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Suggest Treatment For Heavy Vaginal Bleeding

Posted on Tue, 9 May 2017

Question: My daughter is 23 years old and for the last 3 months has been having extremely heavy vaginal bleeding with large clots for extended periods of time (not like normal menstrual time) more like 2 weeks at a time. She went to the dr today and was told she was no longer ovulating (her youngest child is 21 months old) she was also recently on the depo shot but has since discontinued it do to abnormal bleeding and weight gain. Her dr said he had no idea why she was no longer ovulating and is running blood work but as you can appreciate she is scared to death about this. Oh she also was recently told her uterus is tilted. Idk if that has anything to do with this. Is their any advice you can give on possible causes and treatments?

Answered by Dr. Vjollce Mbiarra (1 hour later)

Brief Answer:
Vaginal bleeding can be due to dysfunctional uterine bleeding

Detailed Answer:
Hi and thanks for your HealthcareMagic.

I have read your question carefully and understand her health issue.

Heavy vaginal bleeding without any uterine organic issue (such as fibroids)can be due to dysfunctional bleeding (hormonal imbalances )

90% of dysfunctional bleeding is associated with anovulation.

First-line therapy:

Progestogens are the first-line treatment for DUB, particularly when associated with anovulation.
Anovulation results in continuous unopposed estrogen stimulation of the endometrium.

In cases of chronic anovulation disorders, particularly polycystic ovary syndrome (PCOS), the use of progestogens is helpful for treating DUB as well as preventing the development of endometrial hyperplasia and serious complications such as endometrial carcinoma.

Second-line therapy:

Combined estrogen and progestogen is a second-line therapy that can be used when a progestogen alone is not associated with an adequate response.

Hence she can discuss with her doctor to do a proper examination to determine vaginal bleeding and start the treatment accordingly.

Titled uterus has no relation with heavy bleeding.

She doesn't need to be scared to death because it's a quite treatable condition and once the treatment is initiated and she will be fine.

Hope I have been helpful and please feel free for further discussion.

Best regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Vjollce Mbiarra (1 hour later)

Thank you so much! Yes everything I read seemed to say "no big deal, highly treatable" but the first thing she thought was (of course) cancer and freaked from there. Especially when her dr said he didn't know what was causing it. She didn't take that comment as "everything will be fine, this is no big deal", she took it as "it must be really bad if he's not going into more detail". She's a bit overly dramatic about her health anyway so it didn't take much to get to freaked! Anyway, just wanted to say thanks. I really appreciate your time. Oh one more thing, she will definitely need to take the medication to start her ovulating again so the bleeding is brought under control? Correct? She didn't want to start it yet, mainly because I think she was overwhelmed with what he said and not understanding it. I just want to be able to tell her a definite "yes you need to take that or the bleeding will continue". Anyway really going this time. Thanks again!

Answered by Dr. Vjollce Mbiarra (21 hours later)

Brief Answer:
She should start treatment

Detailed Answer:
Hi again!

She should start a treatment but while she have been on Depo -shot and she have had side effects such as abnormal bleeding and weight gain ,the best treatment for her will be Combined Oral Contraceptives that contain estrogen and progesterone .

Meanwhile ovulation will recover after abnormal bleeding will be treated .

Did she do any blood test to see her female hormones ?
Did she do transvaginal scan to exclude any uterine issue and how thin was inner layer of uterus?
Did she do pelvic exam to exclude cervical issue?

Please write me back with these details and will try to help your daughter.

Hope I have been helpful and please write me back.

Best regards

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Above answer was peer-reviewed by : Dr. Prasad