Abnormal Menstrual Bleeding: Causes and Treatments - Obstetrics and Gynecology

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Abnormal menstrual bleeding can be a complex issue, particularly for women with pre-existing conditions such as uterine fibroids and cervical polyps. In your case, the presence of four fibroids, with the largest measuring 4-5 cm, and a cervical polyp of 0.39 cm, could potentially contribute to your abnormal bleeding patterns.

Understanding Your Symptoms
1. Menstrual Cycle Changes: Your typical menstrual cycle of 23-25 days has been disrupted by episodes of abnormal bleeding, including brownish discharge and sudden heavy bleeding with clots. This can be indicative of hormonal imbalances or structural issues within the uterus, such as fibroids or polyps.

2. Cervical Polyp and Fibroids: Cervical polyps are benign growths on the cervix that can cause irregular bleeding, especially after menstruation. Uterine fibroids, while also benign, can lead to heavier menstrual bleeding and increased menstrual duration. The fact that your fibroids have not increased in size is a positive sign, but they can still cause symptoms depending on their location and size.

3. Heavy Bleeding (Menorrhagia): The sudden onset of heavy bleeding, described as "blood崩," can be alarming. This may be due to the fibroids or the cervical polyp, as both can disrupt normal uterine function and lead to excessive bleeding. It’s also possible that hormonal fluctuations, particularly if you are approaching perimenopause, could be contributing to these changes.


Treatment and Medications
You were prescribed Tranexamic Acid and Norcolut (Norethisterone).
- Tranexamic Acid is an antifibrinolytic medication that helps reduce bleeding by preventing the breakdown of blood clots. It is typically used for heavy menstrual bleeding and can be effective in managing acute episodes of menorrhagia.

- Norcolut (Norethisterone) is a synthetic form of progesterone. It is often used to regulate menstrual cycles and can help manage abnormal bleeding by stabilizing the endometrial lining. The usual recommendation is to take it for 21 days, followed by a break, to allow for a withdrawal bleed.


Concerns About Continuous Use
Regarding your question about the continuous use of Norcolut: it is generally not recommended to take hormonal medications like Norethisterone indefinitely without breaks, as this can lead to side effects and potential hormonal imbalances. It’s important to follow your doctor’s instructions regarding the duration of treatment. If you have concerns about your body temperature being elevated (36.8-37 degrees Celsius), this could be a normal physiological response, but if it persists or is accompanied by other symptoms, it would be wise to consult your healthcare provider.


Next Steps
1. Follow-Up: Since you have experienced significant changes in your menstrual pattern, it’s crucial to have regular follow-ups with your gynecologist. They may recommend further imaging or tests to monitor the fibroids and polyp.

2. Lifestyle Modifications: Maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help manage symptoms. Staying hydrated and managing stress can also be beneficial.

3. Monitoring Symptoms: Keep a detailed record of your menstrual cycles, including the duration, flow, and any associated symptoms. This information can be invaluable for your healthcare provider in assessing your condition.

4. Consideration of Other Treatments: If abnormal bleeding persists, your doctor may discuss other treatment options, including hormonal therapies, intrauterine devices (IUDs), or even surgical options if the fibroids or polyp are significantly impacting your quality of life.

In conclusion, while your symptoms may be related to the fibroids and cervical polyp, it’s essential to work closely with your healthcare provider to monitor your condition and adjust treatment as necessary. Regular check-ups and open communication about your symptoms will help ensure that you receive the most appropriate care.