DEAR DR. GOTT: I am 51 years old and stopped getting my period 21 months ago. All of a sudden this last month I had excruciating lower back pain and then started bleeding lightly. My GYN said it was probably just because I was a little heavy but he did extensive testing only to find nothing abnormal. In your opinion, is being a little heavy cause for me to get my period after 21 months? I have never heard of anyone going through this before.
DEAR READER: Irregular menstrual cycles can occur for a number of reasons, to include the use of specific medications, stress, lifestyle changes, vigorous exercise, eating disorders, weight loss or gain, current medical conditions, thinning of the tissues lining the uterus, and overall health. A cycle can vary from woman to woman when it comes to regularity or irregularity, heavy or light flow, duration of a cycle, and minimal discomfort to intense, debilitating pain. Causes for these variances can result from a thyroid disorder, anemia, pelvic inflammatory disease, uterine fibroids, and high levels of prolactin in the body.
Because you have been 21 months without a cycle, I don’t personally feel your weight is to blame but I must clarify there is a definite correlation with weight and irregular menses; however, that relates to morbid obesity, not minimal weight gain. Generally speaking, and there are exceptions, once you have gone 12 months without a cycle, you are considered to be past menopause or post-menopausal. Most conditions that cause bleeding following menopause are benign, but they should be checked out by a gynecologist.
I feel the most logical possible reasons for your condition are either uterine fibroids, polyps, or endometrial hyperplasia. Uterine polyps that can range from the size of a sesame seed to that of a golf ball are growths that attach to the inner walls of the uterus and protrude into the uterine cavity. If polyps are present, they will likely require surgical removal because of the slightest potential for cancer. Fibroids which are generally benign, are uterine growths that often appear during childbearing years. A woman may be completely unaware of them because fibroids often don’t cause any symptoms at all and are only discovered during pelvic examination. They tend to shrink after menopause (because of a decrease in estrogen levels) and may never require treatment; however, those that grow in size and are associated with post-menopausal bleeding may need to be surgically removed because of the potential for cancer. Endometrial hyperplasia is an abnormal thickening of the uterine lining that results from an increase in the number of endometrial glands. In most instances, the condition is not a serious health risk. Those women most susceptible for this condition are obese, began menstruating at an early age, may have taken estrogen without progesterone, have never had children, and who have had a history of irregular cycles. Most cases can be treated successfully with hormones and possible minor surgery.
Even at 51 you should continue seeing your gynecologist for cervical cancer screening that includes a pelvic exam and Pap smear, breast exam, and laboratory testing. If necessary, and hyperplasia is suspected, a biopsy can be performed for clarification. If you remain concerned, despite the dismissal of problems by your gynecologist, I suggest you request a second opinion from your primary care physician. If he or she agrees with your present specialist, you either have the option of accepting the report or pursuing the issue still further.
Readers who would like related information can order my Health Report “Menopause” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.