Case Studies

Empowering Women's Health

Heavy bleeding at 42

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.

46 years with heavy period and polyp on sonography

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.

46 years old with heavy periods

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.

48 Year old with heavy irregular flow

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 3^rd day. She is now doing well at 18 months from the surgery.

18 year old - PCOS

AN 18-year-old girl came to our clinic with her mother. She had got her menarche at 14 years and since then she was getting periods only once in 3 to 4 months each one lasting for 10 to 14 days. In the last two years she had put on 15 kilos of weight and had also noticed mild acne and hair growth on the face.

Her parents were of normal height and weight and her mother had diabetes during her 2 pregnancies.

The girl on examination had a height of 5 feet 2 inches and a weight of 75 kilos.

She had mild acne and facial hair.

Her investigation revealed normal thyroid prolactin FSH, LH levels but slightly increased testosterone and fasting sugar. Oral glucose tolerance test was also slightly deranged. The Lipid profile was mildly elevated. Her ultrasound examination revealed features of polycystic ovaries.

We counselled her on lifestyle modification, diet control and encouraged her to increase the physical activity.

She was given metformin to help reduce her sugar levels and to help her lose weight. She was given hormonal tablets to regulate her periods.

She discontinued the hormonal tablets on her own after the first 6 months as she wanted to see if she could get her periods normally after stopping them. She then remained only on metformin.

She has lost approximately 7 kilos in the last 2 years and her acne and hair growth is much better. Her cycles are better and come in about 30 to 40 days and last for about 5 to 7 days. Diet remains under acceptable control and she is enjoying her dance and aerobic class.

27 year old - Irregular & delayed cycles.

27 year old female (single though in a relationship) working in a jewellery shop came to our clinic with complaints of irregular delayed cycles and weight gain for the last 3 years. Her parents had mild diabetes and she had noticed mild acne in the last few months. She was 165 cms in height and 80 kilos in weight.

On investigations she had normal liver kidney and lipid profiles. The hormonal profile also was normal. Her sugar levels were normal, but insulin was mildly elevated. Her general and local examination were unremarkable. Sha was advised to do pap smear.

She was advised to reduce her daily calorie intake, to reduce the intake of high fat and energy dense foods and to reduce intake of salt. She was advised to increase the intake of a fruits and vegetables. We encouraged her to increase the physical activity gradually to at least 60 minutes of moderate intensity physical activity for five days of the week. She was given combined oral contraceptive pills to regulate periods and to provide contraception and was advised to take metformin to manage her sugar and insulin levels.

Over one year she has lost weight, has regular cycles and feels good with a positive frame of mind.