Menopause

I am 47. I had 1 month of bleeding in July. In September I had quite normal ultrasound & normal uteral biopsy. The doctor said I am fine.Then I was bleeding whole November, then 1 week off - now it started again. My breasts are tender - everything seems like normal heavy period just very long (1 month or longer). I also have IUD (good for 10 years)- this is 11th year. I am afraid of ovarian cancer but generally I am feeling good except for slight menstrual-type cramps. Should I take out IUD & get on birth-control pills?
Could this all be menopause related? Please help. Thank you, Elita

[Machelle Seibel, MD]

Q. It is difficult to say what the problem is as it could be a number of things. Here are some thoughts. You could have an inflammation of the uterine lining from the IUD causing the bleeding.  A course of a general antibiotic such as tetracycline might stop the bleeding if that is the case. You could remove the IUD and use a diaphragm for the next few years.

Sometimes decreased iron caused by the heavy bleeding can cause spotting. Ask your doctor to check your blood count and a serum iron level and serum iron binding capacity. If they are low, go on an iron supplement for at least 3 months and that will stop the bleeding.

You might just be in perimenopause. That can be controlled hormonally with a three month course of estrogen and progesterone. Talk about these options with your doctor. The option you mention of taking out the IUD and going on the pill is another option and it could work as well.
Machelle M. Seibel, MD