Abnormal Uterine Bleeding

I was diagnosed with Abnormal Uterine Bleeding 1 year ago, I am 46 years old.  Transvaginal US and Endometrial biopsy came back normal.  Endometrial lining was only 4mm thick.  No action was taken and periods were every other month and with light spotting/ bleeding.  6 weeks ago large clots and very heavy bleeding started and bled off and on for six weeks.  Went to OBGYN again and did pelvic exam and second Ultra Sound which now shows a 18mm thick uterine lining.  Now wants to schedule a second Endometrial Biopsy and insert progesterone IUD to control bleeding.  What are the chances that this is cancer or that the IUD won't work?

[Machelle Seibel, MD]

If an endometrial biopsy and pelvic ultrasound were normal one year ago, the chances of cancer are extremely small. A progesterone IUD is a reasonable treatment for this and often works. Sometimes the doctor will want to insert a small telescope (hysteroscope) into the uterus to see if there is a polyp or other cause of bleeding.

Hormonal changes leading to menopause and polyps are the commonest causes of bleeding such as you describe. Low iron and abnormal blood clotting factors are also possible but much less common in your situation. There are other possible causes as well.

You should know if the IUD works in a month or two. Some people find taking an Advil or similar medication just before inserting the IUD helps reduce the cramps that sometimes happen when the IUD is inserted.
Machelle M. Seibel, MD