Hello XXXXXXX,

Thanks for writing to us. I am trying to explain your query.

You are in post menopausal age group (53 yrs) and in this age group, irregular bleeding or spotting occurs sometimes in some women. It may be due to hormonal imbalance, caused by dysfunction of ovary leads to progesterone deficiency.

According to your previous hysteroscopy and D & C report, it seems to endometrial thickness (ET) is slightly higher (your 6.2 mm) than normal ET (less than 3 mm without HRT).It suggests more possibly endometrial hyperplasia,causing occasional bleeding/spotting.

As you are persistent with pain for 1 week and now mild spotting, we have to rule out other possible causes of bleeding or spotting in current context once again. These are as follows:
1) Endometrial atrophy (thinned out)
2) Endometrial hyperplasia (previously you have)
3) Endometrial cancer (uterine cancer)-more risk in postmenopausal bleeding.
4) Others- polyp, infection, adenomyosis, certain medication etc.

Complete physical examination including pelvic/speculum exam and colposcopy if indicated, is needed to rule out underlying pathology.

Possibilities can be narrowed by several investigations like blood test for thyroid profile & clotting factor abnormality, Trans Vaginal Sonography (TVS) scan, Pap smear test to detect cancerous changes and endometrial biopsy (which may be needed).

There is certain treatment protocol with initiation of haemostatic agent combined with progesterone pill if the case is endometrial atrophy or hyperplasia. Though periodic monitoring of ET is needed.

If above medical treatment fails to control bleeding, then approach would be surgical by the means of Dilation and curettage (D&C), Operative hysteroscopy to remove polyp if any, endometrial ablation in case of hyperplasia.

Lastly, total hysterectomy (removal of entire uterus) is the ideal choice to control bleeding & other complication in your age group.

Treatment depends on underlying etiology.So please consult with gynecologist for proper guidance through investigation, physical examination and medication with suggestive measures.

Follow some basic measures that will be helpful:
1) take healthy diet with iron supplements and avoid salty food stuff.
2) drink more water and eat XXXXXXX vegetables & fresh fruits.
3) avoid stress/tension by XXXXXXX breathing with adequate sleeping.
4) maintain genital hygiene properly and check up for BP.
5) may take some anti spasmodic/ analgesic for temporary relief of pain.

Hope I have answered your query. If you have any further questions, I will be happy to help.

Wish your good health in future.

Regards,
Dr Soumen.

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Hello XXXXXXX,

Thanks for follow up query.

Yes, you can carry on alprax in low dose if you unable to sleep properly at night.

Pain around left waist side may be neurogenic in origin, associated with knee arthritis. For this, you can consult with rheumatologist for better exploration and suggestive measures. Vitamin B12 or methylcobalamin supplement is essential to treat nerve degeneration in such cases.

Also you should avoid certain food stuff to reduce arthritis problem like red meat, caffeine, sugar, antacid, eggplants, red peppers, tomatoes, white potatoes,butter, margarine, fried food and vegetable oil etc.

If you do not have any clarifications, you can close the discussion and rate the answer.

Take care yourself.

Regards,
Dr Soumen

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Hello XXXXXXX,

Thanks again for query.

For better visualization and elaboration, Trans Vaginal Sonography (TVS) scan is recommended than plain abdominal ultrasound to measure endometrial thickness (ET) in case of post menopausal bleeding.

So you can consult with sonologist regarding this.

If you do not have any clarifications, you can close the discussion and rate the answer.

Be well and stay healthy.

Regards,
Dr Soumen

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