QuestionGod, that worries me. The amount of bleeding reduced to what I would consider a normal level, but it is the length of bleeding that hasn't been fixed. I have read somewhere that extended bleeding can be caused by "unopposed" estrogen and had assumed this is why this coil was recommended. Please could you explain to me why you think I need more estrogen so that I can have an educated conversation when I go back in 6 months? Or would you recommend that I try to change the course of my treatment before then? Thank you for your trouble.
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Followup To
Question -
Age 38, two kids one age 10 one age 3, LMP 25/10/04. I was having long heavy periods and some pain mid-cycle. I was diagnosed with an ovarian cyst which was removed in January this year and I had thermal ablation at the same time, but the periods continued to last 14+ days. There is also a lot of aching and tenderness in the lower abdomen, across the site of my caesarean scar. I have had a mirena coil fitted this week but am not convinced that sufficient thought has gone into solving the problem. The first week of the period I have red blood, but the second week it is more like a brown sludge. Lovely. Do you have any ideas please? Thanks.
Answer -
If an endometrial ablation failed to lower your bleeding and you still continue to bleed more than 14 days, the only other course is to remove your uterus (hysterectomy). I would not even recommend Mirena IUD, which increases your progesterone level. I think you need more estrogen to control the bleeding.
AnswerIf a woman has too much estrogen or not enough progesterone, a state of "unopposed" estrogen may exist. In those circumstances, adding progesterone (either Prometrium, or use of Mirena IUD, or cycling with progesterone) may help to regulate the cycle. However, if there is not enough estrogen, or if a woman has excessive bleeding, estrogen alone will stop the bleeding. Usually, when a patient merely has long periods or has been bleeding for an extended period of time, I will either use Provera 10mg twice a day for 5 days and she will, at first, bleed heavier and then will stop bleeding completely; of I will give her IV Estrogen to stop the bleeding and then will cycle her with a combination Estrogen/progesterone birth control pill. There are many ways to regulate one's bleeding. If the ablation did not work, and hormonal therapy does not appear to help, the only alternative is to remove the source of the bleeding, the uterus (hysterectomy). Discuss it with your gynecologist.
