2-3 months.

In such means, using hormonal treatment for about three months is good. Some metrorrhagia without any adenomyosis, uterine fibroid, or polyp, may accompany huge bleeding.

In such case, we can do curettage to remove the inner bleeding source and use medicine and hemostatic during hospitalization.

If the amount of bleeding is huge, you must visit the hospital ASAP. In a contraceptive pill, there are female hormones like estrogen and progestin.

Depending on the thickness of the endometrium, we prescribe them individually. But, this knowledge is OBGYN-specialist level, or OBGYN resident level, so for our subscribers, it's sufficient to think in a simple way: contraceptive pills for metrorrhagia.

Let's assume that a woman had metrorrhagia 2 weeks ago and got an ultrasound examination and hormonal therapy.

But she had metrorrhagia again after 3 weeks. Then, we do the ultrasound scan again. In such case, she might ask why we are repeating the ultrasound.

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"Wooridongsan" is a Korean abbreviation for OBGYNs in our neighborhood. 🌄
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