What Causes Prolonged And Heavy Menstrual Bleeding?

Posted on Tue, 28 Oct 2014

Question: I have had normal periods most of my life. In the last year they have gotten a bit longer 7-10 days but once a month until Aug 7. when I started a normal cycle and never stopped. It became extremely heavy with lots of clots to the point of gushing some days. I saw my gynecologist she did a pap smear, vaginal ultrasound and biopsy all of which came but normal. I was on medroxyprogesterone 20 mg a day for 15 days. The bleeding slowed a little but not much. I am now taking Gildess FE 1-20 generic for loestrin 1-20 tablet. I am now on day 13 and the bleeding is still heavy with lots of clots. When I went to the gynecologist 2 weeks ago by hemoglobin was 8.7. I have been taking 3 iron supplement pills a day for about 3 weeks now. My doctor does not seem overly concerned about my iron. She says it should go up once the bleeding stops. My concern is, is it going to stop? Should I be concerned or should it have stopped by now? My impression was that it should have stopped already. I keep trying to wait and see but don't know if that is the right thing. Should I try something different or be concerned?

Answered by Dr. Aarti Abraham (59 minutes later)

Brief Answer:
SHOULD TRY HIGH DOSE CYCLICAL PROGESTERONE

Detailed Answer:
Hello
Thanks for writing to us with your health concern.
At 44, the commonest reason for such a problem is endometrial hyperplasia.
Due to hormonal imbalance inherent in this age ( perimenopausal transition ), the lining of the uterus builds up, and gets shed irregularly leading to heavy and prolonged and erratic menstrual bleeding.
I would have recommended a Pap smear,vaginal scan and biopsy, which is exactly what was done.
Can you upload the reports, are you sure they came out normal ?
Also, Get additional hormonal tests done if possible - thyroid and blood sugars more importantly.
The best treatment is cyclical progesterone 15 days every month, for atleast 3 months.
That should resolve the issue.
Hormonal pills containing both estrogen and progesterone are slightly less efficacious.
You are getting anemic also, inspite of taking iron supplements.
It should definitely have slowed down by now.
If you take the rest of the 7 active pills, and it still does not stop, you need to switch over to high dosage of progesterone.
Alternatively you can consider having the Mirena IUD ( intra uterine device ) inserted, that is always a good option.
Rarely, if all medial therapy fails, endometrial ablation or hysterectomy should be considered.
In your case, I think you need 3 months of high dosage cyclical progesterone, if the combined estrogen - progesterone pills are not making much of a difference.
There is nothing to be overtly concerned about, apart from the anemia, since the biopsy and scan and Pap are fine.
All the best
Please feel free to discuss further.

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