[27F] Prolonged menstrual bleeding post-implant removal

Patient Description

A 27-year-old female has been experiencing a prolonged menstrual period for about a month, which started after the removal of the Nexplanon implant in March. She has noticed small clots but no significant cramping, and has also been feeling dizzy, lightheaded, and unusually fatigued. She has a stable weight and no known allergies to medications. Her current medications include Lamotrigine (200 mg once daily) and Buspirone (10 mg twice daily) for a mental health condition diagnosed in 2014, along with hair, skin, and nail vitamins, one-a-day women's vitamins, and ibuprofen. She smokes cigarettes but has no family history of bleeding disorders or other gynecological conditions.

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Arora's Assessment

What might be happening

Based on the information you have provided, possible explanations for your prolonged menstrual bleeding include:

  • Hormonal Imbalance: This is a common cause of prolonged or irregular periods. Hormonal imbalances can be caused by a variety of factors, including stress, significant weight loss or gain, or certain medications.

    • Treatment typically involves hormone therapy or birth control pills to regulate the menstrual cycle.
  • Polycystic Ovary Syndrome (PCOS): This is a condition characterized by hormonal imbalances and metabolism problems that may lead to irregular periods, among other symptoms.

    • Treatment for PCOS often involves lifestyle changes like diet and exercise, and sometimes medication to manage symptoms.
  • Uterine fibroids or polyps: These are noncancerous growths in the uterus that can cause heavy or prolonged periods.

    • Treatment can range from medication to manage symptoms to surgical removal of the fibroids or polyps.
  • Endometrial hyperplasia: This is a condition in which the lining of the uterus becomes too thick, which can cause heavy or prolonged periods.

    • Treatment often involves hormone therapy to thin the lining of the uterus.
  • Side effect of stopping the contraceptive implant: It's not uncommon to experience changes in your menstrual cycle after stopping hormonal birth control, including prolonged bleeding.

    • This usually resolves on its own over time as your body adjusts.

Please remember that this is not an exhaustive list and other conditions could also explain your symptoms.

What you can do

You should make an appointment with a healthcare provider to discuss your symptoms. They may wish to perform a physical examination or order tests such as blood tests or an ultrasound to help determine the cause of your prolonged period. In the meantime, you can:

  1. Monitor your symptoms: Keep track of the length and heaviness of your periods, as well as any other symptoms you experience. This information can be helpful for your healthcare provider.
  2. Stay hydrated: Prolonged or heavy periods can lead to dehydration, which may be contributing to your feelings of dizziness and lightheadedness.
  3. Take over-the-counter pain relievers: Non-prescription medications like ibuprofen can help manage any discomfort you may be experiencing.

What you should look out for

Please seek immediate medical attention if you:

  • Are soaking through one or more pads or tampons every hour for several hours
  • Are feeling dizzy or lightheaded even when lying down
  • Are experiencing severe abdominal pain
  • Have signs of anemia, such as pale skin, fatigue, and shortness of breath

Remember, this advice is intended to be general in nature, and specific causes may not apply to your situation. Always consult with a healthcare provider for accurate information.

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9 mo ago

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People Also Ask


Can stopping a contraceptive implant like Nexplanon cause prolonged menstrual bleeding?

Yes, stopping a contraceptive implant like Nexplanon can cause changes in your menstrual cycle, including prolonged bleeding. This is because your body is adjusting to the change in hormone levels, and it usually resolves on its own over time.


What are the common symptoms of hormonal imbalance that might affect menstrual cycles?

Common symptoms of hormonal imbalance affecting menstrual cycles include irregular periods, heavy or prolonged bleeding, mood swings, weight changes, and acne. These imbalances can be caused by stress, medication, or other health conditions.


How can uterine fibroids or polyps affect menstrual periods?

Uterine fibroids or polyps are noncancerous growths in the uterus that can cause heavy or prolonged menstrual periods. They may also lead to pelvic pain, frequent urination, or difficulty emptying the bladder.


What lifestyle changes can help manage symptoms of Polycystic Ovary Syndrome (PCOS)?

Lifestyle changes that can help manage symptoms of PCOS include maintaining a healthy weight through diet and exercise, reducing stress, and possibly using medications to regulate menstrual cycles and manage symptoms like insulin resistance.


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