What are the causes and treatment for menorrhagia & AUB?

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

It sounds like you have been navigating persistent menorrhagia (heavy bleeding) and abnormal uterine bleeding (AUB), which is understandably frustrating given your normal hormone levels and ultrasound results. The fact that Primolut N (norethisterone) manages the bleeding but does not address the underlying cause suggests a second opinion could be beneficial.

Possible underlying factors contributing to your menorrhagia & AUB (despite normal tests):

Even with normal hormone and ultrasound results, several potential factors could be contributing to your symptoms:

1. Endometrial dysfunction: The uterine lining may be experiencing issues with thickness or shedding, leading to prolonged and heavy bleeding.

2. Coagulation disorders (bleeding disorders): Conditions like Von Willebrand disease can cause excessive bleeding and may not be detected by routine hormone tests.

3. Progesterone withdrawal sensitivity: The immediate bleeding upon stopping Primolut N suggests a strong dependence on artificial progesterone for cycle regulation.

4. Subtle uterine abnormalities: Conditions such as adenomyosis or microscopic fibroids may not always be visible on standard ultrasounds.

5. Perimenopausal changes (regardless of age): Fluctuations in progesterone levels can occur, sometimes even when basic hormone tests appear normal.

Recommended next steps:

1. Seek a second opinion from a gynecological specialist: A reproductive endocrinologist or a gynecologist specializing in complex menstrual disorders can provide a more in-depth evaluation.

Consider advanced diagnostic testing:

1. Endometrial biopsy: To evaluate the uterine lining for abnormalities like inflammation or hyperplasia.

2. Hysteroscopy: A direct visualization of the uterine cavity, especially if ultrasound findings are inconclusive.

3. Coagulation factor tests: To assess for underlying bleeding disorders.

Explore alternative treatment strategies:

1. Hormonal options: Discuss switching to a combined oral contraceptive (COC) such as Microgynon or exploring other hormonal approaches like the Mirena IUD or tranexamic acid.

2. Non-hormonal options: If hormonal treatments are not suitable, consider tranexamic acid or non-steroidal anti-inflammatory drugs (NSAIDs) like Mefenamic acid to manage bleeding.

Important note: It is essential to emphasize that this information is for general knowledge and does not replace professional medical advice. A comprehensive evaluation by a qualified healthcare provider is crucial for accurate diagnosis and personalized treatment. Would you like resources to find a specialist in reproductive endocrinology or more information on the tests and treatments mentioned?

I hope this answers your query.

Please let me know if I can assist you further.