Prolonged Menstrual Cycles: Causes and Solutions

For the past ten years, my menstrual period has lasted fourteen days each time?

Hello Doctor,
I have a few questions:
1.
It has been over nine years since my youngest friend was born.

2.
However, for the first three to five days of my menstrual period, the flow seems normal, but afterwards it becomes very light, just a few drops.

3.
It isn't until after ovulation that I am completely free from the discomfort for the next fourteen to fifteen days.

4.
Previously, doctors have said it might be due to poor uterine contractions or hormonal imbalances, so I have been prescribed estrogen or progesterone, but the intermittent treatment has been ineffective, leading to sporadic visits.

5.
Regardless of whether I take medication or receive injections, it seems I cannot escape the fourteen-day menstrual period.

6.
Recently, I consulted a new doctor, and after some time on medication, there has still been no improvement.
(The doctor informed me that examinations of the uterus, ovaries, endometrium, and cervix were all normal, except for a small, unclear fibroid in the uterus that does not affect anything.)
7.
Later, the doctor mentioned having read a paper suggesting that if a cesarean section is not properly sutured, it could create a hole in the uterus, causing menstrual blood to accumulate in that cavity and then slowly drip out.

8.
The doctor asked the ultrasound technician to check, and as suspected, there is a hole in the lower part of the uterus.

9.
The doctor recommended a hysteroscopy, and indeed, there was a hole (though I couldn't understand it).

10.
The doctor said, "No need for medication anymore." They suggested that I could either have another child or undergo surgery to repair it, but it may not necessarily improve the situation.
Regular check-ups would suffice.

11.
I am unsure what to do and would like to ask the doctor for advice on my next steps.
Over the past ten years, I have spent five years on my menstrual period, which is quite exhausting and frustrating.
Could you please provide some recommendations or guidance on what I should do next? Thank you, Dr.
Chen.

Wishing you peace and happiness.

Xiao Mei, 40~49 year old female. Ask Date: 2008/08/26

Dr. Chen Changfu reply Obstetrics and Gynecology

I apologize, but the physician has performed a hysteroscopy and confirmed the diagnosis.
Please refer to the physician's recommendations.
I have no better suggestions.
Oral contraceptives can suppress ovulation to achieve contraception and also help regulate menstrual cycles and reduce menstrual flow and duration, but it cannot be guaranteed that they will be beneficial for you.

Reply Date: 2008/08/26

More Info

Prolonged menstrual cycles can be a significant concern for many women, and your experience reflects a complex interplay of factors that can contribute to this condition. Based on the information you've provided, it appears that you have been dealing with prolonged menstrual bleeding for an extended period, which has led to frustration and discomfort. Let's break down the potential causes and explore possible solutions.

1. Understanding Prolonged Menstrual Cycles: Prolonged menstrual bleeding, also known as menorrhagia, can be caused by various factors, including hormonal imbalances, uterine abnormalities, and other medical conditions. In your case, the history of uterine contractions and hormonal treatments suggests that hormonal dysregulation may be a contributing factor. However, the presence of a uterine cavity defect, as indicated by the ultrasound findings, could also play a significant role.

2. Uterine Abnormalities: The discovery of a "hole" in the lower part of your uterus, as mentioned by your doctor, could be a result of previous surgical procedures, such as a cesarean section, where the uterine wall may not have healed properly. This defect can lead to abnormal blood flow and retention of menstrual blood, causing the prolonged bleeding you are experiencing. The fact that your doctor has suggested a hysteroscopy indicates that they are considering a direct approach to assess and potentially correct this issue.

3. Hormonal Treatments: You mentioned that you have been prescribed estrogen and progesterone without significant improvement. Hormonal treatments can be effective for some women, but they may not address structural issues within the uterus. Since your recent evaluations have ruled out significant abnormalities in the ovaries, cervix, and endometrium, it may be time to reconsider the approach to your treatment.

4. Next Steps: Given the findings from your recent evaluations, here are some potential next steps:
- Hysteroscopy: If you have not already undergone this procedure, it may be beneficial. Hysteroscopy allows for direct visualization of the uterine cavity and can help identify and treat any abnormalities, such as polyps, fibroids, or the defect you mentioned. This could potentially resolve the issue of prolonged bleeding.

- Regular Monitoring: If surgery is not an option or if you prefer to avoid it, regular monitoring of your condition is essential. Keeping track of your menstrual cycles, symptoms, and any changes can provide valuable information for your healthcare provider.

- Lifestyle Modifications: While hormonal treatments may not have worked for you, lifestyle changes such as maintaining a healthy diet, regular exercise, and stress management techniques can sometimes help regulate menstrual cycles. Additionally, ensuring adequate iron intake may help manage any anemia resulting from prolonged bleeding.

- Second Opinion: If you feel uncertain about your current treatment plan, seeking a second opinion from another gynecologist or a specialist in reproductive endocrinology may provide new insights or alternative treatment options.

5. Emotional Support: Dealing with prolonged menstrual cycles can be emotionally taxing. It may be helpful to seek support from friends, family, or even a counselor to discuss your feelings and experiences. Connecting with others who have similar experiences can also provide comfort and understanding.

In conclusion, while your situation is complex, there are potential avenues for treatment and management. Hysteroscopy may provide clarity and possibly a solution to your prolonged menstrual cycles. Regular follow-ups with your healthcare provider are crucial to monitor your condition and adjust your treatment plan as necessary. Remember, you are not alone in this journey, and seeking support can make a significant difference in your overall well-being.

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