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    What causes severe menstrual bleeding?

Posted on Wed, 25 May 2016 in Women's Health
Question: I am 40 yrs, am having adenomoyama in uterus of size 5.5 x 3.5 in the anterior wall n endometrial echo measures 3.9 mm in thickness ,as per the ultrasound report.
I was regularly taking endoreg 2mg (1 tab per day) frm may 2015 to Dec 2015, bcoz of heavy menstrual pain.
On XXXXXXX 18 ,2016 period started n as advised by my doctor, did a pap test which was negative. But for infection I have advised to take meterogyl n after that bleeding has increased. I took one injection Texid+depot proveca , after that bleeding controlled but toping continued so my doctor advised to take primolet 3 tabs per day, but still bleeding continued.
I changed my doctor aftet 30 days n advised to stop primolet n start endoreg 2mg with trenexa 2 tabs per day. Still bleeding continued n i have admitted to emergency n stayed 3 days in hospital. During my stay have given injection of trenexa n ravicie thrice a day. Bleeding under controlled.
But after 3 days doctor stopped injection n given tab trenexa twice a day n ravici thrice a day with endoreg 2mg twice a day n have been discharged from hospital but still am bleeding between 2 pm to 7 pm. Rest of the time little toping is there. I am bleeding since XXXXXXX 18 till date. My new gyno said it will be controlled slowly, but still am helpless. My gyno still unable to find the exact reason of bleeding. I am having no issues, failed two cycles of IVF. My HB is 9.7. Anyone plz advice am totally confused n bed ridden.
Answered by Dr. Manisha Jain 37 minutes later
Brief Answer:
Hysteroscopic fractional curettage advised

Detailed Answer:
Hello Mam, thanks for trusting health care magic.
I have read your history and seen all he reports and understand your anxiety about it.
In my opinion you need a hysteroscopic guided fractional curettage and thus an adequate sample from appropriate place of the uterine cavity.
It is unusual to have such an erratic menstrual complaint and especially minimal response to endreg.
Endoreg is very effective in this type of bleeding though definitely it is not very effective in adenomyosis in the long run.
In the mean time you need a GnRH analogue depot to tide over the time and then Hysteroscopy at the earliest.
Yours is definitely a different presentation of a common problem so needs a thorough work up in an organised manner.
You can discuss the findings of the Hysteroscopy anytime with me on this forum.
Dr Manisha Jain

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Manisha Jain 22 minutes later
Thanx XXXXXXX mam for ur reply. Mam I wud like to mention that I have done hysterscopy two times during my two failed IV cycle during 2011.
I have also done colscopy in 2015 n report was fine. I am uploading those reports too, for ur reference plz.
Answered by Dr. Manisha Jain 3 hours later
Brief Answer:
Hysteroscopy still advisable

Detailed Answer:
Hi dear, I have seen the attached reports and in my opinion still get a fresh Hysteroscopic guided biopsy as I'm not very convinced with the sequence of events and cannot assign it to just adenomyosis.
Plus I would like to ask a very straight question - Do you still want to have a baby or are you ready for a surrogate cycle of IVF?
Because as far as fertility is concerned, in my opinion your womb will not be able to support pregnancy after looking at all the reports and knowing the history.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Manisha Jain 45 minutes later
No mam, I don't need or wish any pregnancy. .since I have already one adopted daughter of 2 n half yrs old. My documents uploaded are with dates...so won't be much difficult to correlate. As u opined that ...it's not adenomoyama. ..if it's so then what else is causing me to have severe pain n bleeding during periods. What are the other possible causes ?
Answered by Dr. Manisha Jain 17 hours later
Brief Answer:
Hysterectomy is the only solution

Detailed Answer:
Yes I have seen all the reports and I'm quite sure that the pain and uncontrolled bleeding is not because of adenomyoma.
It is most likely either multiple endometrial polyps or adenomyosis which is having a diffuse distribution apart from adenomyomata.
Frankly if not controlled on dienogest then hysterectomy is the only solution for this problem.
In case you have any question or need any second opinion over this then please feel free to discuss anytime.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Manisha Jain


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