Perimenopausal with unusual bleeding

During the last couple of years my periods have started to become sporadic. My last doctor said perimenopause was the cause. I have a stenotic cervix from previous cryosurgery and was told sometimes it's hard for the blood to get out during the month as the opening is so small.  Had a d&c five years ago for irregular bleeding and an ultrasound a couple of years ago for the same.  No hyperplasia was noted at the time, but was told there was evidence of some type of harmless cyst. Nothing to worry about. Have also had regular pap smears. I just turned 50 and have not had a period for four months and have been experiencing hot flashes. Approx. a month ago I started to get PMS symptoms, bloating, swollen breasts etc. and figured I was going to get another period.  I started spotting for several days, then noticed a much heavier flow, but quite foul, which frightened me, but no fever. That lasted a few days and turned lighter and lighter and eventually the bad smell went away. I still do have very tender breasts, though. I have been to a new doctor and he told me I may have had endocervicitis, but didn't explain what caused it. He was vague about that, but ordered an ultrasound for next week. He also said everything about my pelvic exam seemed normal. Everything I read about my symptoms points to cancer and I guess I'm just trying to find out if there could be other reasons for this type of bleeding, as I am quite anxious awaiting this ultrasound. My mother just died of colorectal cancer at 64 and my dad has cancer also, so I'm quite concerned. Appreciate any advice.

[Kevin Pho, MD]

Bleeding at the age of 50 needs to be comprehensively evaluated.  You're right in that cancer is a possibility that needs to be ruled out.  The ultrasound is a reasonable initial test, but I would consider an endometrial biopsy to exclude the possibility of endometrial cancer.  

Also, with your family history of colorectal cancer, it is recommended that you be screened for colon cancer at age 40 - meaning a colonoscopy is recommended if you haven't had one already.  

I would discuss these options with your gynecologist or personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
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