Prolonged Menstrual Bleeding: Causes and Next Steps - Obstetrics and Gynecology

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Menorrhagia


Hello Dr.
Chen: Since March, my menstrual periods have lasted over two weeks.
I later went for an examination and was found to have uterine polyps, which I had surgically treated in May.
However, starting in September, I had two menstrual cycles, and the second one did not stop.
On October 12, I had another period that continued without interruption.
On October 29, I visited the gynecologist, who performed a hysteroscopy and indicated that there were no significant issues, only mentioning mild adenomyosis, which is considered normal for my age.
My menstruation briefly stopped for a few days starting October 30, but on November 4, it returned and has not stopped as of today, November 22.
The flow was heavier in the first few days and is not just spotting; there is also bright red blood.
I have to change sanitary pads several times a day.
The doctor prescribed hormonal medication, stating that I could take it if the bleeding does not stop.
However, I have a benign tumor in my breast, so I am hesitant to take hormonal medications, especially since I have thalassemia and my hemoglobin is only 9.0.
I would like to ask the doctor what could be causing the continuous bleeding and if I should undergo any further examinations.
Thank you, Dr.
Chen, for your response.

Ada, 40~49 year old female. Ask Date: 2021/11/22

Dr. Chen Zhiyu reply Obstetrics and Gynecology


Regarding your concerns, here is the response: If there has been a history of endometrial polyp removal via hysteroscopic surgery and you are experiencing abnormal bleeding again, which has been confirmed by hysteroscopy as not being a recurrence, then the abnormal menstrual bleeding should primarily be attributed to issues within the uterine body.
Based on the information you provided, it is possible that changes in the condition of adenomyosis are contributing to this.
If medication treatment has not only failed to improve the situation but has worsened it, it may be advisable to discuss further management options with your treating physician.
Thank you for your inquiry, and I wish you health and happiness.

Reply Date: 2021/11/22

More Info


Prolonged menstrual bleeding, also known as menorrhagia, can be a distressing condition that significantly impacts a woman's quality of life. In your case, it appears that you have been experiencing extended menstrual periods since March, with a history of uterine polyps and adenomyosis. The fact that you have undergone surgery for the polyps and have been monitored for adenomyosis indicates that there are underlying factors contributing to your bleeding.

Menorrhagia can arise from various causes, including hormonal imbalances, structural abnormalities in the uterus (like fibroids or polyps), and systemic conditions such as blood disorders. In your situation, the presence of adenomyosis may be a significant contributor to your ongoing bleeding. Adenomyosis occurs when the tissue that normally lines the uterus grows into the muscular wall of the uterus, leading to heavy and painful periods.

The fact that you have experienced two menstrual cycles in September and then continuous bleeding since October raises concerns. While your gynecologist has performed a hysteroscopy and found no significant issues, it is essential to consider that adenomyosis can still lead to prolonged bleeding, even if it is not deemed severe. Additionally, the hormonal medications prescribed may help regulate your cycle, but given your concerns about benign breast tumors and thalassemia, it is understandable that you are hesitant to start hormonal treatment.

In terms of next steps, it is crucial to continue monitoring your symptoms closely. Here are some recommendations:
1. Keep a Menstrual Diary: Document the frequency, duration, and volume of your menstrual bleeding. Note any associated symptoms, such as pain, clots, or changes in color. This information can be invaluable for your healthcare provider.

2. Follow-Up Appointments: Regular follow-ups with your gynecologist are essential. If your bleeding continues or worsens, or if you experience new symptoms (such as severe pain or dizziness), you should seek medical attention promptly.

3. Consider Additional Testing: If your bleeding persists, further evaluation may be warranted. This could include blood tests to check for anemia, hormone levels, or imaging studies like an ultrasound to assess the uterus and ovaries for any changes.

4. Discuss Treatment Options: If hormonal therapy is not suitable for you, discuss alternative treatments with your doctor. Options may include non-hormonal medications, such as tranexamic acid or NSAIDs, which can help reduce bleeding. In some cases, more invasive procedures, such as endometrial ablation or even a hysterectomy, may be considered if other treatments fail.

5. Lifestyle Modifications: Ensure you maintain a balanced diet rich in iron and vitamins to help manage anemia. Staying hydrated and engaging in regular physical activity can also support overall health.

6. Seek a Second Opinion: If you feel uncertain about your current treatment plan or diagnosis, consider consulting another gynecologist for a second opinion. This can provide you with more options and reassurance.

In conclusion, prolonged menstrual bleeding can stem from various causes, and it is essential to work closely with your healthcare provider to identify the underlying issue and develop an appropriate treatment plan. Your concerns about hormonal medications are valid, and open communication with your doctor about your medical history and preferences will help tailor the best approach for your situation.

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