Seeking Medical Insights on Heavy Periods and Anemia
Hello, I'm reaching out to gather some general health information rather than seeking a specific diagnosis. I reside in the UK and utilize the NHS for my healthcare needs. As a 38-year-old woman (5'6, 94kg - actively working to lose weight, having shed 18kg in the past year), I have endured a prolonged struggle with exceptionally heavy and painful menstrual cycles that include clotting, along with recurring iron-deficiency anemia. Previously, I experimented with both the combined oral contraceptive pill and the Mirena IUD; however, neither provided relief, as the IUD resulted in additional cramping and discomfort. I do not have children or prior pregnancies. My current medications include: - Duloxetine 60mg taken daily (for anxiety and depression) - Ferrous gluconate 300mg once daily - Vitamin C 1000mg daily (self-sourced, based on research suggesting it aids iron absorption) Recent bloodwork showed the following: - Hemoglobin: 110 g/L - MCV: 76.5 fL - MCH: 24.3 pg - RDW: 14.7% - Serum ferritin: 8 µg/L - White blood cells and platelet counts were normal A pelvic ultrasound indicated: - A normally positioned anteverted uterus - Endometrial thickness measured at 13 mm - An echogenic focus in the endometrium (62 × 74 × 44 mm) with a blood supply, suspected to be an endometrial polyp - Normal ovarian appearance, and no free fluid present I have several inquiries: I was informed that an iron infusion may not be necessary since my levels aren't sufficiently low, and I was advised to continue taking iron pills for three months followed by a re-evaluation with additional blood tests. However, I feel quite unwell. Should I advocate more aggressively for an infusion or consider private options? Is the size of the polyp linked to increased bleeding or iron-deficiency anemia? Should I be worried about potential malignancy due to its dimensions? In premenopausal patients exhibiting these symptoms, is a 13 mm endometrial thickness something to be concerned about? My general practitioner suggested that I “shouldn’t worry” and mentioned a 7-8 month wait to consult with a gynecologist. Nevertheless, I’m finding it difficult to cope with the pain, the heavy bleeding, and the anemia, which remains difficult to manage; other bleeding causes have been excluded. What are the standard procedures following this? Should I seek a more immediate referral? When hormonal therapies do not yield positive results, what other treatment options are typically explored? Thanks for your attention to my situation. Summary: 38-year-old female enduring chronic heavy, painful menstrual flows with clots and iron-deficiency anemia (Hb 110, ferritin 8). Pelvic ultrasound indicates a sizable potential endometrial polyp (62 × 74 × 44 mm) with a feeding vessel and endometrium thickness at 13 mm. Seeking general medical advice on whether this could clarify my symptoms and the steps I should take next.
Answers (1)
12/16/2025, 11:40:55 AM
OpenHealth AI
It sounds like you are facing several challenges related to heavy menstrual bleeding, painful cycles, and recurrent iron-deficiency anemia. It's important to address these issues thoroughly. Your concerns about the potential endometrial polyp and overall management of your symptoms are very valid.
Key Points:
- Heavy Periods and Potential Causes: Heavy menstrual bleeding (menorrhagia) can indeed be linked to endometrial polyps, and the size of the polyp can contribute to excessive bleeding.
- Iron Deficiency and Symptoms: Anemia can lead to fatigue, weakness, and discomfort, and it's crucial to manage your iron levels effectively.
- Waiting Times and Options: Given your symptoms and the impact on your daily life, it may be worth considering a more proactive approach to your healthcare.
Explanation:
- Endometrial Polyp: A polyp is a growth in the endometrial lining, and larger polyps can cause increased bleeding. While most polyps are benign, their size and the presence of blood supply may warrant further investigation to rule out any malignancy.
- Endometrial Thickness: In premenopausal women, a thickness of 13 mm can be within a normal range, but in the context of heavy bleeding and the presence of a polyp, it should be closely monitored.
- Symptoms of Anemia: Your hemoglobin level indicates anemia (normal is typically above 120-130 g/L for women). This can significantly affect your quality of life and suggest that your body is struggling to cope with blood loss.
Next Steps:
-
Consider the Iron Infusion: Since you are feeling unwell, it might be beneficial to advocate for an iron infusion, especially given your low serum ferritin and ongoing symptoms. Discuss this option further with your GP or consider seeking a private consultation for a quicker assessment.
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Gynecological Referral: If the waiting time for a gynecologist is too long and your symptoms are debilitating, consider pushing for an expedited referral or explore private options. Emphasize how your quality of life is affected.
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Monitor Symptoms: Keep a detailed record of your symptoms, including menstrual flow, pain levels, and any signs of fatigue or weakness. This can provide valuable information for your healthcare provider.
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Alternative Treatments: Discuss other therapeutic options with your GP or gynecologist if hormonal methods have not worked. Options may include:
- Progestin-only treatments: Would be an alternate hormonal approach.
- Non-hormonal medications: Like tranexamic acid to manage bleeding.
- Surgical intervention: If the polyp is confirmed and continues to cause issues, a D&C (dilation and curettage) or polypectomy may be recommended.
Final Thoughts:
Your health and comfort are important, and it’s valid to seek more assertive treatments given your chronic symptoms. Be open and communicative with your healthcare providers about how you're feeling and do not hesitate to seek additional opinions if needed. You deserve to feel better and have manageable periods. Please let me know if you need further clarification or support!
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