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Menopause, Ovarian cyst and uterine wall thickening
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Menopause, Ovarian cyst and uterine wall thickening

I am 49 and have not had a period in 1 1/2 years. I also am hypothyroid and take 88 mg of Synthroid. I started having pelvic pain 2 weeks ago with some back pain and over last few days pain was radiating down my leg. I was set to see my family doctor but then today I had some light vaginal bleeding. I was told by my doctor to go to the emergency dept. I had a pelvic exam, intravaginal and abdominal ultrasound and X-ray. They also wanted to do blood draws but couldn't because I was dehydrated. I was told by the ED doctor that the blood was coming from my uterus and there was thickening on the wall. I also had a cyst which she said is causing the pain. She referred me to an obgyn to have a biopsy done. I have not had a pelvic exam since 2008 and results were normal. ED doctor said that it does not look like I should be in menopause maybe because it appears I still have some estrogen? She wonders why my periods stopped. She said that my thyroid levels may be up and I might need an adjusted medication level. My last thyroid levels taken 2 weeks ago were TSH 1.98, Free T3 2.65, Free T4 1.13. My last levels that were taken in July 2011 were TSH 1.18, Free T4 1.6, no Free T3 was taken. My question is how likely is this cancer and could my thyroid levels keep me from having periods?
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1761037_tn?1313540958
Dear BAA49,

Thanks for the query.

I can understand your concern.

While I would like to emphasize that thyroid hormone levels are often associated with menstrual irregularities, the question whether this is responsible for your symptoms or not, can be answered only after you can send us the units in which these hormones are measured. For example, T4 levels can be measured in mcg/dL or IU/ml. Only once we have the units, we would be able to assess whether these values are normal or not.

The irregular vaginal bleeding may be related to perimenopausal hormonal disturbances. The bleeding can be due to an endometrial abnormality like polyps, endometriosis or a hyperplastic endometrium but it can be diagnosed only after doing an endometrial biopsy.

A serum Follicle stimulating hormone level (FSH) level will help in differentiating whether this bleeding is post menopausal or perimenopausal in origin.
This disorder can occur due to the following reasons:
• Psychological stress
• Weight changes (obesity, anorexia, or a rapid change)
• Excessive exercise
• Endocrinopathy
• Neoplasms
• Drugs
• In some cases, no cause can be identified.

The possibility of this being related to cancer can be predicted once the biopsy results are available. The management of this condition would require treatment with progesterone to stabilize the endometrium and reduce bleeding. However, definitive management can be done once the cause is identified. I would suggest that you see your gynaecologist who can evaluate you and perform appropriate tests. Further management can then be decided accordingly.

I hope I have answered your query. I will be available for follow up queries.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Rakhi Tayal
4 Comments
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I have the lab measurements you wondered about. TSH measured as uIU/mL, Free T4 ng/dL, Free T3 pg/mL. Also, the only time I had my hormone levels checked was the same month of my last period prior to this latest event which was Aug 2010. At that time they were Estradiol 236 pg/mL, FSH 47.0 mIU/mL, LH 28.8 mIU/mL and Progesterone 0.4 ng/mL. Does this provide any answers?
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Also, I am on 88 mg of Synthroid.
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1761037_tn?1313540958
Dear BAA49,

Thanks for writing again.

Currently, your thyroid hormone levels are within normal limits. The levels of follicle stimulating hormone and luteinizing hormone are on the higher side suggestive of decreased ovarian function. This might be responsible for not having periods for last 1.5 years.

I would suggest that the LH and FSH levels be repeated on day 3 of the cycle ( the 1st day is the day bleeding begins) to know about an impending menopause. Once we have the results, we can investigate further to decide the cause. I would suggest you consult your gynaecologist for the same. But an endometrial biopsy would be required in any case so that we can clearly rule out a problem in the endometrium.

I hope this answer is helpful.

Wish you an early trouble free recovery.

Best Regards,
Dr. Rakhi Tayal
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