Bleeding, bleeding, bleeding…

Dear Dr Mitchell,

I have been on the injection for a year now, and ever since June I have been bleeding. I went to a local doctor and he gave me some Primolut tablets but I am still bleeding. I went to the clinic and they gave me yellow tablets but I am still bleeding. What is causing these symptoms? Is it the contraceptive injection?

The contraceptive injection Depo Provera (Medroxyprogesterone acetate) is an effective method of preventing an unwanted pregnancy and is usually given every 90 days. Women are usually advised that in the first year of use this may be associated with irregular bleeding from the uterus. This usually settles down by the third injection and then there is no period.

The irregular bleeding may be in the form of light vaginal spotting or heavy bleeding. If the bleeding is persistent, then a second injection may be given before the usual 90 days and this helps to stop the bleeding. The other options to stop the bleeding include the use of the provera tablets or even using the oral contraceptive pills. Provera is progesterone tablets, somewhat similar to the depo provera injection. This usually has to be given in high dosage to stop the bleeding.

The oral contraceptive pill is somewhat more effective in controlling the bleeding because it has oestrogen in addition to progesterone. The oestrogen component in the oral contraceptive pills in addition to the progesterone helps to stabilise the lining of the uterus and prevents breakthrough bleeding. This can be used in the usual fashion, taking one tablet daily, or by taking one tablet twice daily until the bleeding stops. This method of treatment is safe and works well in situations where there is no contraindication to the use of oestrogen. This should not be used in women who have had a history of clots in the legs or lungs, or breast cancer.

Prolonged bleeding can usually be effectively controlled by using one of the methods, and iron tablets should be taken to prevent the onset of anaemia from excessive blood loss.

If the bleeding persists despite treatment, the injection should be discontinued and detailed investigations done to rule out other underlying causes of abnormal bleeding from the uterus. A blood count, pelvic ultrasound and a pap smear should be done.

In some situations, the abnormal bleeding may be due to abnormal changes in the lining of the cavity of the uterus, or even abnormal changes in the cervix. A dilatation and curettage may also be indicated to rule out cancer of the uterus and to stop the bleeding in some situations where the bleeding persists despite treatment. Consult your doctor who will advise you further.

If you have not done so already, you should also ask your doctor to administer the HPV vaccine to prevent cervical cancer. This is widely available and involves three injections over a six-month period. After the first one is given, the second one follows a month later, followed by the third six months from the first injection.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.