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Suggest Treatment For Multiple Fibroids And Mild Endometriosis

Posted on Wed, 11 Mar 2015

Question: Hi, I have had issues with my period and was in the hospital on 2/1 with what my gynecologist said was a ruptured cyst. My question is this...I start my period a week before this and it was extremely light, I continued to bleed with a couple of week a very dark brown think discharge and for the last 7 day very heavy with clots ranging in size from a golf ball to a baseball. I have fibroids and mild endometriosis. Is it normal to bleed for 27 days?

Answered by Dr. Sameer Kumar (50 minutes later)

Brief Answer:
menorrhagia due to fibroids...explained

Detailed Answer:
Hello,
Thanks for the query to HCM,
having seen the ultrasound report, it indicates that there are multiple fibroids both intramural and sub serosal. Also the endometrial thickness is 16mm which is high. At your age group , presence of fibroids can cause irregular uterine contractions while menses and hence menses can last for longer time . Also , chances are that endometrial hyperplasia exists , exhibited by thickened endometrium which causes heavy bleeding in form of clots. An endometrial biopsy would be required to prove that.
ideally if the heavy menses are episodic and not with every cycle , then antifibrinolytics like tranexamic acid can be used to reduce the bleeding. However if the menses are regularly heavy and prolonged , then with multiple fibroids and endometriosis in the background, with fertility not being a concern any more , it is suggested that hysterectomy should be planned after an endometrial biopsy to rule out endometrial cancer or atypia.
regards

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

Follow up: Dr. Sameer Kumar (40 minutes later)

Thank you for your quick reply. My periods have always been heavy...unable to leave the house on days 2-3 but they remained at 5-7 days. This time it has gone on for 27 days with no sign of letting up. Could the ruptured cyst have caused more bleeding?
Also, what is atypia?

Answered by Dr. Sameer Kumar (14 minutes later)

Brief Answer:
answered...

Detailed Answer:
ruptured cyst is not the reason for you heavy menses at all.
the concern during heavy prolonged menses is primarily endometrial cancer, which in its initial stages can be predicted by the quality of endometrial lining which can be hyperplasia with or without atypia.
atypia means atypical or abnormal precancerous cells. any evidence of atypia would warrant a hysterectomy to prevent from cancer developing.
regards

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

Follow up: Dr. Sameer Kumar (52 minutes later)

To rule out atypia or endometrial cancer would require a biopsy?

Answered by Dr. Sameer Kumar (4 minutes later)

Brief Answer:
endometrial biopsy with pipelle.....

Detailed Answer:
thats right , an endometrial biopsy would be required for the same. Its an office procedure and can be painlessly done with the help of a special instrument called PIPELLE.
it just has to be inserted into the uterus and a strip of endometrium can be scraped out without any pain . No anaesthesia is required.
regards

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

Follow up: Dr. Sameer Kumar (12 minutes later)

I am going to call my doctor again tomorrow. I hate to be a nuisance to them but she basically told me this was a combination of the ruptured cyst and pre-menopause. Thank you so much for your help...I may even ask to see another doctor in the practice.

Answered by Dr. Sameer Kumar (6 minutes later)

Brief Answer:
you are welcome

Detailed Answer:
thanks .
please see you physician and let me know the reports as well.
If you have no further queries , then you may please close the query.
regards,
Dr.Samiir Kumar

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

Follow up: Dr. Sameer Kumar (4 minutes later)

I will be in touch, thank you again

Answered by Dr. Sameer Kumar (4 minutes later)

Brief Answer:
thanks

Detailed Answer:
thank you .
I shall look forward for the follow up.
regards
Dr.Samiir Kumar

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