Worried. Abnormal vaginal bleeding. Dr very dismissive.

[Badvocatyuletide]

So.
This is now my 3rd bleed since 12th nov.
It is also dark brown (which a quick google search tells me is bad)
But...I had a scan and endometrial biopsy last may and my latest smear (June) was normal. I have also recently been on HRT for 3 months which I have stopped.
How likely is it to be serious? :(
Am so fed up of it all...my periods have always been a nightmare but this is getting ridiculous.
Thoughts?
Dr said I should go back next week for swabs (I think she is thinking infection?)

Do not be fobbed off by your gp, go back and insist on further investigations, if you get no joy then if you can see another gp in the same surgery. It may be an infection if so swabs need to be done asap, you may benefit from a gyne referal.

Did you notice any changes when you stopped hrt?

Good luck and hope that you can find answers and a treatment that helps you.

I did feel very fobbed off tbh.
I will phone on Monday and see someone else.

to you, sounds like the start of an action plan, hope that you get the help that you need.

Checking for infection is a sensible step. But in your shoes, I'd be pushing for a referral for a scan. If it's clear, then perhaps the irregularities could simply be the weirdities if the menopause. But a check for fibroids, polyps, cysts etc is worth doing as those can all be treated.

I will push for a referral too.
Thanks.

If your periods have also been a nightmare as well (may I ask in what way/s e.g very painful?) this is yet another reason to seek a referral.

Insist on a referral and do not be fobbed off.

Thing is I had tests done last year (scan and biopsy) which they said were normal. And have just had a normal smear result....
I had blood tests in June to see if I was menopausal and I'm not (or wasn't then)
It has been a very difficult few months (family bereavement, I have been ill too - just had my gallbladder out) and I am wondering if it's related?
:(
Am googling and scaring myself silly :(

Attila...I started my periods at age 10 and they were always very irregular and heavy and painful until I went on the pill at 18. They were still painful but at least I knew when I would come on.
I was taken off the pill after I had my eldest ds as I had started to get hemi plegic migraines and I was classed as a stroke risk.
Nothing since then has suited and I have tried: pop pill, depo injection and mirena coil.
Dh has now has the snip!
Both my mum and sister had hysterectomies in their mid 30s due to heavy bleeding (mum) and fibroids (sis).
Feel very fed up. 30 years of this!!
I know that the next stage is prob endometrial ablation but I'm not keen...the success rate for younger women (I have just tuned 41) is low.

The blood tests for menopause are notoriously unreliable. One of the characteristics of (peri)menopause is that your hormone levels fluctuate.

Even if you have all the investigations and they don't find anything serious, there are still medicines they can give you to help with the bad periods. Definitely push for a referral and don't be fobbed off!

I had similar problems last year. For the first time in my life, my periods went haywire-2 week period, followed by a month of dark brown discharge (sorry if TMI). Dr couldn't have cared less - oh, it's probably an infection, here are some antibiotics. Took myself off down to family planning clinic to check coil was still in right place, and they found a large mass on my left ovary. Cue the year from hell - I've had 7 (!) ultrasounds, and an mri, and last Wednesday had a 6cm endometrial cyst removed from my left ovary and a 3cm from my right.

The whole thing has been a bit of a battle - I've had to push and push for things. You'll probably have to do the same - emphasise that this isn't normal for you, no matter how dismissive the gp is. Push for a referral to Gynae and for another scan.

You're symptoms do sound quite menopausal, although I'm also wondering about endometriosis. Has that ever been mentioned?

Women who describe their periods as a nightmare often have heavy and or painful periods. Mine have been very similar in nature from the age of 14 (in my case endometriosis was the cause).

Now I have read that, it does make me think that endometriosis as a cause is not beyond the realms of possibility here. Also many GPs do not always think of this as being a possible cause. "Old" brown blood like you describe is also a possible indicator of endometriosis. They may well have suggested a hyst to your mother because of underlying endometriosis.

Endometriosis if it is there is not readily picked up on an internal ultrasound scan; it is usually only diagnosed through a keyhole surgery op called a laparoscopy.

Push for a referral to a gynae and do not take no for an answer!!!.

The more I think about it the more annoyed I am about the dr yesterday...
So...
I have phoned the surgery and the dr is not there today (natch) so she is going to phone me on Monday and I am going to get a private referral letter (am covered for investigations through bupa with Dhs work)
I have phoned and got an appt for Thursday morning with a gynae at a local private hospital.
It doesn't sit well with me to have to do it but I am so fed up of being fobbed off.
If I need treatment it will have to be NHS though!
Plum...that's awful! You poor thing. Are you ok now?
What is the treatment - if any - for endo?

Hmmm....yes. The symptoms do sound right.
But I have had issues with my periods all my life...surely a dr would have suggested it before now!? :(
Don't fancy another op though :(
Just to be told it's endo and there is noting they can do!
My family is complete so no fertility issues.

The key to this is your HRT, your age and your hormones. And yes, blood tests are not accurate in the peri stage because your hormones are all over the place day to day.

HRT during the first 3 months use often causes irregular bleeding.
This varies a lot depending on whether your periods had stopped prior to HRT or not.

Had your periods stopped?
why did you try HRT?
was your scan and biopsy in may 2012 or may 2013?

Biopsies are something like 98% accurate as are scans.

(I've had both BTW!)

It really sounds hormonal.

How old are you?

Endo causes period pain but not abnormal bleeding outside the cycles.

It is likely to be 'nothing more' than low progesterone- which is really common in peri. The treatment is progesterone- like the mini pill.

Seriously- I think you are over worrying. Bleeding outside your cycle is much more of an issue in post meno women when it can be a sign of endometrial cancer. But you've had tests to exclude this and it's rarely found in women under 50 anyway.

One other thing- if you are covered for investigations via BUPA then you ought to be covered for anything else that needs doing- you won't have to go back into the NHS for that unless your insurance only covers you for out patient consultations.

If you are older, it might also be adenomyosis (like endometriosis, but instead of it being in random wrong places, it grows into the wall of the uterus) though this tends to cause heavy, clotty periods (not random ones). It's a diagnosis of exclusion (ie you need a full gynae once over to exclude the worrying causes, and then see if that's the diagnosis that remains and looks possible on scan).

For random bleeding (mid cycle, or after sex) one obvious (and almost invariably benign) cause is a cervical polyp - something which can be easily and painlessly removed.

I understand why you've gone private. NHS is slow, slow, slow, and it can be so distressing waiting. Hopefully things will get going for you now.

I'm doing fine, thanks - was in quite bad pain for a few days after the operation, but getting back to normal now. Just waiting for biopsy results now... No idea when they'll be.

As far as I know, the most effective treatment for endometriosis is to have it lasered off during laparoscopy. As Atilla said, endo can only really be diagnosed this way. Because mine had formed a large cyst on my ovary, they removed it, although I understand there is quite a high rate of recurrence.

I totally understand your frustration with the whole process. I personally feel very angry towards the first female gp I saw who fobbed me off. Trust your own instincts-you know when something isn't right with your own body better than anyone else.

Are your periods still painful? Would suggest having a look at www.endometriosis-uk.org to see if you have any of the symptoms. It's not impossible that you've had endo for a long time and never been diagnosed.

I am just 41.
Dr put me on oestrogen only HRT in may/June to try and help my pmt/period issues. Still having periods.
Not sure if it helped or not really but when the progesterone was introduced it really didn't suit me. Came off it in sept.
Have been taking magnesium, b6 and evening primrose to see if they help with the mood swings etc.
Biopsy and scan were in may last year (2012)
I had the mirena in then as a treatment but had it out 6 months later...didn't help at all.
If the blood tests aren't accurate how on earth do you know if you are menopausal!?
:(

Oh...and after I had my first ds I was told that bleeding for 6 months after was "normal" ....
Obv I now know it isn't!
GPS just don't give a toss about gynae issues, do they?

Sorry but your dr sounds clueless. There is NO WAY that anyone with a uterus is given oestrogen only HRT!!! It's against prescribing rules. You always have to have progestins to stop the lining building up. (I've been on HRT for 5 years under a consultant gynae.) There are several types of progestins so if one doesn't suit the advice is to change to another.

The other thing is women are rarely given HRT to regulate periods. In your early 40s you'd be more likely to be given the Pill. The only time you'd be suitable for HRT is if you have meno symptoms that are making like quite unbearable- hot flushes, insomnia, depression and a whole lot more.

Re. blood tests- abnormal bleeding is investigated by a scan, biopsy or hysteroscopy. If everything is normal then it's usually accepted that it's hormonal, by excluding any other cause.

If you are menopausal then you are likely to have other symptoms as well as the more frequent periods- or is it more like spotting?

I did wonder about that...the notes in the pill box did say that if you had your ovaries you should take both...
I was having lots of horrid symptoms...insomnia, depression etc.
I bled on 12th nov - for about 4/5 days.
Started again on 27th nov - for about 4/5 days
Started again yesterday (12 dec) - brown to begin with
Who knows what's going on!
Over the past few years I have had a gp tell me I have a "bulky uterus" (?)
I have tried several contraception methods.
I just don't know what else to do :(

It's not whether you have ovaries but whether you have a uterus. Progesterone opposes the oestrogen and prevents the lining building up so when you stop the progesterone tablets you will bleed. Without progesterone there is a risk of the lining growing out of control and pre cancerous or cancerous changes taking place.

You do sound menopausal.

I honestly do not think from what you have said that there is anything wrong with you physically except your hormones are all over the place.

Some women have more frequent periods, some have then further apart. At one stage I had 17 day cycles.

Hopefully you will get more sense out of the consultant . it's my guess he will want to do 2 blood tests- one on day 3 of your cycle and one mid cycle. Then he might suggest HRT or the Pill to help control the hormones.

Try not to worry- I know it's miserable but I don't think you have anything seriously wrong.

Thanks.
Maybe I should have stayed on the HRT?
I can't have the mini pill sadly.

'bulky uterus' isn't a great term, but it quite commonly used to describe the change in form that goes with fibroids or adenomyosis.

Really?
Cosmic.
:(