I receive a lot of emails from women who want to learn how to decrease bruising from low molecular weight heparin injections (such as Lovenox, Clexane, Innohep, Fragmin) or from FSH stims (such as Follistim, Gonal F, Menopur). I used Lovenox or Innohep or Arixtra or FSH for many months while trying to conceive both of my daughters and throughout both of my pregnancies – so I consider myself a “pro”! Here are some tips that I would like to share with you.
- Never take a hot shower or bath immediately before or after your injection. The warm water dilates abdominal blood vessels, increasing blood flow to the injection site and decreasing the ability of the blood to clot.
- The medication should be injected subcutaneously into the fat on the abdomen. The injection should not go into muscle tissue.
- Finding just the right spot to inject is vital. Once a handful of good spots are found, these areas should be remembered and “reused” in future injections. After a while, I discovered and remembered areas on my abdomen that hurt less and bleed less following an injection.
- Do not inject within 1.5 inches below, above, or to the left or right of the belly button. These areas tend to bleed more.
- Blood vessels and nerves tend to be located next to each other. A good way to stay away from blood vessels is to stay away from nerves. To do this, use the very tip of the needle to gently push on an area that you are considering for the injection. If it hurts, move away from that spot (just a millimeter to the left or right) and locate an area that does not really hurt. If it does not hurt, you are less likely to bleed a lot or get a large bruise or hematoma.
- Once a good spot is found the area can be iced before the injection. Although once I became a “pro”, I just skipped the ice and did the injection. I just didn’t need it after a while. But in the beginning, it made the injection a lot easier.
- Swab the area with an alcohol prep pad and allow it to dry completely (if it is still wet the injection may sting even more than it normally would).
- Gently “pinch” (pinch is probably the wrong word. I should say, gather the fat between your finger tips) the fat and skin at the injection site.
- Hold the needle at a 45 degree angle and inject so that the needle (notice that the tip is beveled – lead with the most pointed part of the needle) goes into the fat layer. At this point, imagine holding the baby that you are trying to create – this imagery makes the discomfort much more bearable and meaningful.
- Slowly inject the liquid. Once all liquid has been injected, wait a second and then slowly release the fat and remove the needle.
- Do not put pressure on the injection site, even if it is bleeding. Putting pressure on a site that has been injected with a “blood thinner” will not encourage the blood to clot faster and will likely make a bigger bruise or a hematoma.
- Do not use a band-aid or a bandage on the injection site. Just wait patiently for it to stop bleeding (if it bleeds at all). Usually, if a good spot is found, it will not bleed and it will only leave a 1mm circular purplish spot.
Why would someone need a low molecular weight heparin when trying to conceive? Below, I have listed some examples of hematologic abnormalities that may cause infertility or miscarriage.
*MTHFR gene polymorphism
*PAI-1 gene polymorphisms
*Low Protein S/ Protein C activity
*Leiden Factor V (R506 or H1299)
*Factor XIII gene polymorphism
*HPA-1 gene polymorphism
*anti-phosphatidic acid antibodies
*anti-beta 2 glycoprotein I antibodies
This information is not intended to be medical advice. Always follow your physician’s instructions for administration and use of low molecular weight heparin products.