My mom is having irregular periods and severe back pain

Dear Dr Mitchell,

My mom is 51 and she started menses at age 15. For the past year her menses have been very irregular. The last time she had her menses was last year April, then it came in December and again this April gone. Each time it comes it lasts for as much as 18 days – a light-brownish flow on some days then large clots a next. Her last pap smear was ok and we are waiting for results for the next one. She also has serious back pains in the morning. I hate to see my mom worry, how can I help her?

Your mother is at the age where most women usually attain the menopause. This is the time when the period stops completely. Before the actual cessation of the menses, the ovaries start to decline in function and the production of oestrogen falls off dramatically. This usually results in the menstrual period becoming very irregular. This may cause the periods to be very short with an extremely light flow

or the period may be prolonged, heavy and also irregular with missed periods for several months at intervals.

However, the time of the menopause is the age that women usually have abnormal bleeding due to an underlying malignancy of the uterus or cervix. It is important that all women who experience abnormal vaginal bleeding in this age group be evaluated by a gynaecologist. The abnormal bleeding should only be attributed to the decline in oestrogen from the ovaries after full examination and investigations to rule out cancer of the uterus or cervix. The fact that she also experiences severe back aches is significant, since advanced cervical cancer may present in this way.

Your mother needs to have an ultrasound done to check the lining of her uterus to see if it is excessively thickened. This will also determine if there is any abnormal growth in the ovaries. Some ovarian tumours produce oestrogen, which stimulates the lining of the uterus, resulting in abnormal uterine bleeding. If the lining of the uterus is abnormal then a biopsy is absolutely necessary to determine if any cancer is present. A pap smear is also necessary to determine if there is cancer of the cervix. She needs urgent evaluation by her family doctor or gynaecologist.

In most cases however, abnormal uterine bleeding is due to a benign (non-cancerous) condition in the uterus and so you should encourage and reassure your mother, while assisting her to obtain all the necessary investigations.

-Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.