Managing Heavy Bleeding with Uterine Fibroids: Treatment Challenges

Continuous bleeding after medication for uterine fibroids?

In April and May of this year, I noticed abnormalities in my menstrual cycle.
After an examination in June, a 4 cm uterine fibroid was discovered.
Due to a gradual decline in hemoglobin levels to 8 over the past three years, and an iron level of around 4 in March, I suspect that iron deficiency anemia may be the cause (gastrointestinal issues have been ruled out).
However, by May, my menstrual flow was still within an acceptable range, averaging a change of sanitary products every two hours, although the duration of my periods had started to lengthen, with intermittent bleeding that did not fully resolve.
In June, after experiencing a 14-day menstrual period, I went for an examination and was initially prescribed pain relief and anti-inflammatory medication, as well as Tranexamic acid for a 7-day course.
After starting my next menstrual cycle, I experienced a significant increase in bleeding, with two days of heavy bleeding that nearly caused me to faint.
After finishing the 7-day course, my menstrual bleeding did not stop; it fluctuated between heavy and light, causing me to miss my scheduled appointment with the doctor.
I had to purchase Tranexamic acid on my own.
Eventually, after about 15 days, the bleeding slightly tapered off to a light flow, requiring three sanitary pads a day.
I returned for another consultation due to the severity of the issue, and a hysteroscopy has been scheduled for next week, along with a prescription for Gestrin and cervical softening medication before the surgery.
I have taken one dose of Gestrin, but the bleeding has not shown any signs of stopping.
I would like to inquire about the following:
1.
Neither Tranexamic acid nor Gestrin has stopped my bleeding; will this affect the upcoming surgery? I initially thought the medication prescribed would help control the bleeding, but upon researching, I found that it is intended to suppress ovulation.
Next week is indeed my ovulation period, but I am still bleeding.
Is this an expected and acceptable situation? Should I inform my doctor that the bleeding has not stopped? How many days before the surgery should I continue to monitor and report this?
2.
I have just taken one dose of Gestrin and will take the second tomorrow.
However, I experienced unusual fatigue, dizziness, and low mood the day after taking it.
On the third day, I had severe headaches, joint pain, and abnormal appetite, which were painful enough to disrupt my daily life, even waking me up at night.
These symptoms seem similar to the side effects listed in the medication guide, but since I have only taken one dose, it is difficult to determine if they are indeed side effects.
Should I continue taking it? Currently, my treating physician is unavailable, and I am unsure who to consult.
I expect to have surgery after taking the third dose, but these past few days of medication have been quite painful.
3.
Regarding the severe headache mentioned in question 2, is it permissible to take NSAIDs for pain relief, such as Etodolac? The pain feels as if I have been run over by a truck, making it difficult to sit still.
4.
I have received 4 doses of Misoprostol.
Given that I am still bleeding, will inserting it vaginally affect its efficacy? The nurse only informed me to use two doses the night before, but she forgot to mention what to do with the other two doses, leaving me somewhat confused.
5.
My hemoglobin levels had recovered to 12 after receiving iron supplements for three months from the gastroenterology department.
However, when I visited the obstetrics and gynecology department, they did not prescribe any more iron since my levels had reached 12.
After experiencing heavy bleeding, I have not had my levels rechecked, but my lips appear pale.
After communicating with the obstetrics and gynecology department, I am unable to obtain iron supplements.
Previously, the gastroenterologist advised that even if hemoglobin levels return to normal, I should continue iron supplementation due to my low iron levels.
Can I return to the gastroenterology department to continue receiving iron supplements?
I apologize for the many questions, and thank you for your assistance.

Mi Mi, 20~29 year old female. Ask Date: 2021/08/06

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, the medication prescribed by your doctor is to help with blood clotting, making it easier to operate during surgery.
Please continue taking it.
You can take pain relievers as they will not interfere.
We need to check for anemia through a blood test to know for sure.
Wishing you good health.

Reply Date: 2021/08/06

More Info

Managing heavy bleeding due to uterine fibroids can be quite challenging, especially when it leads to significant complications such as iron deficiency anemia. In your case, it seems that the situation has escalated, and you are right to be concerned about the implications for your upcoming surgery. Let's address your questions one by one.

1. Effectiveness of Tranexamic Acid and Gestrin: Tranexamic acid is typically used to reduce heavy menstrual bleeding by inhibiting the breakdown of fibrin, which helps in clot formation. However, it may not be effective for everyone, particularly if the underlying cause of bleeding is not solely related to clotting issues. Gestrin, on the other hand, is a progestin that can help regulate menstrual cycles and reduce bleeding by stopping ovulation. It is not uncommon for patients to experience continued bleeding during the initial days of treatment, especially if they are close to their ovulation period. If you are still bleeding heavily, it is crucial to inform your doctor as this could affect your surgical procedure. Ideally, you should report any persistent bleeding as soon as possible, especially if it continues up to a few days before your surgery.

2. Side Effects of Gestrin: The symptoms you are experiencing, such as fatigue, headaches, and joint pain, could indeed be side effects of Gestrin. It is essential to monitor how you feel after taking the medication. If the side effects are severe and impacting your daily life, it may be worth discussing with your healthcare provider, even if they are not available immediately. You could consider reaching out to another healthcare professional, such as a pharmacist or a nurse, for advice on managing these side effects. If the pain becomes unbearable, you may need to weigh the benefits of continuing the medication against the discomfort it causes.

3. Use of NSAIDs for Pain Relief: If you are experiencing severe headaches, it is generally acceptable to use NSAIDs like Etodolac for pain relief, unless contraindicated by your medical history or current medications. However, be cautious with the dosage and frequency, and ensure that it does not interfere with your bleeding. Always consult with a healthcare professional if you are unsure.

4. Use of Misoprostol: Misoprostol is often used to help with uterine contractions and can be effective in managing bleeding. If you are still bleeding at the time of administration, it may not significantly affect the drug's efficacy, but it is essential to follow the instructions given by your healthcare provider. If you have any confusion about the dosage or timing, do not hesitate to reach out for clarification.

5. Iron Supplementation: Given your history of iron deficiency anemia and the recent blood loss, it is reasonable to seek iron supplementation again, especially if you are experiencing symptoms of anemia (such as fatigue, pallor, etc.). You can return to your gastroenterologist or primary care physician to discuss your need for iron supplements. It is important to continue iron supplementation until your iron levels are stable, even if your hemoglobin levels have returned to normal.

In summary, it is crucial to maintain open communication with your healthcare providers regarding your symptoms and treatment responses. If you feel that your current treatment is not effective or if you are experiencing significant side effects, do not hesitate to seek a second opinion or consult another healthcare professional. Your health and well-being should always come first, especially as you prepare for surgery.

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