How can I maintain uterine health?

Maintaining Uterine Health: Evidence-Based Recommendations

Regular screening and appropriate contraceptive management are the cornerstones of maintaining optimal uterine health. The following comprehensive approach will help preserve uterine health and prevent complications:

Routine Screening and Monitoring

• Schedule regular gynecological visits to assess uterine health, with frequency determined by age, risk factors, and current contraceptive method 1
• Cervical cancer screening should be performed according to current guidelines, though routine screening pelvic examinations in asymptomatic women are not recommended 2
• Monitor for abnormal uterine bleeding patterns, which may indicate underlying pathology; normal menstrual periods last 3-6 days with blood loss up to 80ml 3
• If using hormonal contraception, follow recommended monitoring schedules, including blood pressure checks for combined hormonal contraceptive users 1

Appropriate Contraceptive Management

• Choose contraceptive methods that align with your reproductive goals and medical history, as some methods may help maintain uterine health 1
• Consider long-acting reversible contraceptives (LARCs) like IUDs, which can provide benefits for uterine health in addition to contraception 1
• For those using IUDs, verify proper placement by checking for the presence of IUD strings during follow-up visits 1
• Be aware that levonorgestrel-releasing IUDs can reduce menstrual blood loss and may help prevent endometrial hyperplasia 4
• When using hormonal contraceptives, understand that breakthrough bleeding is common, especially in the first 3-6 months, and generally decreases over time 4

Managing Abnormal Uterine Bleeding

• For abnormal uterine bleeding, seek evaluation to rule out underlying conditions using the PALM-COEIN classification system (polyps, adenomyosis, leiomyoma, malignancy, coagulopathy, ovulatory dysfunction, endometrial disorders, iatrogenic, not yet classified) 5
• First-line treatments for idiopathic abnormal uterine bleeding include levonorgestrel IUD, tranexamic acid, oral contraceptives, or NSAIDs 3
• For heavy or prolonged bleeding with hormonal contraceptives, NSAIDs for 5-7 days are recommended as initial treatment 6
• If using extended regimen combined hormonal contraceptives and experiencing breakthrough bleeding, a hormone-free interval of 3-4 days may help (but not during first 21 days of use) 7

Infection Prevention

• Practice safe sex and use barrier methods when appropriate to prevent sexually transmitted infections that can affect uterine health 1
• Before IUD insertion, screening for STIs can be performed at the time of placement if routine screening has not occurred according to guidelines 1
• Women with purulent cervicitis or current chlamydial infection or gonorrhea should not undergo IUD insertion until appropriate testing and treatment occurs 1
• Standard practice includes cleansing the cervix and sterilizing instruments prior to and during insertion of an IUD 8

Lifestyle Factors

• Maintain a balanced diet rich in fruits and vegetables, which may have a positive impact on gynecological health 9
• Consider Mediterranean diet patterns, adequate vitamin D intake, and consumption of plant-derived compounds, which may benefit uterine health 9
• Limit consumption of red meat, alcohol, and excessive caffeine, which may contribute to gynecological disorders 9
• Maintain a healthy weight, as obesity is associated with various gynecological conditions 2

Special Considerations for Fertility Preservation

• If planning future pregnancy, discuss fertility preservation options with your healthcare provider, especially if treatments that may affect fertility are being considered 1
• For women with hormone receptor-negative early-stage breast cancer requiring chemotherapy, GnRH agonists may help protect ovarian function 1

By following these evidence-based recommendations, you can maintain optimal uterine health throughout your reproductive years and beyond, reducing the risk of complications and preserving fertility when desired.