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Periods Irregular, Have Clots In Them, Have Bulky Uterus. On Ovral G, Sevista. Not Working. Other Treatment?

Posted on Fri, 15 Jun 2012

Question: I AM ON OVRAL G, SEVISTA AND SIOCARE FOR BULKY UTERUS (MEASURING 9.8 X 4.6 CM) FROM 16.07.11.MY PERIODS WERE STOPPED AND HAD NORMAL PERIODS IN OCTOBER. FROM 02.11.2011 THE PERIODS STARTED AND IS STILL CONTINUING WITH HEAVY CLOTS. THE USG REPORT ON 19.11.11 GIVES THE FINDINGS AS " BULKY UTERUS MEASURING 13.7 CMS IN LENGTH. AN ILL DEFINED HYPOECHOIC LESION OF SIZE 3.8 X 4.0 CMS IN THE ENDOMETRIUM CAVITY" PLEASE SUGGEST WHAT TO DO?OUR DOCTOR HAS SUGGESTED D&C, SHOULD WE GO FOR IT? WHAT LINE OF TREATMENT SHOULD BE CARRIED FOR THE LESION? THE DOCTOR HAD PRESCRIBED SEVISTA FOR BULKY UTERUS, BUT THE SIZE OF UTERUS HAS INCREASED DURING THE COURSE OF TREATMENT, SO SHOULD WE GO FOR SOME OTHER TREATMENT OR CONTINUE THE CURRENT MEDICATION?

Answered by Dr. Minoo Bhagia (2 hours later)

Hello.
Thanks for your query.

Ultrasound findings are suggestive of submucous fibroid in the uterus.
I would like to know your obstetric history means the number of children and their age.

In case of bulky uterus with long history of menorrhagia, endometrial biopsy is required.
If fibroid is submucous polyp in the cavity it has to be removed by hysteroscopy.
It is the choice of your doctor whether he or she wants removal of fibroid or hysterectomy if you have completed your family.

Sevista can cause withdrawal bleeding, so it is better to take progesterone like medroxyprogesterone or norethisterone. The dosage should be taken under your doctor's guidance and prescription.

Get your haemoglobin levels done. Take food XXXXXXX in iron.

I hope I have answered your query. Please accept my answer in case you do not have further queries.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. Minoo Bhagia (16 hours later)

MADAM,
I HAVE TWO CHILDREN, IST ISSUE ON 27.03.2002 AND 2ND ISSUE ON 03.07.2009.
BOTH THE ISSUE WERE PRE MATURED DELIVERY AND THE DELIVERIES WERE CEASAREAN.
THE HB% AS ON 19.11.2011 IS 12.3%.

PLEASE SUGGEST WHAT SHOULD BE DONE?

Answered by Dr. Minoo Bhagia (1 hour later)

Hello,

Thanks again for following up.

I have reviewed your ultrasound report. It doesn't show any fibroid in the cavity or in the muscle of the uterus. Endometrial thickness also seems normal. The size of uterus is big means it is bulky which is causing excessive bleeding.

Since your children are young and your have not attained menopause yet, you may need to be put on progesterone pills orally or mirena coil can be put inside the uterus which is a reversible method.
Mirena releases progesterone slowly and controls the bleeding within three to four months. It is costly though.
Dilatation and curettage may be planned if the symptoms are no controlled by medical treatment.

You can discuss these options with your gynecologist.

Hysterectomy is the last option which you should keep in mind.

Hope I answered all your questions. Please accept my answer in case you do not have further queries.

Wish you Good Health.

Best wishes

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Minoo Bhagia (10 days later)

DUE TO THE CONSTANT BLEEDING I WAS ADMITTED TO THE HOSPITAL AND UNDERWENT THE FOLLOWING OPERATION: -"HYSTEROSCOPY + D&C + ENDOMETRIAL POLYPECTOMY ON 24.11.2011" AND OBSERVATION WAS GIVEN ANS " LARGE ENDOMETRIAL POLYP SEEN ON ANTERIOR WALL OF UTERUS".
I AM PRESENTLY PRESCRIBED WITH
1. TAB. MODUS 10 MG 1 TAB. THRICE DAILY
2. TAXIM OZ 1 TAB TWICE DAILY
3. PAN D 1 TAB ONCE DAILY
4. PAUSE 2TAB THRICE DAILY.
BUT THE BLEEDING HAS NOT STOPPED OR UNDER CONTROL.
PLEASE SUGGEST ME WHAT DO BE DONE.

Answered by Dr. Minoo Bhagia (10 hours later)

Hello

Welcome back

You can try norethisterone tablets instead of modus. The dosage should be planned by your gynaecologist.
If it doesn't stop, hysterectomy is the only answer.It can be an abdominal hysterectomy or TLH (total laparoscopic hysterectomy) depending upon surgeon's skill

Take care
Best wishes

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Minoo Bhagia (55 minutes later)

MODUS 10 HAS BEEN PRESCRIBED FOR MINIMUM THREE MONTHS, BUT FOR IMMEDIATE CONTROL OF BLEEDING, THE DOCTOR HAS PRESCRIBED PAUSE TABLET TWO TABLETS THRICE DAILY. EARLIER ANOTHER DOCTOR HAD PRESCRIBED TRANEXA MF TABLET. WHICH MEDICINE WOULD FASTER ACTION, THAT WOULD CONTROL THE BLEEDING EARLY. WHAT WOULD BE THE DOSE FOR THE MEDICINE.?

Answered by Dr. Minoo Bhagia (8 hours later)

Hello.

Thanks for following up.

Pause and Tranexa MF are same thing. Modus is long acting progesterone, controls heavy bleeding.

You can try them as advised by your doctor.

Take iron tablets.

Hope, this helps. Please accept my answer in case you do not have follow up queries.

Wish you speedy recovery.

Regards.

Above answer was peer-reviewed by : Dr. Jyoti Patil

Follow up: Dr. Minoo Bhagia (1 hour later)

FOR HOW MANY DAYS AT A STRETCH CAN PAUSE OR TRANEA MF BE TAKEN? IS THERE ANY ADVERSE SIDE EFFECTS OF TAKING THESE MEDICINES FOR A LONG PERIOD OF TIME?

Answered by Dr. Minoo Bhagia (11 hours later)

Hello,

I do not give for more than 5-10 days each cycle depending upon the amount of bleeding. Every tablet of Pause MF contains 500 mg of tranexamic acid and 250 mg of mefenamic acid. The maximum dose of tranexamic acid ( which is present in Pause MF) that can be taken is 2 tablets(each of which contain 650 mg) three times a day for 5 days.

If required I switch over to injection tranexamic acid. As such, this agent is not given for a long period of time. The most commonly reported adverse events with tranexamic acid are headache, sinus and nasal symptoms, back pain, abdominal pain, musculoskeletal pain, joint pain, muscle cramps, migraine, anemia and fatigue. So there is nothing to be worried about.

I hope I have answered your query. Please accept my answer if you have no further queries.

Above answer was peer-reviewed by : Dr. Aparna Kohli

Follow up: Dr. Minoo Bhagia (4 hours later)

PRESENTLY I AM TAKING PAUSE 500, TWO TABLETS THRICE DAILY. WOULD YOU SUGGEST TO TAKE PAUSE MF IN PLACE OF PAUSE 500, FOR BETTER RESULTS?

Answered by Dr. Minoo Bhagia (27 hours later)

Hello.

Welcome again.

Yes, Mefenemic acid along with Tranexamic acid gives better results. You can get Pause MF prescribed from your treating doctor.

Hope, this helps. Please accept my answer in case you do not have follow up queries.

Wish you good health.

Regards.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Jyoti Patil