Dear Dr. Northrup,
Over the past six months, I have had two episodes of prolonged vaginal bleeding (over three weeks) following my menstrual period. An ultrasound showed two fibroids: one outside of my uterus, the other on the inside. Both were small (1.5 by 1.7 cm). My doctor told me it’s unlikely that the fibroids are causing the bleeding and that the culprit is likely a low progesterone production that is causing anovulatory cycles.
Last month, I tried bioidentical progesterone cream. I applied 50 mg a day starting from the 12th day of my cycle, but it did not reduce or stop my bleeding. I still bled for 22 days. My doctor said only 50 percent of women respond to bioidentical hormonal creams, and I am probably not one of them. He suggests that I use the Mirena IUD with progestin. I am reluctant to do this because I had a bad experience with an IUD when I was younger. And I also don’t like to use synthetic hormones. However, I don’t know what else to do at this point.
Could you please recommend me something? Do you think the Mirena IUD will help?
Thank you very much in advance for your help – A.P.
It has been my experience that even small fibroids, if located submucosally—just underneath the endometrial lining of the uterus—can cause abnormal bleeding. And in your case, this could be causing the bleeding. You could have that submucosal fibroid removed via hysteroscopy. And that may well take care of the problem. The Mirena IUD, which contains synthetic progestin, is another option. It’s certainly worth a try. The only problem there is that they are expensive. The good news is that, if it doesn’t work well, it’s easy to remove. No harm done.
I have a few questions for you. Are you in the perimenopausal age group? Say 42 or above? If so, then the bleeding is apt to be from estrogen dominance and not enough progesterone. A dose of 50 mg of bioidentical progesterone is very low. I’d increase it to 100 mg daily for two weeks out of every month. The other thing is this: You have had only two episodes of prolonged bleeding in six months’ time. In other words, for most months, your bleeding has been normal. You could simply watch and wait. Acupuncture often works very well in situations like yours.
One final thing. Are there any stresses in your family (blood family) that involve money, power struggles, or sexual issues? These are all second chakra issues that can affect the uterus. It’s all food for thought. And I’m certain that as you meditate on this response, the right course of action will come to you!
Best of luck – C.N.