Thyroid problems and abnormal bleeding
Dear Dr Mitchell,
I am a 44-year-old woman who suffered from thyroid problems in the past but it is now under control. However, of late I have started abnormal bleeding immediately after my usual menstrual cycle. The bleeding is sometimes heavy and after certain periods I have cramps and the blood clots before it comes out. This is my third week and it is giving me serious concern to the extent that it affects me psychologically. Please advise me. I am so worried.
Abnormal uterine bleeding should always be investigated to determine the underlying cause. Abnormal uterine bleeding may be due to several factors and these include:
. Problems with the lining of the uterus such as polyps or fibroids, excessive thickening of the lining (endometrial hyperplasia), cancer of the lining of the uterus, inflammation of the lining of the uterus (endometritis);
. Problems with the muscles of the uterus such as uterine fibroids or adenomyosis (endometriosis in the muscles of the uterus);
. Hormone imbalance which may be due to infrequent ovulation or failure to ovulate, thyroid problems, problems with abnormal production of hormones by the pituitary gland;
. Problems with the cervix such as cervical cancer, or cervical polyp.
As you go up in age and certainly once you are over 35 and develop abnormal uterine bleeding it is important that you are thoroughly investigated to rule out an underlying cancer of the uterus or cervix. It is not unusual as you get close to the menopause for the periods to become irregular and sometimes heavy but you should not assume that the problem is due to the onset of the menopause or uterine fibroids until you have done all the investigations to rule out an underlying cancer of the uterus or cervix. Prolonged bleeding for up to three weeks will cause you to develop low blood count so it is important for you to take iron supplements.
You will need to have a pap smear and detailed ultrasound scan to check the lining of the uterus and sample the lining of the uterus. The lining of the uterus can be sampled by doing a dilatation and curettage or by simply using a small plastic device called a pipelle canula. Sometimes hysteroscopy has to be done if it is difficult to obtain tissue from the lining of the uterus by these methods. This involves using an instrument to directly look inside the uterus and then taking the sample of the lining under direct vision.
If you have completed your childbearing and the lining is abnormal or the bleeding is persistently heavy, then a hysterectomy might have to be done. You should consult your gynaecologist who will advise you further and arrange for all the relevant investigations to be done. You should not take any hormones to control the bleeding until you are properly investigated as this will only make the problem worse especially if the problem is due to cancer of the uterus.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.
