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Having coagulation problem, near to get menopause, slightly anemic. What should i do?

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Internal Medicine Specialist
Practicing since : 2001
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I was recently on here in the past few weeks due to female issues and corresponded with Dr. Koregol. (sp?) an infertility specialist. I really need a Dr. who can listen to what I am saying and help guide me on what to do. Dr. Koregol helped me, but now it has gone beyond what he can do I believe, atleast in part. My doctors in my area are either not listening to me, or they contradict each other and I am quite frankly frustrated. I am also very much apt to handle my health as naturally as possible and without meds. I hope you are able to see my correspondence with Dr. Koregol. It would be a lot to type if not. I will be breif as possible, but get to the point as best I can. I am 47, female, and have had 5 children. I am about 154 lbs., and 5'6". I am healthy in many respects (blood pressure, cholesterol, etc), but have been dealing with a lot of stress in my life and menstrual bleeding which is what has gotten me to where I am now..also thanks to a Dr. who did not treat me right. I am not crazy, and I am very educated, so therefore I do my research and read and it seems the more I do, the more the doctors do not want to listen to me as they get the attitude that I know nothing and must be wrong and they are always right. I am not saying I am completely right, but they still are not listening to my full history and things to me are just not adding up right or making sense and they think they are. So, this is it: I have always had heavy menstrual bleeding since age 14, at first menses was two weeks long. I bruise easily, and after each child I bled more than I wanted to, but not life threatening..but it went on longer than normal in my opinion. Also at age 18 with all four wisdom teeth out, I got dry socket. And, 12 years ago, during 3 hour breast lift surgery, the dr. said it took 5 hours instead as I was "oozing" during surgery. I also have every year been at hemoglogin levels of 10 or 11 during cbc physicals and probably dropped to 9 or so every month during my heavy cycles that come every 3 weeks or so, earlier than 28 days usually. My docs would always say: "you are slightly anemic". I would tell them I was eating right and taking supplements and they would be fine with that. I trusted them to do what I needed if they didn't think what I was doing was right. But to be below 12 ALL the time is probably not good. I am now seeing all the symptoms put together. I am always cold in AC places, nails get brittle, etc...all iron low symptoms I have. Anyway, my nightmare started this past May as far as serious. For the first time ever I got two periods (very heavy) 16 days apart. I knew it might be that I was getting older, but knew I should get checked out. I had a doc order a uterine ultrasound. It should masses, abuout two. I went then to an OBGYN who made things worse for me. He is a very volatile, arrogant dr., but not at first. I also had a cyst on my left ovary, along with "stuff" in my uterus. (Oh, forgot to mention I also had endometrial surgery at age 22 (laparoscopy?) and was "cleaned out"). So the dr. and I discussed my past history and the cyst and the uterus. He said to do a follow up ultrasound 3 months later to ck the cyst. For the uterus, he said let's do a biopsy. So, on JUly 2nd, I had the biopsy in his office vaginally with a hysteroscope. It was done while I was awake with ibuprofen and hydrocodone. It was only 7-8 min. long. I asked him if it was polyps or fibroids, and he said he wouldnt' know til biopsy came back, but that is not what he said prior to. He said during he would be able to see on the camera. Anyway, he said I would just spot for a few days after. I did for 2.5 weeks. Then all went to hell. On July 20th, I started bleeding very heavily like the first 3 days of my period is, so heavy that I was having accidents in the car while driving, just 30 min of driving, public accidents in the store, having to take changes of clothes with me, going through over 120 tampons in 8 days and pads. Clots were being passed from nut size to golf ball size. It was like my period, but wouldn't end. I started to get out of breath going up stairs at home, (and I usually play softball), I couldn't play, and i slept most of the time. I thought: "All this from a biopsy?" I did call my dr. all the time, letting his staff know how much I was bleeding. I asked for him to call me, and they said no he could not. They said "The dr. says your uterus is irritated and this is normal, but if you want to go to the ER, you can, or you can come in XXXXXXX I asked what he could do for me, they wouldn't say. I needed to know from them what to do, and they kept putting the decision in my hands. I needed guidance and got none. In the meantime, the dr. was waiting for two things: me to stop bleeding and he was arguing with my insurance because he wanted the surgery to remove the "stuff" to be done in his office and my insurance would only approve it at an outpatient setting/hospital. So, while he had it out with them, he never won and on Aug 23rd, I had surgery to remove the stuff in my uterus with a hysterscopic tool under anesthesia. He did not do a D&C, just removal of the growths. I bled up until the surgery, but it had started to slow. Then after the surgery I started bleeding again, but moderately (I don't think much was in there at this point), and bled for about 5-6 days. Then I didn't expect a period for a while, but only 18 days later, I bled very heavily for about 5-6 days. Also on day of surgery, my hemoglogin was 8.4. When I went to the dr. 18 days after surgery, I insisted to see a hematologist because I felt terrible and was at a loss that I was bleeding again so soon. He suggested the hematologist per my request and to do a uterine ablation. I was in such distress I agreed to an ablation scheduled for two weeks out. I then went home, thought it over and called two days later to cancel the ablation telling the staff I wanted to see what my body does post surgery a bit longer, AND get the follow up ultrasound, AND see the hematologist first. He was so angry he called me to yell at me and said I was getting advice from "friggin morons XXXXXXX etc...Anyway, I decided I wasn't going back to him, and continued on to find a hematolgoist and the follow up ultrasound. The ultrsound came back showing post surgery a possible growth at top of uterine cavity (Maybe blood clot), and still a thickened uterine lining, which I have had for years. So, they still saw some stuff and this was done after the 18 day bleed after surgery in late SEpt. about a month after surgery. In the meantime also, on Oct 1st, this month, my hematologist drew blood and at my insistence I wanted a test for VWD. I kept thinking of all the past history: long period at menarch (two weeks), problems during surgeries, dental extraction problems etc..I even had petichae a few times last year and no one knows why. My ankles swelled a few times in the past 18 months, but that could be due to the anemia. Two days later, early blood results showed hemoglobin still low and ferritin low. Hemo was 8.5 and I was at 7 weeks post surgery. I was ordered on a Friday to bed rest til monday and then to come in. I felt awful. I went in and she put me on 6 iron IV infusions to be done in one week. I had allergic reaction so I had to have benadryl before too. I did get bad cramping and diahrea during. That was completed last week while I waited for VWF test. I never expected to see what I saw two days ago when those results came in.

They said the opposite of what I expected. I don't wish for VWD, I just wanted solid answers as to why I bleed like this and have varied symptoms. My results showed factor viii at 219!! My vwf was 176! factor xiii was 141! and RBC 3.51,HCT 30, MCH 24.2, MCHC 28.3. other stuff was normal range. The doctor said "your platelets are working fine, in fact too good XXXXXXX She never addressed what she saw on my results shows a flag for risk of VT etc...and mentions a risk for birth control pills. But she then suggested that when I saw my NEW obgyn, which was yesterday, to possibly think of BC pills to control the bleeding since she said my bleeding is all due to mechanical issues with the uterus and not VWD. (By the way, both biopsy and surgery tissues, two times showed pathology for uterine was benign). So in my research, I have found many sources telling me that factor 8 and vwf can be raised due to trauma, post surgery, emotional stress (I was a basket case in her office on Oct.1 when they drew my blood, crying etc... and have been very stressed even wtih family issues), and also in early July before the hemmoraghing, I was hit badly on the right leg with a ball very hard and it resulted in a contusion on my calf muscle that bruised the size of small football and bruised down to my ankle. It was horrible, and still is slightly bruised 3 months later. I feel that post two surgeries, stress, and trauma to my leg might have elevated my factors. So, the problem is this: I am also type O blood, which according to what I read has a lower incidence of these factors and to control my cyles, I am afraid to do BC pills if this test IS right, but is it? I asked the hemo doc if it is accurate and she assured me...but I am not so sure when all these factors come into play and she ignores my pleas. Also, I have not bled since mid Sept., and my new OBGYN is ordering a new ultrasound to be done at the tail end of the next cycle whenever it arrives. Until then, I am on 300 mg of iron daily for the next 3 months because after the infusions I have hemo at only 11, which is where I hovered at most of my life until I bleed. I do not want a hysterectomy if no cancer and I want to make sure I don't have VWD because if a hysterectomy is ever in the future, that is surgery and I seem to bleed after surgeries. I am not convinced about my results, are you? I am tired of docs who seem to downplay my knowledge and put me off when I say something they don't know. Please advise if I should demand a new vwF test in a few months when I am less stressed and more healed, or change doctors also. Also, if it comes back the same, what about BC pills to get me through to menopause? I don't think I am facing menopause for a while, but the cysts on my ovaries (2nd ultrsound showed one on right now), could cause issues. I don't want an ablation or IUD. Sorry for the long story, but I need someone with great knowledge here, not just a dance around doctor. Thank you for all your help.
Posted Thu, 15 Nov 2012 in Medicines and Side Effects
Answered by Dr. Ram Choudhary 6 hours later
Thanks for writing in to Healthcare Magic!
There are many people these days around, who believe they can out-smart the doctors by reading 40-50 pages from internet on an isolated topic.
In fact this unfortunate lot suffers more than the illiterate folks due to their apathy and poor concentration/compliance with the Doctor's orders.
Please stop this ideation, as a layman you can not out smart the poorest kind of doctor, let aside the doctors in your vicinity.
It was a real pain to read such a long document, full of pain, blood, rift, discord, lack of trust, suffering, wastage of time, effort and money.
It is a serious affair!
Come to your basic problem. Your hematologist is satisfied about yours coagulation profile so am I. Some persons may have excessive bruisability due to their constitutional make up, tests would so normal reports but bruisability and oozing is due to excessive capillary fragility which may be in turn due to weakness of the connective tissue make up.
Retesting the vWF is meaningless because even a level as low as 30% of normal will prevent oozing, so what will you get; I think you should coincide with your hematologist.
With this type of issues of bruisability and lurching dangers of bleeding from uterus anytime due to local lesions and poor endometrium (which I think is related to the poor collagen/elastin support; the constitutional issue with you) you are likely to suffer much morbidity in coming times.
My sincere advise would be to go for number one solution in such cases - the hysterectomy.
You have completed the family, you are nearing menopause but there are chances that the trouble would continue to bother you even then if uterus would remain.
Even a day spent in morbidity is a day lost from your life, why an educated person should suffer like that, while the solution is so promising, it is so safe and it can be done even vaginally without external scars and it does not affect your sexual life.
I just do not find a rationale, why should you bear an idea like "no hysterectomy" in such a scenario.
It is my friendly advise to you; bring an abrupt end to the misery, take a rational stand and live a peaceful, pain free and trouble free creative life in full harmony with All The Doctors.
When you start living a great life post- hysterectomy, please go to that doctor to pay thanks, who first advised you for Hysterectomy and sent you in a tizzy!
You can guess I want to be the last doctor to advise you a Hysterectomy.
God bless you.
If you have any further query please let me know I would try to answer it for you.
Wish you a great health!
Above answer was peer-reviewed by
Follow-up: Having coagulation problem, near to get menopause, slightly anemic. What should i do? 7 hours later
Maybe you should re-read my story. Not one doctor has yet suggested, and I repeat, not once, for me to get a hysterectomy. I do not have cancer, and it is absoulutely untrue that ALL women do not suffer a lack in libidio due to hysterectomy and many also have their ovaries shrink to nothing in about two years if those are left. I prefer to do things naturally since I do not have cancer...which is the number one reason to do a hysterectomy. Other reasons to do one that are less of a reason, I can control without taking drastic measures such as a hysterectomy. It is very sad that you, a MAN don't have the compassion (such as you saying I have discord), to realize what it means to a woman to keep her female organs if possible and to enter menopause naturally. To say that my story was a waste of time, money, and painful for you to read shows you have no good bedside manner for a doctor and do not care about one's medical history and to see that knowing their history helps you make better decisions. You apparently did not read the part that my blood was drawn right after two surgeries and an injury which can raise factor Viii levels and Vwf levels. Also one can have a bleeding disorder such as that and have normal results. It IS important that I find out for sure so as to not find out during a serious surgery or accident, plus the disorder is genetic and I have children. How would you like it if I suggested to you without cancer, to have yourself castrated since you are not needing more children? Until you are a man in your next life, you need to find some compassion and not act like a doctor that does know EVERYTHING, because you indeed do not. Until my condition becomes life threatening, I will not seek to have a hysterectomy and until I have all answers. I was hoping to find more answers with you and a doctor who was open minded and listened to his patient, but that is not the case with you. I came on here for help, not for you to tell me that my story was painful to read and waste. Apparently this website is a ripoff because the last time I was on here, I asked specifically for someone in the OB field and got that with just $9.95 and no problems. THis time, it seems to be an issue. Now, why on earth would you think it is ok for me to talk to a pediatrician or anyone on your site think that is ok? This is an absolutely ridiculous website AND you talk about me reading things on the internet....well aren't you on the internet too? Who do you think you are? You are the same as all the doctors putting out all the info I am reading....ON THE INTERNET. You did no XXXXXXX me in person, you do not know enough about me to have judged me that made me, a patient, feel like shit. Thank you for nothing. No go get yourself castrated because you will still have a libiio. Have a nice day.
Answered by Dr. Ram Choudhary 2 hours later
Welcome back to Healthcare Magic Physician's Desk!
I had no intention to hurt you.
I do not understand how did you judged that I thought your document was a pain for me to read and you have misunderstood the content a waste of time, effort and money, I was actually referring your time, your money and your effort, just have a relook-
XXXXXXX a real pain to read such a long document, full of pain, blood, rift, discord, lack of trust, suffering, wastage of time, effort and money XXXXXXX
Anyway I hope you would be a big hearted lady and would forgive me for the flat and unpalatable content.
The major issue I want to impress is that our organs are to support our body system and should not drain the resources and consume the reserve and resilience of the system.
I have no hesitation in accepting that I would get Castrated if I had a problem in my testes and you were my doctor, telling me that I am getting more harm than benefit by keeping the testes there.
You should also know that in man the testes is physiologically as active as in young but unfortunately that is not the case in females.
The female uterus and ovaries become worn out organs by 50years.
If they are creating difficult to treat health problems then can easily be sacrificed without much effect on the woman.
In nutshell I wanted to impress upon you the need for an urgent management of your problem. If you do not agree with me then you should agree with your OB for the BC to control the bleeding, if that works that is welcome.
If not then try some thing else short of surgery.
If you continue to suffer then you can need frequent blood transfusions to build Hb, which can lead to transfusion related health problems.
You might catch genito-urinary infection, which can be a challenge to control.
You may get depleted of body resources due to constant loss from bleeding.
I know you have labelled me a vindictive man who should be Castrated but trust me I had no intention to irate you.
I hope you would appreciate me for my timely advise and options later on like my other patients who initially reacted heavily but today they are my fans.
Wish you a great health!
Above answer was peer-reviewed by
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