I am glad to help you. Answers are intended to provide general medical information only.
There are several possibilities. First whenever a sexually active woman has any issues with bleeding or pain, it is important to do a pregnancy test.
Even if there have not been any skipped periods or she is using contraception, it is an important first stpe to be sure there is no pregnancy complication causing the bleeding.
If the pregnancy test is negative, bleeding and cramping could be related to a cervical or uterine polyp or non-cancerous tumor of the uterus called a fibroid. Other possibilities include cervical infection and erosions. Of course it is important to be sure the pap smear is up to date to be sure the bleeding is not from a cervical precancer or cancer.
Occasionally, this kind of bleeding and cramping can be from an infection of the vagina or cervix. A careful exam along with cultures for infection and looking at any discharge under the microscope would be able to diagnose an infection as a cause of bleeding. Cervical polyps would be visible on exam as well. In order to diagnose a uterine polyp or fibroid, an ultrasound would be needed. It is helpful to have a saline infusion ultrasound if the lining of the uterus is thickened. This makes it easier to see polyps or fibroids along the lining.
Sometimes this kind of bleeding and cramping can be related to thyroid disease or hormonal irregularities. When a woman skips an ovulation it can cause prolonged bleeding.
A test to check for thyroid disease may be helpful. Hormonal irregularities may also cause prolonged bleeding and be due to stress, weight changes, eating disorder and excessive exercise.
Another possibility is endometriosis.
This can be hard to diagnose because it doesn't show upon ultrasounds. It can cause abnormal bleeding, cramping and pain with intercourse.
Endometriosis can only truly be diagnosed by doing a diagnostic laparoscopy and taking biopsies of any suspected endometriosis lesions.
Often instead of doing a diagnostic laparoscopy, we treat with a 3 month trial of continuous birth control pills to see if that helps the symptoms or not.
Other unusual causes of prolonged bleeding would be liver disease and blood coagulation disorders.
But these would not usually cause cramping pain along with the bleeding. If there is cramping , there is usually a reason in or around the uterus.
Yes the Mirena could certainly do it.
It is typical to have spotting with the Mirena for up to 5 months after insertion so that by itself is not very concerning. Usually the bleeding gets lighter and lighter as time goes by.
A certain small percentage of women don't tolerate having an IUD in place.
This is more common in women who have never carried a pregnancy to term.
The uterus is smaller in such woman and sometimes the uterus feels the IUD as a foreign object and wants to expel it.
They will continue to cramp and bleed until the IUD is removed.
4 months is about the length of time to be thinking that the IUD is not working and consider having it removed.
Usually if the bleeding and cramping is getting gradually better, it may be worth trying to stick it out longer but if it seems the same or getting worse, it is probably not going to get better until the IUD is removed.
In my experience, women who have this intolerance of IUD feel instantly better when it's removed. In seconds after removal.
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Yes, I do this a lot.
No this doesn't seem ok for 4 months after an IUD insertion. If trying to save the IUD, we would usually treat with antibiotics for 10 days in case of an infection.
If not better after that, usually we would pull the IUD.
Some women just don't do well with an IUD.
Most LOVE them but about 1/50 I put in end up needing to be removed for intolerance of a variety of reasons.
I would say that 4 months is a good length of time to give the IUD to see if the symptoms settle out or not.
If they took cultures and all are negative, ultrasound shows its in the right place and exam doesn't show anything else, it does sound like intolerance of the IUD.
Yes, many women can't feel the string.
There was a research study that showed that many women who haven't carried a pregnancy to term have a width of uterus that is narrower than the IUD is. This may be the reason why some women can't tolerate an IUD.
Any other questions?
It's always a shame to have to pull an IUD because they are really a great form of contraception. But sometimes it has to be done.
As long as cultures were taken and an ultrasound checked the position then it does sound like intolerance of the IUD. It may still get better over time, maybe giving it another 2 months?
I'm not sure what you wrote.
usually on ultrasound, the technician will be able to tell if the IUD is sitting in the middle and at the top of the uterus like it should be.
They should be able to tell if one of the IUD arms has imbedded into the wall.
With a negative pregnancy test, negative cultures and ultrasound showing IUD correctly located in the uterus, it's most likely that symptoms of bleeding and cramping are related to intolerance of the IUD. Giving it another 2 months may be reasonable if keeping the IUD is very important. Giving 10 days of Doxycycline antibiotic would be reasonable too in order to try to save the IUD.
ok, I hope this information was helpful I hope it calms down soon. Please click accept so I get credit and be sure to ask follow-up questions into this chat if you think of any. I'm very glad to provide as much information as you need. I've placed 1000s of IUDs and have much experience with them.
Did you think of any more questions?
In that case it may be time to pull the IUD.
Usually that will solve the problem if the problem started when it was placed.
I hope this chat was helpful in figuring out what might be the right thing to do.