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Coumadin, blood clots in lungs, hypothyroid, menopausal bleeding. Vitamin D or inhaled steroid the cause ?

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Internal Medicine Specialist
Practicing since : 1998
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58 yr old female, taking coumadin (history of blood clots in the lungs and pulmonary vein). Esophogeal varices under control (twice yearly endoscopy). Hypo thyroid, taking levoxothyrine. History of post menopausal bleeding due thickened endometrial lining. Eliminated soy from my diet and that cleared up the bleeding. Biopsies show no cancer. Recently starting taking Dulera and 1000 mg Vitamin D daily. Since I started these I have also started bleeding. Wondering if either the vit d or the inhaled steroid could be causing.
Posted Thu, 12 Apr 2012 in General Health
Answered by Dr. Jasvinder Singh 54 minutes later

Thanks for posting the query.

The increase/recurrence in the lining of the endometrial lining is unlikely to be due to either the use of the inhaled steroids or the vitamin D.

However, the primary pathology seems to lie in the endometrium and the use of Coumadin increases the chances of bleeding.

It could be due to the hyperplasia (thickening) of the endometrium. You need to consult your gynecologist again, although the biopsy has not shown the cancer.

Since Coumadin can’t be stopped for long due to the increased risk of recurrent clot formation in the XXXXXXX veins and pulmonary embolism, it makes sense to do hysterectomy (removal of the uterus) if the bleeding persists.

You can continue with the inhaled steroids and the vitamin D as they do not cause increase in the risk of bleeding.

Please consult a physician also as you might need a down titration of the dose of Coumadin transiently in view of the bleeding.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us. I will be happy to answer your queries.

Wishing you good health.

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