Probably there is nothing very bad going on. But it is important to be sure. If you are starting to bleed after 2 1/2 years it should be checked out. Most of the time this is done by having an office test called an endometrial biopsy. A thin catheter is placed into the uterine lining and a few cells removed for inspection under the microscope. It causes some cramps that last for a few minutes but the cramps usually stop after a short while. To be sure, take an over the counter pain reliever such as Tylenol or Advil/Motrin on the way to the office, and go with someone to drive you home.
Sometimes an ultrasound of the uterus is done before the exam to see if the uterine lining is more than 4 millimeters thick or if there is a polyp inside the uterus or any growths on the ovaries.
Sometimes women who are overweight have a buildup of the uterine lining. Fat cells make a week estrogen, but if there are enough fat cells, they make enough week estrogen to build up the uterine lining and that can lead to bleeding. The above tests will answer the question for you.
As I mentioned, it is not likely going to be a serious problem, but it deserves to be evaluated to be sure it is not.
Machelle Seibel, MD
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