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Diagnosis Of Absent Periods, Spotting, Lower Back Pain, Cramps?

Posted on Thu, 6 Mar 2014

Question: i am 52 years old and female. Last full menstrual period was September 2013. No period in October, November (first time ever missed a period). December had a prolonged period of about 18 days of light bleeding. Since then two days with one very small spotting episode. no kids, never on pill, started period early and went until september of this year. Overweight. Symptoms: low back pain, tired, bleeding as noted above, a little crampy from time to time. No loss of appetite, no bladder issues and just has a clean colonoscopy 2 weeks ago. Clean pap in march 2013. Recent tvu findings 1. Borderline endometrial thickening (15 mm) with a focus of cystic change. This likely represents cystic endometrial hyperplasia, however, clinical/cytologic correlation is recommended. 2. Two intramural uterine fibroids, one of which demonstrates subendometrial/submucosal extension. How ominous are these findings? Endo biopsy tomorrow. What is the likelihood that this is cancer????

Answered by Dr. Sree Gouri SR (52 minutes later)

Brief Answer: Metropathia hemorrhagica Detailed Answer: Hi, Thanks for the query. According to you age, menstrual history and ultrasound findings the possible causes of your problem are: - Dysfunctional uterine bleeding, possibly metropathia hemorrhagica. At perimenopausal age group because of hormonal imbalance this type of menstrual irregularity can be seen. It presents with endometrial thickening, cystic glandular hyperplasia, painless bleeding etc signs and symptoms. -Sometimes fibroids can present with menstrual irregularity. But usually bleeding due to fibroids will be associated with pain. Tiredness and other symptoms could be due to blood loss leading to anemia. In all possibility, I consider the chance of malignancy as less according to history and investigations. If your doctors are concerned, endometrial biopsy will help in ruling out the possibility of malignancy. Hope I have answered your query. I will be available to answer followup queries. If you are satisfied with the response, please give your review at the end of the discussion. Take care.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sree Gouri SR (5 hours later)

i do have lower abdominal and back pain that runs into my buttocks and upper thigh. all very left side focused, pain is constant and some days better or worse. i can almost pinpoint the spot of pain and if i press on it hard enough it sort creates nauseous feeling. been sort of nauseous overall since this all started. appetite ok though. i have actually gained weight. in the past year and half (10 pounds)--even prior to this event. one fibroid 3cm is calcified and lies in the left uterine fundus. another is half that size and not calcified and lies in left uterine body. it mildly distorts endometrium. uterus shape is normal. ovaries are normal and echogenecity with blood flow on doppler is normal. there is no free fluid. i am not anemic and only had the two small episodes of spotting since Dec 26--day of last prolonged bleeding. all my blood work was good. urine sample showed trace of bacteria. no family history of gynecological cancer. does this provide anymore insight? could the fibroids be causing that pain? they are not large really. do you still feel that it is less likely a malignancy? very upset by it of course and trying to become as educated as i can. thanks

Answered by Dr. Sree Gouri SR (14 hours later)

Brief Answer: Biopsy can rule out possibility of malignancy Detailed Answer: Hi, Fibroids can present with pain and menstrual irregularities. The possible causes of your pain are: -During menstrual flow when uterus tries to push the bleeding outside. -As both fibroids are located in left side there could be some stretching of ligaments. -Possibility of adhesions inside the pelvis. By undergoing endometrial biopsy, the possibility of malignancy can be ruled out. During perimenopausal age some amount of weight gain can be seen. Weight gain sometimes can lead to menstrual irregularity. If the cause of menstrual irregularity is found as dysfunctional uterine bleeding, hormonal treatment can cure the problem. With the attainment of menopause fibroids will regress usually. Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sree Gouri SR (31 hours later)

Thanks. One more quick question. Impressions from my ultrasound noted the two growths as fibroids. Is there any chance those are not fibroids or is ultrasound pretty definitive? I think this is my last question. Thank you!! :-)

Answered by Dr. Sree Gouri SR (2 hours later)

Brief Answer: Ultrasound can differentiate Detailed Answer: Hi, Usually ultrasound can differentiate fibroids from other growths by their echogenicity etc characters. If you want you can go for MRI which can give better picture regarding the growths. Take care.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar