Abnormal Bleeding: Insights on Menstrual Irregularities and Fibroids

Abnormal bleeding

Hello Dr.
Tsao: I started experiencing menstrual irregularities at the end of 2014, with one instance of menstruation occurring every 10 days (this happened twice in a row, and after taking medication, the doctor diagnosed it as irregular menstruation).
I also had a delayed period of about 10 days.
After taking progesterone to regulate my cycle in January 2015, my menstrual cycles have been relatively normal for the past six months (though the flow has not been as heavy as before; it has been lighter over the past three years).
From August 4 to August 9, 2016, I had my period, but then I started again on August 18 (the flow on August 18 was heavier than my recent menstrual flow and bright red in color).
I consulted a gynecologist and had an ultrasound, which showed that I have uterine fibroids and a normal endometrial thickness of about 0.39 cm.
In 2014, a different doctor recommended an endometrial scraping procedure, but two other doctors believed that as long as the endometrial thickness was under 1 cm, it was unnecessary, so I did not undergo the procedure.
Could you please confirm if my endometrial thickness is within normal limits, and if so, can I rule out endometrial issues? Additionally, the doctor who regulated my cycle prescribed progesterone for me, and I have a history of breast fibrocystic changes.
Does this medication contain hormonal components that could affect the cysts? I had my hormone levels tested this year, and they were normal.
Thank you!

Ai Li Si, 40~49 year old female. Ask Date: 2016/08/22

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if the endometrial thickness is within the normal range, there is no need to perform a dilation and curettage (D&C) procedure at this time.
Hormonal medication can be used to regulate the menstrual cycle, and progesterone has little effect on cysts.
Wishing you good health.

Reply Date: 2016/08/22

More Info

Abnormal bleeding, particularly in the context of menstrual irregularities and the presence of uterine fibroids, can be a complex issue that requires careful evaluation and management. Based on your description, it seems that you have experienced a range of menstrual irregularities since late 2014, including episodes of frequent menstruation and changes in flow volume. You also mentioned the presence of uterine fibroids and a thickened endometrial lining, which are important factors to consider in your case.

Firstly, it is essential to understand that menstrual irregularities can arise from various causes, including hormonal imbalances, structural abnormalities like fibroids, and other underlying health conditions. Uterine fibroids, which are benign tumors of the uterus, can lead to heavy menstrual bleeding (menorrhagia), prolonged periods, and even intermenstrual bleeding, as you have experienced. The fact that you have had episodes of heavy bleeding, particularly with bright red blood, could indicate that the fibroids are affecting your menstrual cycle.

Regarding your endometrial thickness, a measurement of 0.39 cm (or 3.9 mm) is generally considered within the normal range for the follicular phase of the menstrual cycle. However, the endometrial lining can vary throughout the cycle, and it is crucial to monitor any changes, especially if you experience abnormal bleeding. The differing opinions from various healthcare providers regarding the need for a dilation and curettage (D&C) procedure suggest that there may be some uncertainty about the necessity of further intervention. If your endometrial lining remains within normal limits and you are not experiencing other concerning symptoms, it may not be necessary to pursue invasive procedures at this time.

As for the use of progesterone (like the luteal phase hormone you mentioned), it is often prescribed to help regulate menstrual cycles and can be beneficial in cases of irregular bleeding. However, if you have a history of fibrocystic breast changes, it is understandable to be concerned about the hormonal effects of such medications. Progesterone can influence breast tissue, but the impact varies from person to person. It is essential to discuss these concerns with your healthcare provider, who can help weigh the benefits and risks of hormone therapy in your specific situation.

In terms of monitoring your condition, regular follow-ups with your gynecologist are crucial. They may recommend periodic ultrasounds to assess the size and number of fibroids, as well as to monitor the endometrial lining. If you experience any new symptoms, such as increased bleeding, severe pain, or changes in your overall health, it is vital to seek medical attention promptly.

In conclusion, while your current hormonal levels are normal and your endometrial thickness appears to be within the acceptable range, the presence of fibroids and your history of menstrual irregularities warrant ongoing observation. Open communication with your healthcare provider about your symptoms and concerns will be key in managing your condition effectively. If necessary, they may refer you to a specialist for further evaluation and treatment options, which could include medication, lifestyle changes, or, in some cases, surgical interventions if the fibroids significantly impact your quality of life.

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