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Ask Dr. Norm S. Your Own Question
Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11288
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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I am 42. I have recently been having very haphazard periods

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I am 42. I have recently been having very haphazard periods and spotting. My periods have been very heavy for a number of years. More recently I have had irregular periods and occasional spotting between periods, sometimes prolonged. Last month I started spotting/streaking on day 17 of my cycle. This carried on for about 8 days and then turned into a lightish (for me) period - overall bleeding for 13 days. I have now had another period 29 days from onset of spotting. This has been heavy for 4 days and now I have a brown very watery foul smelling discharge. Is this just old blood? I don't normally get watery discharge, which I know can be a symptom of cervical cancer! I am fairly certain I am experiencing perimenopausal symptoms - very sore breasts, irritability, depression, extreme anxiety, acne, greasy hair, occasional hot flushes and night sweats, though recent hormone tests were apparently 'normal'. I did however have a very low oestrogen reading a number of years ago. My doctor has said because of normal results, I am not menopausal. So what is it? I have had a pelvic ultrasound last week which was normal and recent swabs, also normal. Thyroid function normal. I am now very concerned about cervical cancer, though I am up to date with smears and all have been normal - last one in 2011. I just want to know what is going on and whether this is all 'normal' perimenopausal stuff or could be something more serious. I suffer from extreme anxiety and so really need to have my mind put at rest. Should I ask for another smear or gynae referal? My doctor is very good, but I just feel she is dismissing my symptoms when all the tests come back normal. But something is not right. I am very good at coping when I know what is causing things and more importantly, what is not - eg cancer. I do realise that nothing can ever be certain in this area, but could do with some reassurance and your opinion. Help!
Yes, I think you should ask for a referral to a gynecologist. Your irregular spotting and bleeding should not be ignored, because over time it can lead to cancer. The brown watery foul smelling discharge sounds a lot like a retained tampon, so if there is any chance of that, I would see your doctor if you can't be sure.

I believe that your irregular periods and spotting are the results of the hormonal changes that are not unusual at age 42, which is related to infrequent ovulation. Ovulation is what causes your ovaries to produce progesterone, which is what makes periods regular. Progesterone also causes the changes in the uterine lining so that when you have a period, the lining cleans itself off. Without progesterone, you can have a period but the lining doesn't clean off. That results in further spotting or bleeding, and it can also result in precancerous changes of the lining. I think you need at least an endometrial biopsy (thin tube through the cervix to sample the lining), or perhaps a D&C (which would clean out the lining, stop the spotting, and allow examination of the lining). As long as you've had normal Pap smears, cervical cancer is not a possibility, as it takes many years to develop.

Blood hormone tests are not a good way to tell whether there are hormonal changes, since hormone levels change greatly during the month. The hormonal changes will be reflected in the uterine lining, which you will know from the endometrial biopsy. In case you do have precancerous changes, they can be resolved using progesterone hormones.

Your other perimenopausal symptoms (that's what they are) are related to the large swings in your hormones that tend to occur before menopause, sometimes for many years before menopause. A gynecologist can also help you to deal with that.

I hope that's helpful, and I would be happy to answer any further questions you may have. Best wishes.
Customer: replied 5 years ago.

Thank you so much. I feel very reassured and relieved that someone understands and has been able to explain the hormone function in such a way that it makes sense. The role of prgesterone makes sense of my symptoms. I am due to see my GP on Monday and will request a referal to a gynaecologist.

You're very welcome. What you're going through is very common during the 40's, and the gynaecologist will help you to resolve it.
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