irregular bleeding

HI,
I am 43 years old and have been having a change in my periods for the last 7 months. I went and saw my
OBGYN 6 months ago and told her about my problem. My periods have been arriving on time, but have become
lighter in flow and longer in duration. Used to be about 3-4 days, now about 10 days of very light bleeding.
She did a pap test and transvaginal ultrasound. She said everything looked good on the ultrasound, normal
thickness of the endometrium, no ovarian cysts, and I do have 2 small dime size fibroids which have been there
a long time. She wanted to wait a couple of months as I had just quit the ortho patch, and if the periods did
not become more regular she wanted me to try another form of birth control pill or the ring. Well, this month
I also had bleeding mid cycle for the first time, just light spotting again. I am seeing her again in a couple of
weeks for evaluation. What could this be due to? I'm worried about endometrial cancer. Could it be irregular
hormone production? Perimenopause?? Is it safe to be on the pill at my age??
Thanks for any thoughts you can share.
Donna

[Keith Downing, MD]

The proper work up for irregular bleeding in a woman over 35 would include ruling out pregnancy, checking for an endocrine abnormality (e.g., thyroid hormone changes), assessing for structural lesions within the uterus (like endometrial polyps/fibroids usually by office hysteroscopy--i.e., looking inside the uterus with a small camera--or sonohysterogram--instilling saline into the uterus while simultaneously having a ultrasound), considering anovulation (not ovulating monthly reflective of perimenopause) and performing an endometrial biopsy to look for abnormal tissue inside the uterus (e.g., endometrial hyperplasia or cancer).  With those results proper treatment can be instituted.  

Best regards,

Dr. Downing

[dLoy]

Thank you for you response. I just saw my doctor yesterday. She is very
unconcerned about endometrial cancer or hyperplasia because of the
ultrasound that was performed that showed no abnormalities. I am still
uncomfortable with the suggestion of a novasure ablation without having
a biopsy first. Is is accepted practice to do the ablation without a biopsy
first, she said she would first go in with the hysterscope and scrape the uterus, than do the ablation. Is this then sent to the lab and biopsied then?
I thought they did a biopsy on just about anything they take out during
these kinds of procedures?
Thanks for helping with this one last question!!
Donna