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Dr. Andrew Rynne

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Suggest treatment for prolonged menstrual bleeding

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Dr. S Patra

OBGYN

Practicing since :2011

Answered : 4047 Questions

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Posted on Wed, 27 Aug 2014 in Women's Health
Question: My wife has been suffering from Heavy and prolonged menstrual periods since over 20 years.
She is 36 years old and we have a son (IVF 8 years ago)
For her heavy bleeding the Dr has recommended Deviry 10 from the 16 day of Period to the
26 day (10 days – twice daily now increased to thrice)
The Dr has suggested a DNC since the uterus wall is very thick and insertion of a Mirena
My wife is not very Happy to Insert a Mirena Please let us know if its a good option.
Reading from Current Report of Sonography.
The uterus measures 7.8 x 5.3 x 3.6 cms. in size. Few small intramural fibroids (2 to 3 in number) are seen, the largest of which measures about 8.0 mms in size. Also seen are few nabothian cysts in the cervix. The endometrium is in the midline and measures 9.0 mms. in thickness.
The right ovary measures 2.8 x 1.4 cms. and the left ovary measures 2.8 x 1.6 cms. in size. Both ovaries are normal in size, shape and echotexture. The adnexae appear normal
She has been getting Chronic Uticaria since the Past 11 months,
could the Heavy bleeding be a cause of the same.
Thank you.
doctor
Answered by Dr. S Patra 1 hour later
Brief Answer:
MIRENA IS BEST. BLEEDING NOT RELATED TO URTICARIA.

Detailed Answer:
Hello,

Thanks for writing to us. Followings are my comments:

1) Inserting MIRENA after D & C is a Very GOOD Option for controlling prolonged heavy menstrual period (Menorrhagia). It is levonorgestrel-releasing intrauterine system which is placed inside uterus to prevent pregnancy up to 5 years and arrest heavy bleeding effectively. There will be NO pill side effects.

2) At first, oral hormonal pill (steroid) should be stopped to prevent urticaria. I have reviewed all attached reports and it suggests Immunological Dermatitis. It tends to occur in the Peri-menstrual period or following the use of progesterone supplementation.

I suggest her to undergo LFT (Liver Function Test), Serum Ig E level and repeat the Anti-Nuclear Antibody test after 3 months. It will help to determine next plan of treatment. Kindly, consult with her doctor regarding this.

Hope, it helps for your information. Kindly, close the discussion if you don't have any other query.

Wish her good health and take care yourself.

Regards,
Dr S Patra

For future query, you can directly approach me through

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=63326
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S Patra 5 hours later
Dear Dr. Thank you for your reply.
LFT Report was attached.
- PCS - WEB Reports DATED 05.08.2014.pdf
Points from the report are below....
Ig E level and repeat of the Anti-Nuclear Antibody test
will be done...

INVESTIGATION RESULT
36 Years:AGE
UNIT NORMAL RANGE
Int. Ref. No. :
BIOCHEMICAL TEST
Blood Urea,Urease-GLDH 21.
Blood Urea Nitrogen 10.00
S. Bilirubin
Bilirubin (Total),Jendrassik 0.72
Bilirubin (Direct) (N),Jendrassik 0.25
S. Bilirubin (Indirect) 0.47
S. Proteins
Proteins,Biuret 7.48
Albumin,BCG 4.6 g/dl
Globulin 2.88 g/dl
A/G Ratio 1.60
S.G.O.T(AST),UV Kinetic 18 U/L
S.G.P.T(ALT),UV Kinetic 28 U/L
S. Alkaline Phosphatase,PNP AMP U/L 50
GGTP 20 U/L
Serum Creatinine (N),Jaffe~s Kinetic mg/dl 0.63

Thank you.
doctor
Answered by Dr. S Patra 3 hours later
Brief Answer:
FOLLOW THE ADVICE.

Detailed Answer:
Hello,

Thanks for your response and detailed reports.

1) LFT parameters are within NORMAL range. However, there is reduced LYMPHOCYTE percentage in differential count.

2) I suggest to undergo Serum Ig E and Anti-Nuclear Antibody test (after 3 months) to confirm the diagnosis. It will also help to make a plan for next treatment.

Hope, I have answered your query. You can revert back to me in the given address following those reports.

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=63326

All the best and good luck. Kindly, close the discussion.

Regards,
Dr S Patra
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. S Patra 16 hours later
Dear Doctor.
I met the MD Physician who is treating my wife today, He mentioned that on
physical examination and alongwith the reports he was very sure that she
doesn't have any autoimmune disease such as SLE, Lupus, RA etc,
but mentioned it is atopic uticaria and we could safely take montelukast and Alegra long term till the allery subsides which could take at times months or a year to subside. ( Incidentally my wife had this allergy in 2009 which vanished
after a couple of months and has returned in 2013)

He has also mentioned that the following vaccines would be worth giving.
Influenza Vaccine.
Gardasil Vaccine.
HEP A + HEP B Vaccine

Are these Vaccines safe.

Your valuable inputs would be much appreciated.
Thank you.
doctor
Answered by Dr. S Patra 2 hours later
Brief Answer:
FOLLOW THE ADVICE. VACCINES ARE SAFE.

Detailed Answer:
Hello,

Thanks for follow up query.

1) As her Anti-Nuclear Antibody test result is at BORDERLINE level, she must repeat the test after 3 months to confirm. Though, her other test reports are NORMAL.

Until then, she would take above prescribed medication to get early recovery. She can use Calamine lotion for soothing effect.

2) Yes, she can take all those vaccine safely on scheduled time. However, she must undergo one HPV test before taking GARDASIL vaccine (protects against cervical cancer and genital wart). Kindly, contact with your healthcare provider for proper guidance.

Hope, it helps for your information. Wish her good health.

Good luck and all the best. Kindly, close the discussion.

Regards,
Dr S Patra
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. S Patra 43 hours later
Dear Doctor,
Thank you for your valuable advise. However what are the test for
HPV ? Is it true that women over the age of 26 or who are sexual
active are not a candidate for Gardasil vaccine. Please advise. !

Best regards,
doctor
Answered by Dr. S Patra 5 hours later
Brief Answer:
FOLLOW THE ADVICE.

Detailed Answer:
Hello,

Thanks for query.

1) HPV test is useful to check for HPV infection (Low or High Risk). It checks for DNA and sample collected from cervix.

Pap Smear test is also to be done for screening purpose. It detects abnormal cell changes or cervical dysplasia, related with cervical cancer.

2) She must undergo both tests before taking Gardasil Vaccine. It is MORE effective on women who is NOT sexually active or whose age is below 26 yrs. However, she can take that vaccine on both NEGATIVE test result.

Hope, it helps to clear doubt. If you have any other query, you can revert back to me.

All the best and good luck.

Regards,
Dr S Patra
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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