Why does a woman have prolonged bleeding for almost 50 days?irru

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Thank you for sharing this detailed history — it is extremely helpful for narrowing down potential causes. What you are experiencing is classified as abnormal uterine bleeding (AUB), and given that it has persisted for over 50 days, it warrants further evaluation and treatment.

Summary of your key details:

1. Bleeding duration: Ongoing for approximately 50+ days.

2. Weight: 231.485 pounds.

3. Height: Possibly 1.65 meters (please confirm, as 1.65 ft seems incorrect).

4. Medications tried: Tranexamic acid (both oral and injectable).

5. Investigations: No fibroids, polycystic ovary syndrome (PCOS), endometriosis; pregnancy ruled out.

What might be causing this?

1. Hormonal imbalance – most likely cause: Since no structural abnormalities were found, a hormonal imbalance is the most probable explanation. Specifically-

   1. Anovulation (lack of regular ovulation) can cause unopposed estrogen to build up the uterine lining, which eventually sheds irregularly and heavily.

   2. This pattern is particularly common in individuals with higher body weight, even without a diagnosis of polycystic ovary syndrome (PCOS).

   3. Emergency contraception taken over a year ago is not a likely cause of this ongoing bleeding — its effects are usually short-term (one to two cycles at most).

2. Possible endometrial (uterine lining) abnormalities:

   1. Even if basic imaging showed no growths, endometrial hyperplasia (thickening of the uterine lining due to unbalanced hormones) could still be present.

   2. A transvaginal ultrasound with measurement of the endometrial thickness is the best non-invasive next step.

Recommended next steps:

1. Consider hormonal therapy

   1. Tranexamic acid can reduce bleeding temporarily, but it does not address the root cause if it is hormonal.

2. Ask your doctor about:

   1. A short course of progesterone (for example, Medroxyprogesterone acetate 10 mg for 10–14 days) — this can help stop bleeding and reset your cycle.

   2. If you are not trying to conceive, a combined oral contraceptive pill may offer more lasting cycle regulation.

3. Check for anemia: With this much bleeding, your iron stores are likely affected, even if earlier results were “normal.” Request testing for

   1. Hemoglobin.

   2. Ferritin.

   3. Iron levels.

4. Referral to a gynecologist: If the bleeding does not resolve soon-

   1. Ask for a referral to a gynecologist.

   2. You may need further evaluation, like a hysteroscopy or endometrial biopsy, especially if you are over 35 or have risk factors like obesity.

Additional supportive measures:

1. Take daily iron supplements, particularly if you feel fatigued or dizzy.

2. Avoid NSAIDs (for example, Ibuprofen, Aspirin) as they may worsen bleeding.

3. Track bleeding by noting the number of pads soaked per day — this helps monitor progress and guide treatment.

In summary:

1. This bleeding is not normal, but you have already ruled out many serious conditions — a positive step.

2. The most likely cause is hormonal (anovulatory) bleeding.

3. Emergency contraception from a year ago is not responsible.

4. You likely need hormonal treatment, not just Tranexamic Acid.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.