Heavy bleeding

I am 45 years old and from june 24th to July 28th I had heavy bleeding, bloating and strong menstrual cramps with a strange odor and clots. I saw my gynecologist 3 times during that period. She prescribed 10 days of provera to stop the bleeding and when that didn't work she prescribed cyclokarpon for 3 days,I saw no change and mentioned if she could do a hysterectomy. Meanwhile  a pap test was done and  the last time I saw her I was so tired and fed up of all of this that I asked for a hysterectomy, she scheduled one for september. I called her back wondering if anything else could be done and she mentioned ablation of the endometrium but referred me to a doctor who performs these. My period came back only 8 days later and I bled again for 15 days. The gynecologist she referred me wants me to go for a new ultrasound because the ultrasound that was done was when I was bleeding and the endometrium was very thick, 2.5 cm but everything else was fine. He did a biopsy and when I called for the results his secretary asked my if he removed a polyp and I said no I had a biopsy though and she scheduled me an apointment (but only for after the ultrasound is done)saying the results show that I have a polyp. Can an ablation be done in presence of polyps? What should I demand. My period is back again. Is this the normal cycle. Meanwhile I was called about the pre op test for the hysterectomy and was about to just go that way when I was told by a friend she was surprised this doctor could do a vaginal hysterectomy without looking further at the cause. Can someone help me, I am very confu

[Machelle Seibel, MD]

A. It is always a good idea to find the cause of heavy bleeding.  It can be caused by abnormal hormones, by a polyp or fibroid, by an infection or sometimes by a cancer.  There are many more reasons as well.  It should be possible to find out the cause. Before you have a hysterectomy it is always a good reason to try and find the cause of the problem.  This could be done first step by and ultrasound or doing a biopsy (taking a few cells from the lining in the office for looking at under the microscope).  A hysteroscopy is also often done, which is looking into the uterine lining with a telescope or doing a D&C which scrapes out a larger amount of tissue to make a diagnosis and sometimes stops the bleeding as well. These are usually done in the operating room with anesthesia and the person goes home the same day.  Repeating the ultrasound at this point does seem reasonable to understand what is there.  Things will have changed after the ablation but the cause of the problem seems to still be there.  Maybe you had a polyp and some of it was removed but not all.  That can happen.  When these things are done, it should be possible to understand the causes and then you can decide if you still want a hysterectomy.  Since hysterectomy can result in blood loss, it is a good idea to begin taking iron and a multivitamin to try and build up you blood count.  That might help stop the bleeding and is good planning before surgery.
Machelle M. Seibel, MD