This question was answered on Sun 20, Jun 2010 12:53pm by Dr. Srivastava

Provera has not stopped bleeding, how long does this take, should ablation be considered?

    
Asked by lmfpt3 (Female; 46; Initially, I became concerned with my menstuation when my cycles became close and close together, longer and heavier. At first I thought it was just perimenopause... then it became overwhelming and I saw my physician. My endometrial biopsy was negative, pap was negative, transvaginal ultrasoung negative and bloodwork is tsh, hemoglobin etc... all WNL. My doctor informed me that I had abnormal uterine bleeding caused by anovulation resulting in a prolific endometrium. I started 10 mg Provera 4 pills per day for three days, then three Provera three times per day for three days, then two provera twice daily for three days then one provera per day for seven days. I am now off Provera for three days and have been bleeding more than I ever have ie changing super tampon ever two hours and very thick large clots. Throughtout the entire dosage of the intial provera I bleed the entire time ( 1 tampon per day) except for one day after the second day of provera for 4 times per day. My physician stated that after this, he plans to have me take Provera 10 mg once daily for 1o days per month starting on the first of each month. Should I have any hope that this bleeding will ever stop if the mega doses of progesterone previously did not stop it. I am soo frustrated and I am going to the islands in four weeks. That will be the third day after my last doseage of provera and If I have a period like I have now I will be unable to swim.; Relevant drugs:Provera ) on Sun 20, Jun 2010 07:05am

Initially, I became concerned with my menstuation when my cycles became closer and closer together, longer and heavier. At first I thought it was just perimenopause... then it became overwhelming and I saw my physician. My endometrial biopsy was negative, pap was negative, transvaginal ultrasoung negative and bloodwork is tsh, hemoglobin etc... all WNL. My doctor informed me that I had abnormal uterine bleeding caused by anovulation resulting in a prolific endometrium. I started 10 mg Provera 4 pills per day for three days, then three Provera three times per day for three days, then two provera twice daily for three days then one provera per day for seven days. I am now off Provera for three days and have been bleeding more than I ever have (ie changing super tampon ever two hours and very thick large clots.) Throughtout the entire dosage of the intial provera I blead the entire time ( 1 tampon per day) except for one day after the second day of provera for 4 times per day. My physician stated that the plan is to have me take Provera 10 mg once daily for 1o days per month starting on the first of each month. Should I have any hope that this bleeding will ever stop if the mega doses of progesterone previously did not stop it. I am so frustrated.I am going to the islands in four weeks on vacation. That will be the third day after my last doseage of provera and If I have a period like I have now I will be unable to swim. Except for that one day on the provera that the bleeding stopped, i have blead everyday for almost 50 days. HELP!!! Am I wrong in thinking that the Provera is not going to work and that I need another procedure like an Ablation?

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Answer by Dr. Srivastava  on Sun 20, Jun 2010 12:53pm:

Hi, You seem to have severe menorrhagia due to endometriosis as per your description. Endometriosis can be treated by controlling your hormones with provera. Here abnormal endometrial lining is stopped from growth and thus bleeding by provera. As a result menstrual periods stop with provera treatment and remainder tissue becomes shrunken away. But, this may prove effective in mild to moderate menorrhagia. Many a times any underlying coagulation defects may cause heavy bleeding becoming cause of menorrhagia. In such cases a combination of hormonal therapy with tranexamic acid tablets may prove helpful. As you have recently stopped provera so it may at times take few days (3-10 days) to recover but if the condition remains same or worsens then you may enquire with your doctor about any such possibility of combined tranexamic acid tablets to help resolve any possible coagulation issues. It is shown to reduce blood loss by upto 50%. If still bleeding is not controlled then you may require dilatation and curettage or thermoablation as surgical options. Hysterectomy is last resort for heavy uncontrollable endometriosis. Hope this helps. Take care and do take iron rich diet to replenish lost haemoglobin. Keep us posted in case of further doubts.

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Comment by Dr J Singh on Sun 20, Jun 2010 11:24pm:
Hello, Welcome to the forum and thanks for posting on it. I can understand your concern for the heavy bleeding. What you are having is called menometrorrhagia. It is frequent, excessive flow and can occur due to any of several causes, including hormonal imbalance, endometriosis, uterine fibroids, or cancer. It can lead to anemia in long-standing cases. Since most of the investigations are normal, hence it can be due to endometriosis and menopausal symptoms. Dr Anurag has mentioned the treatment of endometriosis. Apart from progesterone therapy, gonadotrophin releasing hormone agonists, Danazol and conjugated estrogens can also be used. If the medical treatment is not effective, then surgical techniques like D+C, resectoscopic endometrial ablation techniques, non resectoscopic endometrial ablation techniques and hysterectomy( as last resort). I suggest you to discuss the treatment options with your gynecologist because in addition to Provera a combination treatment using these needs to be planned. I hope it helps. Take care and please do keep us posted on how you are doing or if you have any additional doubts. Kind regards. You can find additional information on the following site: http://emedicine.medscape.com/article/255540-over view

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Comment by Judy Jaros on Sun 09, Oct 2011 10:41am:
I am 53 and was on the pill for 30 years. The last few years were awful, with heavy bleeding and clots. Anemia as a result. I have several fibroids. So I stopped the pill and quit bleeding except for occasional spotting for 6 months. Now I have bleeding every day, for 4 months, fairly light. My doctor just put me on Prover 10 mg 8 days ago. I thought it would stop the bleeding right away, but so far everything is the same. Sometimes the blood is normal red, or dark, but mostly it is watery. I have had ultrasounds and two endometrial biopsies. No sign of cancer, phew. Doctors all say to just get a hysterectomy, but that seems extreme without a cancer diagnosis, and such a small amount of bleeding. I can live with this bleeding, but the worry is hard to live with! How long does it usually take for the Provera to stop the bleeding? I understand that it will give me periods again. Hopefully not too heavy! Anyway, my blood tests show that I am in menopause, but I still do have some fluctuations in estrogen and FSH levels. Any advice?

Comment by Jennifer on Sat 17, Dec 2011 10:12pm:
I happen to be prescribed Provera 10mg for 10 days, due because I was bleeding for 7 months straight, I started on Dec 1st and it stopped my bleeding, until the 5th then I was spotting pink, it went on until the 7th then here came the bleeding on the 7th, regular flow what I thought, until the 10th arrived and it was heavier, I was going through a tampon every hour and was afraid of leaving the house it was that bad, I am passing blood clots too, lots of them, it has been a nightmare, and here is day 17th and I am bleeding like no other STILL, but going through a tampon every 3 hours it has let up, but has not stopped, I would really like to know what is happening, I have no insurance to cover medical expenses, and the doctors here in the city i live in does not know NOTHING!! They run me around, guessing what I have, the doctor said I was bleeding from the uterus but he can't diagnose it as cancer, because that is what gyn-ob is for, if he can do a pelvic exam and he is a doctor, why cant he diagnose it? Eh I am so worried, and I can't do nothing because of no money, I am unemployed and don't qualify for gov medical. And I am not about to run to the doctor for him to give me made up information, and I wont be taking Provera again it has been a nightmare on my body, I went through strong cramping, and side pains, and the heavy bleeding while on it and after. I am hoping someone can shine some light!

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