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Took i pill. Having abnormal bleeding. Scan showed multiple fibroids. Took deviry and ic tab. Bleeding stops only when taken tablets. Remedy?

DOCTOR OF THE MONTH - Mar 2013
Mar 2013
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Hello Doc, My wife took ipil within 4 hrs of unsafe sex. Her bleeding started on 14 march. Her normal mensturation cycle ended up on 5th march. For 9 days the bleeding continued intermittently. Than on 25th march she took...tab sylate along with tab deviry...the bleeding stopped..after two days..27th of march she gorgot to take...tab deviry n clotting started...once sgain she took deviry clotying stopped..once missed it again started. Went yo a gyno..she yold to stop deviry...n let bleeding start..as it might reside..after 5 days..else on 6th day....we xan oerform prliv sonogeapghy....n if required put her on oc pills. I am too tensed now as she continues to bleed...heavily.....is this something serious...kindly assist/guide.. Asked by Me , Fri, 19 Apr 2013     Doctor's reply to your question above...Hi,Thanks for the query.Emergency pill can cause menstrual irregularity as a side effect.In some women this will be short living but some women may have prolonged bleeding.Now she can go for one ultrasound to rule out any other possible causes for inter-menstrual bleeding.If no structural abnormality is there, she can start the oc pills from now-onwards.First two days she has to take two tablets per day to decrease the bleeding, after that she can take one tablet per day.After completion of the tablets, she can get the withdrawal bleeding within one week.Then you can decide whether to continue the tablets or wait and watch in the next cycle.Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.Take care.Replied by Dr. Sree Gouri SR , Fri, 19 Apr 2013     Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.Hi doc...thnx for your response...just a small coreection...regarding the dates. Kinfly note:Period started 5 march Period end date: 10th marchIpil taken: 14 th marchBleeding started 25th march It continued till 3rd aprilTook tab sylate n deviry for two days.....bledding stoppedContinued deviry one tab per day...bleeding stoppedForgot to take devery on7th april...resulted in spotting....Spotting coninued even after taking eevery on 8th, 9, 10, 11, 12 aprilOn 13th contacted gyno...and was intructed to stop taking devery....n..to c..ig bleeding stopped.So stopped tsking deviry....from 13 till 18 spril....13th april spotting continued14th april bleeding started15th medium..16 medium17 and 18th spril the bleeding hss been high....Based on the above detaild....Can u pls advice.... Also...if she starts oc pilld...Does it have any dide affects...Is tuis something serious..After taking oc pills will this issue gets sorted..n..her bleeding stop.....Itsbbeen big mistake...of not using contraceptive...and this tablet has been the eoree thing I can suggest to sny one...Anyways..I am too tensed...pls help...I look forward for your views n suggestionThnx,HarishAsked by Me , Fri, 19 Apr 2013     Doctor's reply to your question above...Hi XXXXXXX As I told previously emergency pill can alter the menstrual cycle.It can change the menstruation depending on the period of the cycle when the woman takes the tablet.As your wife took the tablet in the first half of the cycle, it might have preponed her periods leading to early menstruation.Usually these flow will stop in few days.But as your wife is having continuous flow better to get examined once.Deviry should be taken regularly at the same of the day, if the schedule is altered it will induced withdrawal bleeding.So let your wife undergo ultrasound once to rule out any other possible causes of bleeding.If the cause is found to be only hormonal she can start the oc pills and they can help in stopping the flow.After completion of one pack, she can observe the next cycle. If there is no abnormal bleeding she may stop taking the tablets.You can choose some regular method of contraception in the future.Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.Take care.Replied by Dr. Sree Gouri SR , Fri, 19 Apr 2013     Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.Hi doc....thnx for follow up. Today we got the ultrasound done...beliw are the details of report. Kindly suggest:Uterus: is antereted and bulky, measures 10 x 5.8 x 5.9cm. It shows few small isoechoic fibroids largest measuremening 18 x 15mm submucous fibroid in anterior wall.Endometrium : measures 6mmOvaries: both appear normal in size, shape n echotextureRight ovary: 2.3 x 1.5 cmLeft ovary : 3.1 x 1.9 cmPod: no free fluidImpression: 1. Bulky fibroid uterus as described above.Suggest: follow up TVS scanDoctor has recommended tab ovral g. This neefs to be taken gor 21 days...if rewuied might need for two cycles.My questions for u are: Are these tab safe.Is te report normalIs anything serious.Any sugestions or recommendations.Kindly suggest.Asked by Me , Sat, 20 Apr 2013     Doctor's reply to your question above...Hi,-Fibroids develop in the uterus due to estrogen predominance.By taking hormonal pills the natural hormonal levels can be controlled and low level of estrogen can be maintained.So taking pills will help in decreasing the size of fibroids and in relieving the symptoms. So if she is not having any other medical problem, she can take the tablets as recommended by your doctor.-Report is showing presence of multiple fibroids. But these are of smaller size.Report is not normal but there is no serious problem also.-She can continue the tablets as recommended by your doctor. After two months she can go for repeat scan and depending the report further mode of management can be planned.Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.Take care.Replied by Dr. Sree Gouri SR , Sat, 20 Apr 2013     Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.Hello doctor,Follow up on previous call I made. My wife took ovral-g as prescribed by doctor for 21 days. The bleeding stopped than she contnued gor 21 says ..everything was fine. The day she stopped she got her periods /bleeding started. It continued for 5 days n didnt stop. So she stsrted.. the second strip. Even though she took the tablets..its three days still spotting and intermittent bleeding happens. Beliw are my questions: Going with above scenerio the bleeding stopped for 21 days neans her cycle has refuced to 21 days...is tjis normal.2. Now its been 9th day, intermittent bleeding is stii there, though she is back on oc pills (2nd strip). Having said, that means her new cycle will be of hardly 12 days...moment she ends up with 21st ...last overallg tablet. How to regulate the periods...plese suggest..advice..ThanksHarishAsked by Me , Mon, 20 May 2013     Doctor's reply to your question above...Hi,1.The menstrual cycle includes the periods:Menstrual period- around 5 to 6 daysFollicular phase- till 14th or 16th day.Luteal phase- till the starting of menstruation.So being on oc pills, the cycle length becomes 28 days. 21 days pills and 7 days gap. In that gap usually bleeding will occur.2.Sometimes intermittent bleeding can be seen while being on pills.The possible causes are:-Altering the time of intake of tablets or missing the pills.-When the dose is not sufficient.So now what she can do is:Take around 6 tablets of deviry or meprate etc.On the first day of the bleeding she can take deviry thrice a day.Second day twice a day.In the third day morning she can take one tablet and from the night she can start the oc pills pack.Possibly this can help in regularization of the periods.Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.Take care.Replied by Dr. Sree Gouri SR , Tue, 21 May 2013     Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.but doctor....wont there be any side affectsbof having such a heavy dose. Secondly, after taking the pil is a person doesnt sleep......or go for late night sleep...will it reduce the affect...as we had family functions for past couple of days. she used to take tablets same time everyday.but what worries me ..is this normal...or is there any other treatment which u may recommend...Asked by Me , Tue, 21 May 2013     In addition to above query.....will taking oc pills make her put on weight.....Asked by Me , Tue, 21 May 2013     Doctor's reply to your question above...Hi,Usually taking few additional tablets for limited period may not cause any side effects.If you do not want to go for a higher dose, she can try taking one deviry tablet in the morning along with oc pill in the night.If the bleeding controls with this, after one to two days she can stop taking deviry and can continue with oc pills.Usually minimal changes in routine daily activities will not affect the efficacy of the tablets.But they should be taken at the same time everyday.As she is having multiple fibroids and as she is on medical therapy, better to continue this for few more months.And after that by watching the status of the fibroids and menstrual pattern further management can be planned.Using the pills for limited period of time may not increase the weight.Normal weight can be maintained by exercises, dietary management etc.Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.Take care.Replied by Dr. Sree Gouri SR , Tue, 21 May 2013     Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.Your query has been closed.This discussion is closed. If you'd like to re-open it, please recharge by clicking on the button below. The recharge allows you to ask 3 additional questions. The same doctor will continue answering your additional questions.
Posted Thu, 27 Jun 2013 in Women's Health
 
 
Answered by Dr. Aarti Abraham 1 hour later
Hi XXXXXXX
Thanks for your query.
I have gone through the details.
You have a long , complicated history, plus multiple medications have been given.
Please tell me when did she start her current pack of OC pills.
I assume she is using Ovral G which you have mentioned earlier.
Please also tell me the date when she started bleeding. ( I mean the latest episode )
Please tell me her age, details of previous pregnancies or abortions, if any, and any significant medical history.
Looking forward to hearing from you soon.
Above answer was peer-reviewed by
 
Follow-up: Took i pill. Having abnormal bleeding. Scan showed multiple fibroids. Took deviry and ic tab. Bleeding stops only when taken tablets. Remedy? 1 hour later
Thnx, doctor for the follow up. Below are the anserrs to ur question:
1. Overallg she stopoed taking on 2nd XXXXXXX There were still 2 tablets left. As per gyno, it looked to that the salt was not effective. Now she recommended her to go with oc novelon. After 5 days of bleedind. That means she needs to start tuis tab from tommorow 8th of XXXXXXX And within 48 hours bleeding shoukd stop.
2.novelon oc pills
3. The biggest issue sen is after taking overallg, on 22nd day bleeding started, it stopped becsuse she usef to have tablet on time regularly. Therefore there is no pause inbetween. The moment she stops bleeding starts.
4. Spotting started on 1st XXXXXXX regular bleeding started on 4th XXXXXXX -heavy bleeding. And its still there.
5. Age 37
6. Two kids
7. Abortion 2 times. 1st 5 years back and second 1 years back.
8. No other mefical complications.
Yes, one issue she has, on 2nd n 3rd day mensturation cycle is with heavy bleeding n pain beliw naval. I mean she goes thru pain on thise two days.

Mam, please suggest and help. My biggest mistake, I regret.

Kindly help.

Thanks, XXXXXXX
 
 
Answered by Dr. Aarti Abraham 37 minutes later
Dear Mr. XXXXXXX XXXXXXX
I would ask you to upload the exact report of the ultrasound scan.
Also, please let me know if she had this issue of abnormal bleeding before taking the I pill.
I would like to reassure you that you are not at fault.
A single dose of I pill cannot cause such long lasting problems.
There are two possibilities
1. Symptomatic bleeding because of the fibroids - in this case, she needs treatment. If medical treatment fails, then removal of fibroids.
2. FUB _ functional uterine bleeding, where in the absence of any identifiable cause, patient has abnormal and irregular bleeding.
First get the following tests done -
1 . TSH
2. Glucose tolerance test.
3. Bleeding profile and complete blood count.
Now, it is possible that Ovral G has higher hormonal dosage, so she might respond to Novelon.
Personally I think that she has been overmedicated.
A cocktail of contraceptive pills and hormonal pills have been taken.
If you wish to go by my advice,
do the following -
1. Let me know the ultrasound report - not just type it, but upload the exact wording of the report
2. Get the blood tests done
3. Do not take ANY hormonal medicines for atleast a month. In this period, use only condoms as contraceptives.
4. For the heavy bleeding right now, take Tranexamic acid . I would suggest Trapic MF thrice a day for three days , but consult with your gynecologist first.
Normally the bleeding will stop then.
5. Wait for atleast a month. Let there be abnormal bleeding in this period.
6. From the next proper period, start Novelon regularly.
I think the issue should be resolved.

Let me know if you wish to have further discussions.
take care.
Wish you all the best.
Above answer was peer-reviewed by
 
Follow-up: Took i pill. Having abnormal bleeding. Scan showed multiple fibroids. Took deviry and ic tab. Bleeding stops only when taken tablets. Remedy? 56 minutes later
Doctor,

She never had this issue. This is for yhe first time, she is undergoing this truma. I"ll get the other reports iploaded. By that time, below is word to word scan report:


Uterus: is antereted and bulky, measures 10 x 5.8 x 5.9cm. It shows few small isoechoic fibroids largest measuremening 18 x 15mm submucous fibroid in anterior wall.
Endometrium : measures 6mm
Ovaries: both appear normal in size, shape n echotexture
Right ovary: 2.3 x 1.5 cm
Left ovary : 3.1 x 1.9 cm
Pod: no free fluid
Impression: 1. Bulky fibroid uterus as described above.
Suggest: follow up TVS scan

Rest, I vil follow up with scanned copy n other reports.

Thanks, XXXXXXX




 
 
Answered by Dr. Aarti Abraham 6 minutes later
Hi Mr. XXXXXXX
Was this ultrasound also a transvaginal scan ?
If not, please have a transvaginal scan done.
I have the feeling that your wife is having the symptoms due to the uterine fibroids, as submucous fibroids can sometimes cause such problems.
Do not take any medication except tranexamic acid for heavy bleeding this month.
Then next month onwards you can start taking Progesterone preparation from day 15 to day 25 of cycle.
That will control the abnormal bleeding.
Above answer was peer-reviewed by
 
Follow-up: Took i pill. Having abnormal bleeding. Scan showed multiple fibroids. Took deviry and ic tab. Bleeding stops only when taken tablets. Remedy? 0 minute later
Also, doctor. The bleeding d esnt stop, so how will she able to follow. Before she started, second strip of overalg....she had bled almost for 10 days..and was feeling quite week. So not sure, how to proceed.

Or do u mean, first take the Trapic MF n than stop for some time till she gets her normal period. Kindly correct if I am erong.
 
 
Answered by Dr. Aarti Abraham 2 minutes later
I meant take the Tranexamic acid first to control the heavy bleeding she has.
Then wait and do not do anything if the bleeding is mild and irregular.
After her normal period resume medication.
Also Mr. XXXXXXX with such heavy bleeding, I would recommend an endometrial biopsy or a hysteroscopy also.
If that is normal, we can assume there is nothing wrong INSIDE the uterine cavity and the bleeding is due to the fibroids.
Above answer was peer-reviewed by
 
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