I have been suffering with heavy abnormal bleeding during my menstrual cycle. My GYN gave me a diagnosis that began with A, but I can't remember it. I have had a series of tests over the past three months, and now he has started me on birth control pills without estrogen. He did say that if they didn't work I will need a hysterectomy. Can you possibly tell me what condition this is? Is a hysterectomy is the best solution?

--L.

Your doctor may be referring to anovulatory bleeding. This is bleeding that occurs when you don't ovulate and it often is irregular or heavy. The cause of anovulation should be sought and treated. Some of the possible causes are being obese, being underweight, thyroid problems, a pituitary tumor, polycystic ovaries, approaching menopause and stress. Another "A" word is adenomyosis; in this condition, the uterine lining tissue penetrates into the wall of the uterus, causing heavier periods. Progestin-only birth control pills or Depo-Provera may help control this.

Other causes for heavy menstrual flow are uterine fibroids or polyps. Both of these increase the surface area of the uterine lining -- if there is more surface, there is more to be shed with a period. Ovarian cysts may produce hormone imbalances that can affect bleeding patterns.

Hysterectomy is not the only option when dealing with abnormal bleeding. If it is anovulation and the cause is treated, then that can correct the bleeding pattern. Birth control pills or Depo-Provera may alleviate the heavy bleeding. A D&C may provide relief, although it may be only temporary. An outpatient treatment called hysteroscopy with endometrial ablation or resection (burning or removing the uterine lining via a telescope inserted through the cervix) can end bleeding completely or decrease it significantly in about 80 percent of women.

What option is best for you depends on your individual circumstances, your general health, your age and your desire for childbearing.