What could be the cause of heavy bleeding seven days after inserting an intrauterine Mirena (levonorgestrel-releasing) device following surgery for endometrial thickening?
Jun 01, 2023
Source: Cainiu Health
Dr. Lv Aiming
Introduction
Endometrial thickening; heavy bleeding occurred 7 days after insertion of Mirena following surgery, which may be a normal phenomenon, or could be due to factors such as displacement of the Mirena device or local inflammation. Symptomatic management should be based on the specific clinical situation. The pathogenesis of endometrial thickening is not yet fully understood, but it may result from prolonged estrogen stimulation. Hypothalamic dysfunction may lead to sustained estrogenic stimulation of the endometrium.
Endometrial thickening followed by heavy bleeding seven days after insertion of a Mirena IUD may be a normal phenomenon, or it could result from factors such as displacement of the Mirena IUD or local inflammation. Appropriate management should be based on the specific circumstances. Details are as follows:
1. Normal phenomenon
The exact pathogenesis of endometrial thickening is not fully understood and may be related to estrogen stimulation. Hypothalamic dysfunction can lead to prolonged estrogen stimulation of the endometrium, resulting in this condition. The Mirena IUD is a foreign body, and after insertion, the uterine cavity may exhibit a certain degree of rejection response, leading to abnormal endometrial shedding and subsequent bleeding. In such cases, the bleeding typically subsides gradually.
2. Mirena IUD displacement
If intense physical activity is performed too soon after placement or sexual intercourse occurs prematurely, abnormal stimulation at the IUD site may cause the device to shift position, damaging surrounding soft tissues and resulting in heavy bleeding. It is recommended to visit a hospital where the displaced IUD can be removed surgically if necessary.
3. Local inflammation
If aseptic technique was not strictly followed during IUD insertion, external bacteria may enter the body and cause localized chronic inflammation. This inflammatory response can irritate the endometrial mucosa and alter the intrauterine environment, leading to abnormal bleeding. Patients may be prescribed antibiotics such as cefixime capsules or amoxicillin capsules under medical supervision.
In addition, other possible causes include cervical mucosal injury, endometritis, or uterine perforation. If heavy bleeding persists for an extended period, prompt medical evaluation and treatment are advised.
