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HomeAnswersObstetrics and GynecologyadenomyosisMy wife has heavy clots and pain during periods. Why?

Will hysterectomy cure adenomyosis?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Sameer Kumar

Medically reviewed by

iCliniq medical review team

Published At July 17, 2018
Reviewed AtFebruary 12, 2024

Patient's Query

Hello doctor,

My wife usually has a period for six to seven days. On the first two days, she has pain. At times, she has heavy clots also. The doctor had asked us to do the scanning and some test. The scanning report is attached. 'There is anteverted and bulky uterus which measures 4.6 x 4 x 2.2 inches in size. The fundal endometrial thickness is 6.6 mm.' The doctor says the reports are fine. He has asked her to take Regestrone tablet (5 mg) twice a day for 15 days. My questions are:

1. Are the scan reports fine?

2. Is her uterus fine?

3. Should she take the Regestrone tablet?

Answered by Dr. Sameer Kumar

Hello,

Welcome to icliniq.com.

The scan (attachment removed to protect patient identity) shows a bulky uterus which can be due to adenomyosis or possible fibroids in situ, but the absence of fibroids is evident. She is likely to experience painful menses and heavy bleeding due to adenomyosis as well. Again the report shows an endometrial polyp which can often be the cause of irregular spotting as well and pain in the abdomen. This can be removed by hysteroscopy. Adenomyosis is a form of endometriosis and can grow with each menses. So, ideally, the perfect treatment is to control menses by GnRH analogs or Progesterone-only pills (medical management) and if still not controlled medically and the patient is symptomatic and in unmanageable pain, then hysterectomy is suggested.

The plan for giving cyclical Progesterone for 15 days will not apparently help much in her case, as it has been given seeing the thin endometrial wall thickness if she has irregular shedding during mid-cycle which she does not. Also, she is nearing her perimenopausal period. So, the thinning endometrium can be attributed to that. But in either case, cyclical progesterone will not help as the cause is adenomyosis and endometrial polyp for heavy bleeding in her case and not hormonal. Please discuss it again with your doctor and make an informed decision. Regards.

Patient's Query

Hello doctor,

Thanks for your answer. You have said that the perfect treatment is to control menses by GnRH analogs or Progesterone-only pills. But, Regestrone that the doctor has prescribed is also a Progesterone pill. But, he has asked her to take it for 15 days. My question is:

1. What are Progesterone-only pills?

2. For how many days it has to be taken?

3. Is it the same as Regestrone? Her last cycle was on the 23rd.

Answered by Dr. Sameer Kumar

Hello,

Welcome back to icliniq.com.

He has started Regestrone for 15 days only. Once she stops that, she will get the menses again and once the menses arrive, every endometriosis spot and adenomyotic tissue would start bleeding as well and hence bleeding shall increase. So, the aim is to place her on continuous Progesterone-only pills without a break for three to four months so that she does not get her menses. Now, that is what I wanted you to discuss with your doctor for continuous therapy. Please revert for further discussion.

Patient's Query

Thank you doctor,

You said that after taking Progesterone for three to four months continuously she will not get her menses. After three to four months when she stops at that time will she get the menses again and adenomyotic tissue will start bleeding? My question is; if she takes progesterone for three to four months continuously, then will her adenomyotic tissue get repaired and become normal? Will her bleeding also be normal?

Answered by Dr. Sameer Kumar

Hello,

Welcome back to icliniq.com.

The treatment is to be started for three months and then a repeat ultrasound is done to check the uterine size again to see if it has reduced or not. If it shows reduction then after a gap of one month another 3-month course can be offered. Adenomyosis can cause severe pain during menses as it is a variant of endometriosis. Usually, it is not present alone, endometriosis is also present along with it and confirmation is always by a diagnostic laparoscopy. If the size of the uterus and symptoms are not relieved post the 3-month treatment, then the next best option shall be hysterectomy to relieve symptoms permanently. Regards.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sameer Kumar
Dr. Sameer Kumar

Obstetrics and Gynecology

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