HELLO THERE.

Thanks for writing.

I wish to clarify few points before I give my possibilities.

Firstly when was your last period and are your periods irregular?

What was the reason for using MIRENA and when you got it removed? Did you have heavy periods even before using mirena?

Do you have symptoms of depression, decreased appetite, lethargy , pimples or excess hair growth over body?

Have you got your thyroid tests or any other hormonal work up done?
Kindly revert back with the answers.

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Hello there.

Thanks for the detailed information.

The problem you are having is mainly frequent heavy periods known as "polymenorrhagia".

Ultrasound findings of fibroid and ovarian cyst are not alarming in your case.
So DO NOT panic.

The associated finding of ultrasound like fibroid can be the cause of heavy periods.
Your fibroid is too small to be managed.
But the problem which can occur with fibroid is endometrial hyperplasia (increased thickening of uterine lining). This can even occur if the fibroid is small and is responsible for heavy periods.

Since you were using MIRENA which is progesterone containing IUD, the bleeding was controlled till you were using it. This is because progesterone causes thinning of the endometrial lining(uterine lining).
So its not the side effect of Mirena removal. It is mainly withdrawal of the protective effect of mirena due to its removal.
This further favours that you might be having endometrial hyperplasia since your bleeding was controlled during mirena(progesterone) use.

Your ovarian cyst appears to be a simple cyst and not very worrisome.
You can follow it up with a repeat ultrasound after 3 months.
If it increases in size or features of complex cyst appear, you need to get it removed as the probability of cancer is more if there are complex features (thick walls, solid areas, irregular margins) in a cyst. Also complex cyst do not resolve on its own.

For now I suggest you to get an endometrial biopsy done.
This is a minor surgical procedure where endometrial tissue is removed for tissue diagnosis. This will also help in ruling out the rare possibility of cancer responsible for heavy bleeding.
In case there is only endometrial hyperplasia, then you need not worry.

Treatment of endometrial hyperplasia is either medical or surgical.
Choice between medical or surgical procedure is yours.
There are two ways you can choose for your treatment.

1. You can use oral progesterone tablets like meprate for 14 days every cycle for 3 months. This would help reduce your bleeding and is also known to reverse endometrial hyperplasia. After 3 months you can repeat the biopsy and get the follow up scan for the ovarian cyst. If both have resolved , you need not worry.

In case your bleeding does not respond to progesterone tablets , then you can take the decision of a definite surgical procedure called hysterectomy with removal of ovaries too.This would treat the bleeding problem and the cyst as well.

2. The second choice is going directly for a definite procedure like hysterectomy with removal of ovaries.
But DO NOT go ahead with a hysterectomy procedure without endometrial biospy.
Endometrial biospy is a must to know that cause of bleeding is not cancerous before you undergo a major surgical procedure like hysterectomy.

Take care.

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