Tried everything to stop this bleeding
Dear Dr Mitchell,
I am 43 years old. My doctor says I have fibroids — the largest is 5cm. This has resulted in me bleeding for months now. I was put on the Depo injection, which made me bleed more, as well as Provera tablets, which didn’t stop the bleeding. I was booked for surgery to remove the fibroids, but the doctors were unable to operate on me because I have a hole in my heart and they didn’t want to anaesthetise me. The bleeding has subsided somewhat now, and I’m only spotting. What do you suggest? At the last doctor’s visit she suggested that I get the IUD, but I hear that it’s painful and causes heavy bleeding as well.
The use of Depo Provera (medroxy progesterone acetate) injection to control heavy bleeding due to uterine fibroids is a widespread practice which works well with for most patients. In a significant number of women there may be irregular vaginal bleeding associated with the use of this medication, especially in the first year of its usage. With long-term usage there is usually no menstrual period. This allows the anaemia and pain associated with the uterine fibroids to be controlled until surgery can be done to remove the fibroids. The use of the Depo Provera injection will not prevent the fibroids from growing and is an interim measure to control the pain and bleeding.
The use of a drug called Esmya (Ulipristal Acetate) is effective in shrinking the fibroids and stopping the menstrual period. Unlike the Depo Provera injection it is taken by mouth daily for three-month intervals with a two-month break to allow the menstrual period to return so that the lining of the uterus can shed. It is effective in shrinking the fibroids and controlling the pressure symptoms associated with the large fibroids that you now have. It is effective in stopping the menstrual flow, thus allowing you to build up your blood count. If surgery is eventually done, the blood loss is significantly less because the fibroids are smaller. This reduces the complication from blood loss at surgery.
The fact that you have a heart problem putting you at high risk for surgery is significant. The use of Esymya may help you to delay or avoid surgery completely.
The intrauterine contraceptive device containing levonorgestrel (Mirena or Jaydess) can cause a significant reduction in the menstrual flow and the pain associated with the periods. However, it does not cause any reduction in the size of the fibroids so the pressure symptoms will still persist. The Mirena also causes reduction in the pelvic pain associated with uterine fibroids. It can be easily inserted and is definitely not painful. There may be some cramping immediately after the insertion, but this subsides within a short period of time.
If surgery is still necessary, then the operation can be done after you have been seen by a cardiologist and your heart condition stabilised. There are highly skilled anaesthetists who can administer the anaesthesia skilfully either in the form of a general or regional (spinal or epidural) anaesthesia so that the surgery can be done. At the age of 43 you should consider doing a hysterectomy to avoid having to do repeated surgeries for recurrence of the uterine fibroids.
Consult your gynaecologist who will advise you further.
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. All responses are published. 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.
