Question:
I am a 50 year old women and still have my period. Every once in a
while I get tremendous back and abdominal pain when I have my period
along with severe bleeding. I also have 2 cysts on my ovaries and
my uterus is tipped. My doctor said I need to have a hysterectomy.
Is that my only choice, or what else can I do? I need some information
on this! Thanks!
Answer:
Thank you for the very practical inquiry about alternatives to hysterectomy
for controlling dysfunctional uterine bleeding (DUB). This is a medical
term that likely applies to your symptoms. I say 'likely', because
several abnormalities may cause the symptoms that you describe. Because
your age coincides with the average time in life that women develop
menstrual irregularity and stop having menses, one thinks of 'DUB'
first. This condition is one in which the ovarian regulation of the
bleeding fails, so the lining grows, instead of 'maturing' so that
bleeding is controlled. The lack of ovulation is likely during those
heavy bleeding cycles (called hypermenorrhea), so no progesterone
hormone is secreted to 'mature' the lining. The severe cramps that
are associated probably represent the normal effort of the uterine
muscle to push clots out of the uterine cavity. Having a uterus that
is 'tipped back', doesn't help because the angle of the canal for
pushing the clots outward is unfavorable, so more contraction force
is necessary; therefore, more pain.
However, your gynecologist has probable considered, and ruled out
other causes of your symptoms, or you would be expected to have a
specific diagnosis, like endometrial (uterine) cancer, or fibroid
tumors, for example. Also, having two cysts on the ovary at this time
is worry some if they remain unchanged after bleeding several cycles.
And the size of the cysts is important too, since every woman has
a normal small (2 centimeter) cyst each month just before ovulation.
So, you and your physician have information that will be helpful for
making the best decision. Several options are available, so get all
the information and then you will be able to make 'that right decision',
the one that fits you!
Because you are experiencing cycles (bleeding) at age 50, you are
becoming slightly prone to breast cancer, too, so be sure to do self-exams
of your breasts, and have annual mammograms, if you're not already
doing so. There is much more to this risk factor than age at menopause,
e.g. age at first pregnancy (if any) and number of pregnancies. One
only uses the term menopause to describe the last menstrual period,
when looking back for 12 months without having any. Then, one is labeled
post-menopausal.
I urge you to review the archived messages that I've written to other
women on the subject of alternatives. Find them in the Archives section
of the menu on the left side of the web page for the WHPU (http://www-med.stanford.edu/school/whpu/).
Also, I want to direct you to the Library of Medicine for 41 free
abstracts about your likely condition (http://www.ncbi.nlm.nih.gov/PubMed/).
When you reach this site, write the letters DUB + uterus, and search
the database. Select several of them, and then select 'Related Articles'
(over to the right) for any treatment about which you want to be informed.
This response is of educational value only, and may not be construed
as medical advice or opinion useful for making decisions. Consultation
with a qualified physician is advisable before any action is considered
based upon this response. At least you've learned how to access valuable
health information! Best Wishes!
Feature Archives