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Suggest treatment for heavy period bleeding

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Practicing since : 2007
Answered : 5136 Questions
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Im 52 yrs old female. Have had regular periods all througout. Have 2 kids, first was normal and second was caesarian 26 and 22 years ago. Have had one DnC 5 yrs ago because endometrial thickness was 13mm and bleeding used to occur every 20 days. Problem was solved after that. Also have had Tubul Ligation 15 yrs ago.

Currently from Oct '13 to March '14 that is 6 months i had no periods. Thought i had reached menopause. But from March to May '14 bled 4 times in 40 days. Twice was very heavy for many days. Had to stop the bleeding by tablets, Trapic M F thrice a day and Cap Gynace CVP thrice a day for 3 days.

After that i had a DnC in May '14 to rectify this. Sonography was normal. Biopsy was normal.
Since XXXXXXX and July i am having periods (normal to heavy flow) but they are 20 days apart instead of 28 days, which is my normal. It lasts for 4 days each time.

My gynac has said if i have very heavy bleeding which lasts for more than 7 days then i need a hysterectomy, which i want to AVOID. This is because my mother had a hysterectomy and today she is suffering from repeated Urinary Tract infections every month. She is 82 yrs old now. Her Urologist says i too could have UTI when i get older as its in the family history, if i do a hysterectomy.

My questions are: Is 20 days ok between periods? What do you suggest if 20 days is not normal? Also what can i do to avoid a hysterectomy? Endometrial thickness is 6mm and is in the normal range.
Have attached my last songraphy report which was done in May 2014.

I am currently on medication for Hypothyroid (since 15 years) and Rheumatoid Arthritis (since 6 years)
Posted Tue, 5 Aug 2014 in Women's Health
 
 
Answered by Dr. Manisha Jain 34 minutes later
Brief Answer:
ablation of endometrial lining or mirena insertion

Detailed Answer:
Hello dear, thanks for trusting health care magic.
After reading the sequence of events and looking at your age best treatment would be hysterectomy as it will solve the problem forever.
But since you want to avoid hysterectomy then there are two options
- mirena insertion, ├Čt is a medicated intrauterine device like copper t and has progesterone which will cause cessation of menstruation and is effective enough plus there is no surgical procedure involved.
Only problem is intermittent slight spotting which is bothersome to some patients and immaterial to others.
- Endometrial ablation, in which inner lining of endometrium is burnt which was the source of bleeding and thus relief from all problems and is a simple OPD Procedure.
But it is a surgical procedure so needs a mind make up and is a little costly as compared to Mirena.
You can discuss both the options with your gynecologist and in case you have other questions related to this I will be happy to help.
Above answer was peer-reviewed by
 
Follow-up: Suggest treatment for heavy period bleeding 13 minutes later
Thank you for your very helpful advice.

I forgot to attach my Biopsy report which says....

The endometrium is composed of tubular and elongated glands set in a mildly oedematous stroma. The glands are lined by pseudostratified columnar epithelium with uniform nuclei. Tiny bits of polyp are noted composed of similar glands set in a mildly fibrous stroma exhibiting few ecstatic vessels. Few strips of ectocervical epithelium are also seen. No granulomas are seen. There is no evidence of endometritis or hyperplasia or malignancy.
Diagnosis: Endometrium - Proliferative pattern. Benign functional polyp.

After reading the above, would your advice be the same?

Thank you in advance for your valuable time.
 
 
Answered by Dr. Manisha Jain 5 hours later
Brief Answer:
Same advice

Detailed Answer:
Hello Mrs XXXXXXX this biopsy report is suggestive of need of some intervention which as I said best is hysterectomy seeing your age and symptoms.
But at least ablation or mirena is needed.
The good thing in this report is that it is free from malignancy which is the main fear behind advising hysterectomy.
In short my opinion and advice is still the same even after seeing the report.
Wish you all the best.
Above answer was peer-reviewed by
 
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