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Suggest Treatment For Vaginal Bleeding After Mirena Insertion

Posted on Mon, 19 May 2014

Question: Ma'am,
I was on Regestrone for 25 days after having bled for more than two weeks on Mirena insertion(already details were given in my previous mails). After about 10 days of taking Regestrone 5 mg, bleeding subsided with spotting or almost nil in the last few days of the course. Regestrone course completed on 18th Apr'14. Since 20th Apr'14 withdrawal bleeding has commenced. Till today morning bleeding was quite less. But since today afternoon bleeding has increased manifold accompanied with severe abdominal pain.Also there's a feeling of something(may be Mirena thread) protruding downwards towards vagina/vulva, along with itching. Can I take Tranostat MF for bleeding, although my doc has advised to wait for 1 more day and observe. It's really getting too tiring for me as I work in a core industry.Pls advise.
Regards,
XXXX

Answered by Dr. Bhagyashree.B (49 minutes later)

Brief Answer:
start tranostat mf immediately

Detailed Answer:
Dear XXXX
Thanks for writing back.
The first few cycles after IUCD/ mirena insertion can be painful and sometimes it is expelled spontaneously.
Please start the tranostat mf thrice a day. It will reduce bleeding immediately and also prevent any chance of expulsion of mirena. I would also recommend that you take tranostat every cycle for first three days so that you don't have to experience fatigue and heavy flow.
Thanks
Dr Bhagyashree

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Bhagyashree.B (34 hours later)

Ma'am,
Even after taking Trsanostat MF (already 4 doses over) bleeding is quite substantial accompanied with clots, also that pinching sensation is there in the vagina, mostly after urination or defaecation.Is there any chance of expulsion of mirena spontaneously? How long should i continue Tranostat MF; here doctor had suggested three each daily for three days.
Pls advise.
XXXX

Answered by Dr. Bhagyashree.B (3 hours later)

Brief Answer:
wait for two days. start regesterone if heavy flow.

Detailed Answer:
Dear XXXX
Thanks for writing back.
Usually by 2nd day there is good response to tranostat though in some cases it will take 3-4 days.
Spontaneous expulsion chances are always there with any intrauterine device as it's just placed in the Uterus and not stitched to it.
So excessive uterus cramps and bleeding may cause expulsion.
If by 2 days your bleeding has not decreased then again you may need to start regesterone this cycle.
Please write back after 2 days.
Thanks
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Bhagyashree.B (4 days later)

Ma'am,
Yesterday USG of my pelvis revealed that mirena had descended to the cervical canal n so it had to be removed by the doctor.
Bleeding was less, still she has prescribed Primolut-N twice daily for next 20 days so that the next cycle remains under control.
My query is:
Should there be any side-effects after mirena removal?
Do I need to take any other medicine?
Regards,
XXXX

Answered by Dr. Bhagyashree.B (1 hour later)

Brief Answer:
continue with primolut

Detailed Answer:
Dear XXXX
Thanks for writing back.
The mirena was inserted to decrease bleeding. The fact that It has descended means its ineffective so it has to be removed. There are no side effects. Take primolut as advised. It's same as regesterone.

Since you are on primolut, I don't expect you to have serious withdrawal effects. Continue your hematinics.

Thanks
Dr Bhagyashree

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Above answer was peer-reviewed by : Dr. Prasad