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Heavy bleeding with clots and painful cramping - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Excellent Posted in: Menstruation and Miscarriage
Answered by

General & Family Physician
Practicing since : 2005
Answered : 2527 Questions
Doctor :   hi
Doctor :  
how can i help you
User :   I have always had irregular periods. Last one started March 23 and ended on June 30. On July 1 I had transvaginal ultrasound and bloodwork, received results yesterday that I had anemia, hypothyroidism and a thickened uterine stripe.
Doctor :  
i will help u in this
User :   Started on Ferrous Sulfate 325 mg 1xday and levothyroxine .05 mg 1xday yesterday and suggestion to get endometrial biopsy.
Doctor :  
can i ask few Q
Doctor :  
ok
User :   last night started bleeding and cramping again got very heavy today, passing large clots about every 20 minutes and cramps that are worse than i have ever had.
Doctor :  
ok
Doctor :  
can i ask few Q
User :   yes
Doctor :  
wats your age
User :   33

Doctor :  
when did yu attain menarche ?
User :   when i was 12

Doctor :   since how many yrs do yu have irregular periods
User :   since they started. Only irregular when not on birth control. have not been on bc for past 3 years.
Doctor :   do yu have kids
User :   yes, 2. Both normal pregnancies, both C sections. No other pregnancies.
Doctor :   let me first explain the cause for your increased bleed and cramps
User :   ok
Doctor :  
its due to Hypothyroidism
Doctor :  
when thyroxine harmone decreases the menstrual
Doctor :   flow increases with blood clots and menstrual cramps
Doctor :  
so because of blood loss yu have anemia- decreased hemoglobin count
Doctor :  
other than thickened uterine flap did yu have any other finding in the ultrasound
User :   one small cyst on right ovary
Doctor :   thickened uterine flap is increased endometrial thickness
Doctor :  
ok
Doctor :  
did the doctor do D and C- dilatation and curratage
User :   no
Doctor :  
ok
Doctor :  
did yu have white discharge per vagina
Doctor :  
or low back ache
User :   no white discharge, just bleeding and watery discharge. Yes i do have a low backache.
Doctor :  
ok
Doctor :  
when was you last cycle
User :   started on March 23, ended on June 30th
Doctor :   how many pads do yu change per day

User :   about every 2 hours. Most of the blood does not flow to fill pad, it comes out in clots when i sit to urinate.
Doctor :  
ok
Doctor :  
as per your symptoms its heavy flow both in duration and even the amount
Doctor :  
even increased endometrial thickness will lead to heavy flow and watery discharge
Doctor :  
have yu gained wt recently
User :   yes

Doctor :  
ok
User :   not at once, gained about 20 lbs over past year
Doctor :  
do yu have any skin changes over the abdomen or arms
User :   no
Doctor :  
do yu feel more tiredness
Doctor :  
even after doing minor works
User :   definitely
Doctor :  
ok
Doctor :  
any change in the voice
Doctor :  
or cold intolerance
User :   no
Doctor :  
wats your occupation
User :   stay at home mom
Doctor :  
any swelling in the neck
Doctor :  
ok
User :   no
Doctor :  
fine
Doctor :  
overall its
Doctor :  
Hypothyroidism+ increased endometrial thickness=
Doctor :  
increased blood flow - anemia - tiredness
Doctor :  
wats your hemoglobin levels
User :   I don't remember the level, sorry
Doctor :   did yu check your cholesterol levels
Doctor :   ok not a problem
User :   no, not that I'm aware of

Doctor :  
ok
Doctor :  
yu need the following investigations
Doctor :   1. Fasting lipid profile
Doctor :  
2. ECG
Doctor :  
3. Dilatation and curettage
Doctor :   of the endometrim
Doctor :  
dilatation and curettage had both diagnosis and also for treatment
Doctor :  
by curettage the excess of the endometrial tissue can be removed
Doctor :  
so the bleeding will also get controlled
Doctor :  
4. endometrial biopsy
Doctor :  
this to rule out other causes of bleeding and even to rule out cancer
Doctor :  
as you were on BC for a long period
Doctor :  
is that fine
Doctor :  
Now coming to treatment part
User :   ok

Doctor :  
are yu on any medications for increased menstrual flow
Doctor :  
and cramps
User :   no, just naproxen for pain
Doctor :  
Naproxen is only analgesic does not help much
Doctor :  
when is your next appointment with the doctor
User :   not until august 22
Doctor :  
oh thats late
Doctor :  
ok
Doctor :  
Take tab. MEFTAL SPAS
Doctor :  
its a combination of 2 tablets Mefenamic acid and Dicylcomine hydrochloride
Doctor :  
take 2 -3 times a day after food
Doctor :  
for 3 days
Doctor :  
this will help u to control the bleed and the cramps including the low back ache
User :   do i need a prescription for that? Where would I find it?

Doctor :  
its over the counter drug
Doctor :  
in pharmacy yu will get it
Doctor :  
if not MEFTAL SPAS yu can take
Doctor :  
Tab Meftal only
Doctor :  
even this will help yu
User :   ok

Doctor :  
next is to control the main cause
Doctor :  
thats hypothyroidism
User :   ok
Doctor :   at wat time are yu taking the thyroxine supplements
User :   at 2 in the afternoon
User :   no, i take that back, i take that at 9 am, i take the iron in the afternoon

Doctor :  
sorry for the delay
User :   I just did a quick search and Meftal Spas is not available in the US without a prescription. Is there anything else?
Doctor :  
thats good
Doctor :   plain Mefenamic acid is also help ful go for it
User :   ok
Doctor :  
its ideal to take thyroxine supplements in early morning
Doctor :  
if yu take it in early morning the whole medication will be completely utilized by the body
Doctor :   Diet in Hypothyroidism
Doctor :  
diet rich in vitamins and mineral is required
Doctor :  
take plenty of green leafy vegetables
Doctor :   take more vegetables like tomato, onion, carrots, beet, radish, pumpkin and others
User :   ok
Doctor :  
take more fresh fruits like apple, cherry, papaya and others
Doctor :   skimmed milk is ideal as it contains less fat
Doctor :  
low fat on non fat yogurt is good
Doctor :   use olive or canola oil for cooking as they contain less saturated fat
Doctor :  
take a Multivitamin tablets
Doctor :  
which contain B- complex vitamins and selenium
Doctor :  
once daily after food in the nite
Doctor :  
for 1-2 months
Doctor :  
this will reduce the tiredness and keep yu more fresh
Doctor :  
is that fine
User :   yes. How long is it safe to wait to get the d&c?
Doctor :  
diet like cabbage, cauliflower, broccoli, tulips to be avoided as they can cause goiter in hypothyroidism
Doctor :   once the bleeding is under the control
User :   ok
Doctor :  
so dilatation and curettage is for treatment aspect
Doctor :  
but for yu control of heavy bleed is of primary importance
Doctor :  
yu need to take iron supplements correctly
Doctor :   to improve the hemoglobin count
Doctor :  
take it after the food as it ok
User :   ok
Doctor :  
causes gastric irritation
Doctor :  
some amount of black stools will be there
Doctor :  
thats normal
Doctor :  
so the treatment for thyroid is life long
Doctor :  
not to stop medications in btw
Doctor :   thyroid hormones keep fluctuating
Doctor :   so ideal is check the thyroid profile once in 6 months
Doctor :  
not to worry
Doctor :  
be relaxed
Doctor :  
yu have identified the cause
Doctor :  
now its the proper treatment
Doctor :   with proper treatment your problem will be solved
Doctor :  
be relaxed
Doctor :  
Is there any thing else i can help yu with ?
User :   no, you did a fantastic job answering my questions and filling in some blanks for me. I really appreciate it.
Doctor :  
please fill the feed back and comment box
User :   Thank you again. Good night.
Doctor :   good nite

Doctor :  
take care, bye for now
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