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Ask Dr. Norm S. Your Own Question

Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11059
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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I am experiencing constant bleeding due to Endometrial atrophy

Customer Question

I am experiencing constant bleeding due to Endometrial atrophy which at times can get very heavy.
Will trannexamic acid or mefenamic acid help with this kind of bleeding?
Submitted: 3 years ago.
Category: OB GYN
Expert:  Dr. Norm S. replied 3 years ago.
Hello and welcome.
I am Dr. Norm, and I look forward to helping you today.

Are you past menopause? If so, how long?
Have you tried any hormones?
What tests have you had done to be sure there is no other reason than endometrial atrophy? Thank you.
Customer: replied 3 years ago.

No I am still having periods. I have had an ultrascan and nothing was found except a very thin edometrial lining. I have been told this is the lightly cause as blood vessels are not being properly closed off.


I had my period 10 days ago and it has just started getting fresh blood showing again.


Will these pills help if this is the cause?


 

Expert:  Dr. Norm S. replied 3 years ago.
If the bleeding really was due to atrophic endometrium, then tranexamic acid may help, and mefanamic acid probably would not. Tranexamic acid works to help the blood coagulate, so it may be helpful. Mefanamic acid works to reduce prostaglandins, which are produced in the uterine lining. In women with heavy periods, they tend to have increased prostaglandins, but I don't think that would be true with an atrophic endometrium.

However, I doubt very much that your bleeding problem is due to atrophic endometrium. Perhaps it's possible, but atrophic endometrium tends to cause bleeding problems after menopause, and not before. As long as there are normal hormones, most all endometrium will grow and develop. It would be easy to know, since if you take birth control pills for 1 month, that will give your endometrium normal stimulation to grow, and most likely it will stop your abnormal bleeding. It's just far more likely that your bleeding is caused by hormonal changes, and taking the birth control pill will correct the hormones (at least while you're taking it). Sometimes the pill takes 2 months to cause normal periods without breakthrough bleeding.

You could try either tranexamic acid or me mefanamic acid to see it they help. But I think it's far more likely that your bleeding is related to some hormonal changes, and in that case, hormones are needed to correct it.
Customer: replied 3 years ago.

I am already taking the combined pill and have been for 15 years- that's why the lining is so thin.


 


Could it possibly be a polyp that wasn't picked up on the scan? If it was a polyp would tranexamic help with that too?

Expert:  Dr. Norm S. replied 3 years ago.
Which combined pill do you take?
Were you having normal monthly periods in the past? If so, when did that stop?
Customer: replied 3 years ago.

I am taking microgynon 30 and have been for 15 years. They were normal until about 6 months ago when I started getting prolonged periods and spotting through the cycle. The last couple of periods have been extremely heavy at times.


This one that started 10 days ago never really finished properly as I contined to get brown spotting, which today has turned red again with a slight cramps.

Expert:  Dr. Norm S. replied 3 years ago.
Thank you. Now I understand.
Combined birth control pills can actually cause bleeding due to endometrial atrophy. The progesterone in the pill causes the lining to get so thin that it bleeds easily. I didn't realize that you were taking the pill. So your bleeding is also hormone caused, due to the progesterone. Since it is, it can usually be resolved by switching to another pill, stopping the pill for a month to let the endometrium thicken up, or adding some estrogen to the pill, which tends to counteract the progesterone and thicken the endometrium.

Probably the easiest thing for you to do is to switch to a more estrogen dominant pill. Some pills, such as microgynon 30, are more likely to cause the kind of bleeding that you're having. Other pills, such as Desogen, Demulen, and Yasmin are far less likely to cause it, and likely to resolve it. A good alternative would be to stop the pill for 1 month, let the lining thicken, then start a different pill.
Customer: replied 3 years ago.

I have been told that because of my age they will not like to prescribe me higher doses of estrogen.............if I came off of the pill is there any guarantee at my age that my own estrogen levels would be high enough to thicken the lining?

Expert:  Dr. Norm S. replied 3 years ago.
Desogen and Yasmin each have 30 mcg of estrogen, the same as your Microgynon 30. It's because of the progestin that they tend to act more estrogen dominant. However, any estrogen risk associated with age (blood clot risk) seems to be the same.

It's true that at age 48, your ovaries might not produce much estrogen. If you went off the pill, you could take a low dose estrogen pill for a month. Without the progesterone of the pill, that would thicken your endometrium.
Customer: replied 3 years ago.

Could I not take some kind of estrogen supplement for a few months alongside my existing pill to see if it makes a difference? If it does then I know that's the problem and then can address what to do?


 


Also is it possible to double up for a few days by taking 2 pills in one day to stop this bleeding?

Expert:  Dr. Norm S. replied 3 years ago.
You could take an estrogen supplement, but that would be the same as taking a higher dose pill, which is not recommended at age 48.

Doubling up on the pill won't help because it's the progesterone that's causing the thin endometrium, and you'd be doubling up on the progesterone also.
Customer: replied 3 years ago.

I understand it's not recommended for long term use but if it could help thicken the lining and therefore stop these problems I could then change to a different make of pill such as Yasmin as you suggest?


 


I don't see how else I can thicken the lining?

Expert:  Dr. Norm S. replied 3 years ago.
You can thicken the lining by going of the pill (and thereby stopping the progesterone, which is causing the thin lining) and taking a low dose of estrogen. Or by using a more estrogen dominant pill (which still has only 30 mcg of estrogen).

Even short term use of extra estrogen will increase the risk of a blood clot.
Customer: replied 3 years ago.

But if I come off the pill won't my body still produce it's own progesterone?


 


Which brands are more estrogen dominant?


 


Would an estrogen cream help?

Expert:  Dr. Norm S. replied 3 years ago.
Ovaries only make progesterone after ovulation, and you're not likely to ovulate, especially in one month off the pill.

Desogen and Yasmin are estrogen dominant and only contain 30 mcg estrogen.

Estrogen cream might help, but then you're getting too much estrogen again (if you add that to the pill).
Customer: replied 3 years ago.

So on balance - all the things I've told you about being on the pill for so long and my lining only being 2.5mm you think the low estrogen is the likelly cause of these bleeding problems?


As I said earlier they did an ultrascan and colcoscopy and found nothing

Expert:  Dr. Norm S. replied 3 years ago.
I think the progesterone from the pill is the cause of the thin lining and the bleeding problems. It's not an unusual problem, and is usually resolved by switching to a different pill.
Customer: replied 3 years ago.

Yes but do you think the thin lining is what is causing the spotting and heavy bleeding? Can a thin lining do that?

Expert:  Dr. Norm S. replied 3 years ago.
Yes, a thin lining can and does cause both spotting and heavy bleeding.
I have to go for 1-2 hours. I'll be back if you have further questions. Sorry.
Customer: replied 3 years ago.

Thank you so much you have been extremely helpful as I have been trying to get to the bottom of this for 6 months- now I think I understand.

Expert:  Dr. Norm S. replied 3 years ago.
I'm back now.
You're welcome.

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