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Had menorrhagia. Ultrasound showed uterus enlarged. Treatment?

Mar 2013
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Practicing since : 1998
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I had a transvaginal ultrasound, because I had menorrhagia and I couldn't feel the string for my IUD.
The IUD wasn't found during the ultrasound. The conclusion reads: uterus enlarged 250 cc (12.6 x 6.9 x 5.7 cm). Anteverted uterus. Heterogeneous myometruim. Several small myometrial cysts in the fundus. ? Adenomyosis. Fundal fibroid 3.6 cm. Two small posterior fibroids. No IUCD in the endometrial cavity.

Could the IUD have caused the fibroids/cysts? What treatment options are there for adeomyosis and fibroids? Is it common to have them together?
Posted Wed, 5 Jun 2013 in Vaginal and Uterus Health
Answered by Dr. Aarti Abraham 16 minutes later
thanks for your query.
THe IUD cannot cause fibroids / cysts.
For very small fibroids , sometimes no treatment is required, unless there are symptoms like severe bleeding, pain in the lower abdomen etc.
You have mentioned 4 miscarriages, if the endometrial cavity is distorted, then the fibroids could be a cause for the recurrent pregnant losses.
Adenomyosis does not require treatment again unless it is symptomatic.
It can be medically managed with treatments like progesterone cyclical hormonal therapy, other drugs like danazol, gonadotropin analogues etc.
Since you are having menorrhagia, you can go for medical management with drugs or Mirena containing IUD.
If you are planning a family, it is best to consult an INfertility specialist and have treatment for the same soon.

Take care,
Feel free to discuss further.
Above answer was peer-reviewed by
Follow-up: Had menorrhagia. Ultrasound showed uterus enlarged. Treatment? 8 minutes later
I am having very heavy bleeding, and a lot of abdominal pain that radiates down to my knees. This decreased while I had the IUD, but as the IUD is now missing, I am reluctant to get another.

The fibroids were not mentioned in ultrasound reports post miscarriages, I believe they have occurred since.

Since I do have symptoms associated with either the fibroids or the adenomyosis (it appears that they have the same symptoms?) what types of treatment other than the mirena is likely to be suggested?
Answered by Dr. Aarti Abraham 18 minutes later
Yes, fibroids and adenomyosis do have overlapping symptoms, and the menorrhagia is an important symptom that cannot be disregarded.
Treatment options for adenomyosis include:
Anti-inflammatory drugs - By starting an anti-inflammatory medicine two to three days before your period begins and continuing to take it during your period, you can reduce menstrual blood flow in addition to relieving pain.
Hormone therapy - Controlling your menstrual cycle through combined estrogen-progestin oral contraceptives, hormone-containing patches or vaginal rings may lessen the heavy bleeding and pain associated with adenomyosis. Progestin-only contraception, such as an intrauterine device containing progestin or a continuous-use birth control pill, often leads to amenorrhea - the absence of your menstrual periods - which may provide relief.
Presacral Neurectomy. A surgical procedure to interrupt the pain nerve supply, or presacral nerve plexus, to the uterus.
Hysterectomy. If your pain is severe and unremitting, hysterectomy remains the only option. Removing your ovaries isn't necessary to control adenomyosis.

Unless fibroids are causing excessive bleeding, significant discomfort or bladder problems, a fibroid treatment is usually not necessary.

Currently, the medical treatments available for fibroids can make symptoms better temporarily but they do not make the fibroids go away.

Women with heavy menstrual periods and fibroids are often prescribed hormonal medications - estrogen , plus progesterone, or only progesterone, to try to reduce bleeding and regulate the menstrual cycle.

GnRH agonists are a class of medications that temporarily shrinks fibroids and stops heavy bleeding by blocking production of the female hormone estrogen. Lupron is the most well known of these drugs. Although Lupron can improve fibroid symptoms, it causes unpleasant, menopausal symptoms such as hot flashes and, with long-term use, leads to bone loss.
Importantly, lupron should not be used solely for the purpose of shrinking fibroids unless surgery is planned because the fibroids will re-grow to their original size and symptoms will return as soon as the lupron is discontinued.

Although IUD's are typically used to prevent pregnancy, they have non-contraceptive benefits as well. An IUD that releases a small amount of hormone into the uterine cavity has been shown to decrease bleeding related to uterine fibroids.

A new drug, Lysteda, was recently approved by the FDA for the treatment of heavy menstrual bleeding. LYSTEDA is a non-hormonal medication you only take during your period, as opposed to every day. LYSTEDA cannot be used as birth control and because it does not contain hormones, it doesn't have hormonal side effects. LYSTEDA is FDA-approved to help reduce Heavy Monthly Bleeding (HMB). LYSTEDA was also shown to help make a meaningful difference as early as the first menstrual cycle and for all cycles studied.

Myomectomy is an operation in which fibroids are removed from within the uterus. Stitches are used to bring the walls of the uterus back together. For women with symptomatic fibroids who desire future childbearing, myomectomy is the best treatment option.
Myomectomy is a very effective treatment, but fibroids can re-grow. The younger a woman is and the more fibroids present at the time of myomectomy, the more likely she is to develop fibroids in the future. Women nearing menopause are the least likely to have problems from fibroids again.
A myomectomy can be performed several different ways. Depending on the size, number and location of your fibroids, you may be eligible for an abdominal myomectomy, a laparoscopic myomectomy or a hysteroscopic myomectomy.

Hysterectomy is a major surgical procedure in which the uterus (womb) is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy.

Uterine artery embolization is a relatively new treatment alternative to open surgery for symptomatic fibroids. Embolization means blocking the blood flow to the fibroid. By stopping the blood flow, the fibroid begins to die and shrink in size. This will often decrease menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.

MR guided Focused Ultrasound Surgery i, or High Intensity Focussed Ultrasound is a non-invasive, outpatient procedure which uses high doses of focused ultrasound waves (HIFU) to destroy uterine fibroids, without affecting any of the other tissues around the fibroid.

The treatment modality will be decided by your doctor after completely examining you and considering various factors such as age, co morbidities, fertility, nature of fibroids etc.
Above answer was peer-reviewed by
Follow-up: Had menorrhagia. Ultrasound showed uterus enlarged. Treatment? 18 minutes later
Thank you, this is excellent information.
Answered by Dr. Aarti Abraham 10 minutes later
Thanks for the appreciation
Its always a pleasure assisting intelligent patients like you.
Above answer was peer-reviewed by
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