Managing Heavy Menstrual Bleeding and Pain with Uterine Adenomyosis

Q: Managing Heavy Menstrual Bleeding and Pain with Uterine Adenomyosis

Hello： If you have uterine fibroids or adenomyosis, it is common to experience abdominal pain or heavy menstrual bleeding during your period, which may also lead to symptoms of anemia. <br>Using the Mirena IUD is one of the treatment options, but there is a possibility that it ma

Persistent bleeding with large blood clots and lower abdominal pain?

I have a uterine adenomyoma, and for the past year, my menstrual bleeding has been continuous with blood clots, and I have severe lower abdominal pain.
I previously had a special intrauterine device (IUD), Mirena, which provided some improvement, but it fell out after five months (I’m not sure if it was due to increased bleeding or if I exerted myself while coughing from a cold).
After the Mirena IUD fell out, I immediately started experiencing abdominal pain and bleeding again, with large blood clots.
When I followed up with my doctor, they advised against re-inserting the IUD but prescribed birth control pills, which have not improved my condition.
I am still experiencing continuous bleeding with blood clots and significant lower abdominal pain.
What options do I have to resolve this? Please help me.

Yu, 40~49 year old female. Ask Date: 2013/05/05

Dr. Dong Yuhong reply Obstetrics and Gynecology

Hello: If you have uterine fibroids or adenomyosis, it is common to experience abdominal pain or heavy menstrual bleeding during your period, which may also lead to symptoms of anemia.
Using the Mirena IUD is one of the treatment options, but there is a possibility that it may expel.
If it does expel, it can be reinserted, but it may expel again.
Since the cost of Mirena is not inexpensive, whether to reinsert it is worth considering.
Switching to hormonal contraceptives for treatment, given your situation, has not resulted in significant improvement in symptoms.
Have you discussed surgical treatment options with your primary physician? It is advisable to rule out the possibility of uterine cancer or precancerous lesions when considering various treatment options.
The choice of treatment is also influenced by many personal factors, and your primary physician should have a better understanding of your condition.
It is recommended to consult and discuss with your physician to help you choose the treatment option that is most suitable for you.
Thank you!

Reply Date: 2013/05/05

More Info

Managing heavy menstrual bleeding and pain associated with uterine adenomyosis can be quite challenging, especially when previous treatments have not yielded satisfactory results. Adenomyosis is a condition where the tissue that normally lines the uterus (the endometrium) grows into the muscular wall of the uterus (the myometrium). This can lead to heavy menstrual bleeding, severe cramping, and the presence of blood clots during menstruation.

Given your history of heavy bleeding and pain, it is essential to explore various management options. Here are some potential strategies that may help alleviate your symptoms:
1. Medication Management:
- Hormonal Treatments: Since you mentioned that you were previously using a hormonal intrauterine device (IUD) like Mirena, which can help reduce menstrual bleeding, it may be worth discussing other hormonal options with your healthcare provider. Birth control pills, patches, or hormonal injections can help regulate your menstrual cycle and reduce the severity of bleeding and pain.

- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Medications such as ibuprofen or naproxen can help relieve menstrual pain and reduce bleeding by decreasing the production of prostaglandins, which are responsible for uterine contractions and pain.

- Tranexamic Acid: This medication can help reduce heavy menstrual bleeding by promoting blood clotting. It is often prescribed for women experiencing heavy periods.

2. Surgical Options:
- If medical management fails to provide relief, surgical options may be considered. Procedures such as endometrial ablation can destroy the lining of the uterus, which may help reduce or eliminate menstrual bleeding. However, this option is typically considered for women who do not wish to become pregnant in the future.

- In more severe cases, a hysterectomy (removal of the uterus) may be recommended, especially if adenomyosis is significantly impacting your quality of life.

3. Lifestyle Modifications:
- Maintaining a healthy diet and engaging in regular physical activity can help manage symptoms. Some women find that certain dietary changes, such as reducing caffeine and salt intake, can help alleviate bloating and discomfort.

- Stress management techniques, including yoga, meditation, or acupuncture, may also provide relief from menstrual pain.

4. Alternative Therapies:
- Some women find relief through alternative therapies such as acupuncture or herbal supplements. However, it is crucial to discuss these options with your healthcare provider to ensure they are safe and appropriate for your situation.

5. Regular Follow-Up:
- Given the complexity of your symptoms and previous treatments, regular follow-up with your healthcare provider is essential. They can monitor your condition, adjust treatment plans as necessary, and ensure that any underlying issues are addressed.

In conclusion, managing heavy menstrual bleeding and pain due to adenomyosis requires a comprehensive approach tailored to your specific needs. It is essential to work closely with your healthcare provider to explore all available options and find the most effective treatment plan for you. If you experience any new or worsening symptoms, such as severe pain, dizziness, or significant changes in bleeding patterns, seek medical attention promptly.

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