I have heavy bleeding after taking hormonal pills. How to manage?

Question

Hello doctor,

I am a 24-year-old female. I have an 8-month-old baby. I am suffering from a thickened uterine lining (18 mm) and experiencing heavy bleeding for the last three months.

After using hormonal pills (Ovipauz) for one month, the lining returned to a normal thickness of 6 mm, but I still have heavy bleeding. Meanwhile, my husband got COVID-19 positive. I tested negative but had all the symptoms.

I tried keeping drops of lemon in my nose to relieve the blockage and ended up bleeding from the throat the following day. I visited three E.N.T. doctors, and all tests were normal.

The doctor advised me to do CBC and two other tests, in which my MHC and MCV are low. Is it normal or anything to be concerned?

I had low hemoglobin during my pregnancy and took iron injections; after delivery, I am having this bleeding problem. I want to know whether my MCV and MHC are normal. Some are saying it to be thalassemia minor.

I am really worried.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Following is my opinion on your questions;

In pregnancy, the hemoglobin level usually goes down, so do not worry about that.

In the attached reports (attachments removed to protect the patient’s identity), your hemoglobin level is low, along with low PCV (packed cell volume) and low blood indices.

So, it is suggestive of microcytic hypochromic anemia.

There are many causes for microcytic hypochromic anemia, like iron deficiency, thalassemia minor, blood loss, chronic disease, etc.

I suggest investigating further with serum iron, ferritin, and other iron parameters as well.

Since you have a bleeding history twice, it is advisable to investigate with coagulation parameters like a PTT (partial thromboplastin time) and coagulation factor estimation for further workup.

You can visit a hematologist for a detailed discussion and physical examination accordingly.

I hope this helps.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

Yes, bleeding could be due to endometrial hyperplasia as well. But if the bleeding continued, then a coagulation profile test should be done. You can take a Tranexamic acid tablet if endometrial bleeding continues.

In thalassemia minor, the patient complains of chronic fatigue, dizziness, and severe fall in hemoglobin level, like below 7 g/dL, and difficulty in breathing can also occur.

However, symptoms of iron deficiency anemia and thalassemia minor are the same as mentioned above.

In thalassemia minor, bleeding is not the main complaint; instead, fatigue is the main complaint.

To rule out thalassemia minor, an HPLC (high-pressure liquid chromatography) test should be done.

Let me know if I can assist you further.

Best regards.