Mrs XYZ, 42-year-old, married with two children 14 and 12 year old, working as a secretary at a corporate office, presented with heavy flow with clots during periods and shorter cycles since 6 months. She had normal periods until one year ago. Since a year there was increase blood flow leading to fatigue, lethargy and anaemia.
She did not have any other illness such as raised blood pressure, diabetes and was not on any medication. She was using condoms for contraception.
When she visited Dr Agrawal’s clinic she underwent a detailed examination and pap smear, the report of which was normal. She was advised blood tests and they were normal. The sonography of the pelvis was normal.
In view of her symptoms and normal reports she was advised to use a LNG-IUS. It was inserted at the end of a period cycle. She was advised to keep a menstrual chart and was given iron and multivitamins.
At the end of 6 months and 1 year she has considerable reduction in the menstrual flow, the haemoglobin has improved, and she is very happy.
Mrs PQR, 46-year-old married, with one child of 20 years, and working as a tourist guide, presented with very heavy painful periods for one year.She had hypothyroidism for which she was taking medication and it was under control. There were no other medical issues.
In Dr Sangeeta Agrawal’s clinic, she underwent a complete gyne examination and pap smear which was normal. She was advised blood tests and they were within normal limits. She had a pelvic sonogram and that raised the suspicion of a polyp inside the cavity of the uterus.
She was admitted to a hospital and underwent a Hysteroscopic removal of the polyp under general anaesthesia. The LNG-IUS was also inserted at the same time so that it reduces the menstrual flow and prevents the formation of the polyp in future.
The patient had complete relief from the pain during periods. There was a significant reduction in the menstrual blood loss. She reported a few days of minimal bleeding in the first 6 months and spotting for few months. She has no bleeding since the last 4 months.
The patient is happy and can do her tours with a new found energy.
Mrs ABC 46-year-old housewife married with 3 children, complained of heavy irregular bleeding since a year. She did not have any medical issues such as raised blood pressure or Diabetes. She underwent a detailed check-up, pap smear, blood tests and sonography all of which were normal except that she had low haemoglobin.
Dr Sangeeta admitted her to the hospital and she underwent a diagnostic hysteroscopy. The cavity of the uterus was normal. A curettage was done, and the endometrium was sent for histology. The LNG-IUS was inserted after the curettage.
The histology report showed simple hyperplasia. This was reassuring, and the patient was counselled that the LNG-IUS would help resolve the hyperplasia.
The patient had immediate relief from the heavy periods and after one year she did not see any bleeding. After 5 years the FSH levels were in the menopausal range and the LNG-IUS was removed in the clinic.
Mrs ABC 48-year-old housewife married with 3 children, complained of heavy irregular bleeding since a year. She did not have any medical issues such as raised blood pressure or diabetes.
She underwent a detailed check-up, pap smear and blood tests, all of which were normal. The sonography revealed a bulky uterus and thickened lining.
Dr Sangeeta admitted her to the hospital and she underwent a diagnostic hysteroscopy which confirmed thickened endometrial lining. The cavity of the uterus was normal. A curettage was done, and the endometrium was sent for histology. The LNG-IUS was inserted after the curettage and the patient was explained that in case the report of the lining was not good then the LNG-IUS will be removed and further treatment will be done.
The histology report showed complex hyperplasia with atypia in some cells. In view of increased risk of cancerous changes happening in the future, patient was advised to undergo surgery to remove the uterus tubes and ovaries.
The patient underwent the surgery in 2 months’ time. Laparoscopic removal of uterus tubes and ovaries was done. The LNG-IUS was removed at the time of the surgery.
The patient had a safe procedure and good recovery. She was discharged from the hospital on 3rd day. She is now doing well at 18 months from the surgery.