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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Can Pause MF be used for abnormal vaginal bleeding?

Answered by
Dr.
Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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Posted on Fri, 16 Sep 2016 in Pregnancy
Question: My wife underwent a D&C and hysteroscopy on her 7th day on 26th this month. Doctor informed she removed some extra thickness on one side of the endometrium wall. Doctor has prescribed Lynoral .05 mg once a day for 21 days accompanied with monocef, paracetamol, rantac snd vizylac for 5 days. Wife is experiencing continuos outflow of big flakes with blood. We spoke to doctor and she advised to take Pause MF thrice a day until bleeding stops. Please advise if it is safe to use pause mf and what shall be maximum period it can be taken. Also, please advise what could be the possible causes of such continuous bleeding after 5 days of surgery.
doctor
Answered by Dr. Nishikant Shrotri 36 minutes later
Brief Answer:
Addition of Progestational medicine will help

Detailed Answer:
Dear XXXX,

Your immediate aim should be to arrest the continuous bleeding she is having for last 5 days.

Pause MF contains Tranexamic acid which is useful is controlling most of the types of bleeding. However, since this is bleeding from thickened uterine lining (endometrium), addition of some Progestational preparation like Deviry will be more useful in this condition.

She is already receiving antibiotics, painkillers, etc. to take care of infection and other general symptoms. She is prescribed Lynoral. What is the indication of Lynoral? It is a medicine containing ethynilestradiol and is given to build up the endometrium. If her endometrium was already thick on one side, why Lynoral?

Now I would like to know why did she have to undergo D & C and Hysteroscopy? And that too on 7th day of the cycle? Please update me about the indication. Are you getting investigated for infertility or she is a case of heavy uterine bleeding? What is her age?

Has her removed tissue been subjected to histopathology? Please update the reports of histopathology. Also please ask your Gynaecologist about the gross appearance and the naked eye diagnosis of the lesion that is removed from the uterus.

I would definitely like to guide you much more in this respect; however I would need more information. Please furnish me with required information and upload the reports of all the previous investigations.

For any more information or advice, I am always available for you, XXXX.

Dr. Nishikant Shrotri

Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Nishikant Shrotri 10 hours later
Doctor she is being treated for unexplained infertility and this second specialist we are visiting. Last year in July she underwent hysteroscopy and laparoscopy for diagnosis and a polyp of 8 mm was removed. Post that she has been having scanty periods and her endometrium lining remained below 8 mm. She already has taken 7 cycles of sephene and her harmone levels appear to be normal in various tests since then. She was also given progynova for 5 days aling with HMG injections for 6 days to prepare her for IUI which didnt work as eggs were not formed as expected and rather her AMH score also dipped below 1. Previous doctor than gave her medicine to improve her egg store for 2 months. Now current doctor has done hysteroscopy last friday after my wife complained of spotting for 7 days. I have attached recent reports for your reference. Let me know what do you observe and if need any further info.
doctor
Answered by Dr. Nishikant Shrotri 7 hours later
Brief Answer:
Endometrial building up necessary. Work on AMH improvement

Detailed Answer:
Dear XXXX,

So long as controlling the vaginal bleeding is concerned, I maintain my opinion that addition of Progestational preparation to Pause MF will work better.

It seems that after removal of the cyst from the uterine cavity, the endometrium was damaged to considerable extent forming some adhesions inside. Such adhesions are known as Aschermann Syndrome. Your Gynaecologist is working to break these adhesions and restore as much endometrium as possible. She is prescribed Progynova for the same purpose. Sephane is Clomiphene citrate which is anti oestrogenic medicine and will hamper the endometrial building up. I would advise to put some intrauterine device to prevent adhesion formation and then give Oestrogen preparation continuously for 3 months without break which might help building up of endometrium. After the endometrium is well built, then only go for ovulation induction, and that too by MHG/HCG protocol which will not affect the endometrial growth.

D & C in cases of infertility is advised during second half of cycle as close to the menstruation as possible which gives evidence of egg release and the endometrial secretory changes. In first half of the cycle, the endometrium is in growing phase, thin and likely to get damaged by curetting.

Yes, her AMH is rather on lower side, however not hopeless and you may expect success after working on it. The levels of AMH denote the ovarian reserve of the immature ova and follicles.

Of course your query is regarding controlling her ongoing bleeding, which I have explained you. For any more information or advice, please feel free to ask me anytime. You may, meanwhile consider posting a good review with 5 stars rating for me.

Dr. Nishikant Shrotri



Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar
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