Persistent Menstrual Issues: Causes and Solutions

Menorrhagia?

For the first three days before my period, I experience severe localized pain or nausea.
Taking painkillers too late can lead to vomiting.
Sometimes I notice brown discharge and increased vaginal discharge.
After my period ends, I have a break of 5 to 7 days before experiencing some blood clots for 4 to 6 days (which occur during urination).
This means I have two periods in a month; initially, it wasn't monthly, but later the second period included blood clots, sometimes with a bit of blood streaks (also during urination, and more appears with increased physical activity).
There was a time when the amount of blood clots suddenly increased, and I was found to have severe anemia with a hemoglobin level of 7.4.
After seeing a traditional Chinese medicine practitioner for three months, my hemoglobin improved to 9.7, and the second period was lighter.
I went to a gynecologist who said my periods last 7 to 8 days and performed an ultrasound (I have never had sexual intercourse).
However, the report indicated that the ultrasound could only be done if there was no menstrual flow, which made it difficult to see the uterus clearly, although the ovaries appeared normal.
I then started taking birth control pills to regulate my periods, but after almost a month, I still haven't stopped bleeding, and it mostly occurs when I go to the bathroom.
After the fourth day, there are some blood clots and streaks, and one day the discharge was brown.
When I missed taking the pills for two days, the bleeding increased.
Now that I'm almost done with the pills, should I continue taking them? Since the bleeding hasn't stopped, how can I have another ultrasound? I have taken iron supplements intermittently, but because the bleeding increases when I take them, I haven't been consistent.
Why does taking iron seem to trigger more bleeding? What could be the cause of this persistent bleeding?

IRENE, 30~39 year old female. Ask Date: 2023/09/17

Dr. Chen Zhiyu reply Obstetrics and Gynecology

Please follow the doctor's instructions for medication and treatment.
Your concerns should be discussed with your attending physician.
Thank you.

Reply Date: 2023/09/17

More Info

Understanding persistent menstrual issues can be complex, as they may stem from various underlying causes. Based on the symptoms you've described, it appears that you are experiencing significant menstrual pain, irregular bleeding, and possibly anemia, which can all be interconnected.

Potential Causes of Your Symptoms
1. Dysmenorrhea: The severe pain you experience before your period could be a sign of dysmenorrhea, which is often caused by uterine contractions triggered by prostaglandins. This pain can be debilitating and may also lead to nausea and vomiting, as you've noted.

2. Menorrhagia: The heavy bleeding, especially with blood clots, may indicate menorrhagia, which is defined as excessively heavy or prolonged menstrual bleeding. This can be due to hormonal imbalances, uterine fibroids, polyps, or other structural abnormalities in the uterus.

3. Anemia: Your reported hemoglobin levels (Hb 7.4) indicate severe anemia, which can result from heavy menstrual bleeding. Anemia can cause fatigue, weakness, and other systemic symptoms, further complicating your situation.

4. Hormonal Imbalances: The irregularities in your menstrual cycle, including the occurrence of blood clots and the prolonged duration of your periods, may suggest an underlying hormonal imbalance. Conditions such as polycystic ovary syndrome (PCOS) or thyroid disorders can contribute to these symptoms.

5. Uterine Abnormalities: The ultrasound findings that were inconclusive could suggest the presence of uterine abnormalities such as fibroids or polyps, which can cause heavy bleeding and pain.
6. Endometriosis: This condition occurs when tissue similar to the lining inside the uterus grows outside of it, leading to severe pain, especially during menstruation, and can also cause irregular bleeding.

Recommended Actions
1. Consult a Gynecologist: Given the complexity of your symptoms, it is crucial to work closely with a gynecologist who can provide a thorough evaluation. They may recommend further imaging studies, such as a transvaginal ultrasound or hysteroscopy, to better visualize the uterus and identify any abnormalities.

2. Consider Hormonal Treatment: Since you have started taking birth control pills, it may be beneficial to discuss with your doctor the possibility of adjusting your dosage or trying a different formulation. Birth control pills can help regulate menstrual cycles and reduce the severity of dysmenorrhea.

3. Iron Supplementation: Given your anemia, it is essential to address your iron levels. While you mentioned that taking iron supplements sometimes exacerbates your bleeding, it is important to find a suitable regimen that can help improve your hemoglobin levels without causing excessive bleeding.

4. Pain Management: In addition to hormonal treatments, consider discussing pain management strategies with your healthcare provider. Nonsteroidal anti-inflammatory drugs (NSAIDs) can be effective in managing menstrual pain, but timing and dosage should be carefully monitored.

5. Lifestyle Modifications: Maintaining a healthy diet rich in iron and vitamins, staying hydrated, and managing stress can also contribute positively to your overall well-being and may help alleviate some symptoms.

6. Follow-Up Care: Regular follow-ups with your healthcare provider are essential to monitor your symptoms, adjust treatments as necessary, and ensure that any underlying conditions are being addressed.

Conclusion
Your symptoms are indicative of a complex interplay of factors that require careful evaluation and management. It is essential to maintain open communication with your healthcare provider and advocate for your health to ensure that you receive the appropriate care and treatment. By addressing both the symptoms and the underlying causes, you can work towards achieving a better quality of life and improved menstrual health.

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