abnormal vaginal bleeding

Hi Dr Goodman
I was diagnosed of borderline ovarian cancer March 2006 and had a followup surgery on May to remove the right ovary and tube, as well as omentum and appendix because the tumor broke during the first surgery on march. I amd 32 and have been on birth control pills since September. My last ultrasound on Nov was good, nothing unusual. I also had a Pap Smear on Oct, all normal. Starting from last Monday, a week after the end of last period, i've had abnormal vaginal bleeding and it's still on. It's not heavy, more like spotting. My ob/gyn said he doesn't know why i was bleeding but said it's nothing to worry about. I'd like to know how would you approach this. Why am I having this abnormal bleeding? My next follow-up ultrasound is next Monday. Is there any more test that I should take? Thanks.

Regards,
sophie

[Annekathryn Goodman, M.D.]

Dear Sophie,

The most common reason for bleeding on the birth control pill is something called "breakthrough" bleeding. This occurs if the balance of estrogen and progesterone in the pill is not quite right for the lining of the uterus. Then irregular shedding of the lining occurs and that is the abnormal bleeding.
Having said that, I think of "breakthrough" bleeding as a diagnosis of exclusion. I agree with getting an ultrasound to look for fibroids, abnormal cysts on your left ovary and thickening in the lining of the uterus that may represent a polyp. I would also suggest consideration of a biopsy of the lining of the uterus.
best wishes to you

[tigermom]

Hi Dr Goodman
Thank you for your answers. Shall I stop taking birth-control pills? My thinking is if the bleeding is caused by BC pills, once I stop taking it, the bleeding will stop. Is that right? I'm moving to Seattle early Jan, so I will see a new doctor there, nothing will happend here in Toronto in two weeks anyway, don't know which doc to see in Seattle yet. Do you think I should see a gyncologist for this? Is biopsy of the uterus lining a day procedure?

Thanks,
sophie

[akg]

Hi Sophie,
You do not necessarily have to stop the pill. Most breakthrough bleeding settles down after 3-4months of taking the pill. A biopsy takes about a minute in the office. I would suggest taking some ibuprofen or Tylenol before the biopsy because it feels crampy.
good luck on your move.