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Felt pain in lower abdomen. Started spotting and then bleeding heavily. Are they related?

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I'm 53, 5' tall and weigh 137. About 10 days ago I woke in the night with a pain in my lower right side. It felt like a pulled muscle and I thought perhaps a hernia, although I had only been sleeping and making a move to turn over when it hit. Pain was fairly constant for about 5 days, then seemed to die down a bit. I won't have benefits until May and am stalling going to a doctor. On Saturday I started spotting and by yesterday was fully bleeding (I haven't had a period in 7 years). The pain in my lower right side seems to have almost disappeared. Could the bleeding and pain be related?
Posted Mon, 6 May 2013 in Women's Health
Answered by Dr. Timothy Raichle 1 hour later
Hello, I would be happy to help you with your question.

I think that I can help explain what you have experienced, but first answer the following questions:

1. What were your cycles like before they stopped 7 years ago? Were they irregular?
2. Did you ever have bloodwork to confirm that you were in menopause at any point?

Let me know and we will work through a plan.
Above answer was peer-reviewed by
Follow-up: Felt pain in lower abdomen. Started spotting and then bleeding heavily. Are they related? 12 minutes later
Note - I thought I would get an ANSWER to my question from a doctor, not just a RESPONSE to my email, with two questions included. Kind of makes you HAVE to ask another question to get what you paid for. Hmm.

My question was clear - are the two events possibly related?

My cycle was "normal" before periods stopped - meaning normal for entering menopause - a bit irregular, etc. i regularly see a gyno who is also an endocrinologist and have had all the bloodwork necessary to confirm menopause, etc. I take estradiol and progesterone to manage hot flashes.
Answered by Dr. Timothy Raichle 26 minutes later
You are actually allowed several free questions as part of your original question. It is not uncommon to ask for clarification of a question. In your case it is important as you appeared to go through menopause at such an early age. As you likely know, menopause is defined as no period for 12 months. This is clearly the case.

So to summarize: You are a 53 year old postmenopausal female with no bleeding for 7 years (in the setting of slightly irregular cycles prior to the onset of menses) now with an episode of 5 days of pain, followed 5 days later with heavy bleeding. Also you are on estrogen and progesterone for control of menopausal symptoms.

My first concern in hearing your story was that there might have been some confusion as to your actual menopausal state. There are some women who think they have gone through menopause, but in actuality they just don't ovulate and thus never get a cycle. It sounds like the definition of menopause, in your case, has been pretty well established. It is possible that there was some ovulatory event (i.e. you actually produced an egg) and this led to mid cycle pain, followed by what appeared to be a period. This is possible and if you were younger, it would certainly make more sense.

But the fact is that at age 53, all bleeding from the uterus has to be taken very seriously. In women presenting with your complaint, as many as 15% are presenting with pre-cancerous or cancerous changes of the uterus. May 1st is about 2 weeks away, so if I had a patient in your situation, I would probably accept this wait in terms of evaluating this complaint. The main issue is the anxiety of waiting to find out what is going on. Here is exactly what needs to happen:
1. You need a visit with your OB/GYN and an exam
2. During this exam they need to perform an endometrial biopsy
3. You then need an ultrasound to look at the ovaries and the endometrial lining

If the biopsy is normal and the 'lining' of the uterus is 4mm or less, then there is absolutely no concern for cancer.

Of note, the most common cause of bleeding after menopause is related to the 'thinnin' and fragility of the lining of the uterus, followed by polyps of the uterus (which are common).

I hope that this answer helps. Please ask me if you have a followup question about my answer!!
Above answer was peer-reviewed by
Follow-up: Felt pain in lower abdomen. Started spotting and then bleeding heavily. Are they related? 49 minutes later
Thanks for this review. I plan to see my doc after May 1st. My immediate concern is that the hernia-like pain I experienced was perhaps not muscular but gynecological. Is it possible that it was a cyst of polyp that ruptured?

If you're comfortable with the two week wait (in reality it will likely be closer to three weeks 'cause ill be in a new job and have to take time off), then that works for

My doc and I gave been juggling hormones to get the right balance and I have experienced intermittent spotting/bleeding. It's the bleeding following abdominal pain and that the relief from pain coincides with the onset of bleeding. Thoughts?
Answered by Dr. Timothy Raichle 11 hours later
Thank you for the followup and I am sorry for the delay.

Given that the pain on the right side has largely disappeared, it will be very difficult to figure out what was going on. If you were to have had an exam while in the midst of pain, it likely would have been sorted out quite easily. But given the association with vaginal bleeding, it must be assumed to be of a GYN source, and an ultrasound would certainly help in this regard. If you had recurrence of this pain, I would not wait until 5/1 to be seen.

I am saying that if I had a patient with a similar story, I would be comfortable with them waiting, but I am in no way telling you what to do or giving you medical advice in this situation, as I am completely unfamiliar with your history or exam.

It is possible that you had a cyst rupture on the right side. Until you sort out the cause of the bleeding, then you probably should not be on hormones. You need to talk to your doctor about this. Based on your last comments, though, the cessation of pain with the onset of the bleeding suggests something going on inside the uterus where there was buildup of blood, referred pain to the right lower quadrant, and relief from the pain with release of the blood. The options would include: uterine fibroids, uterine polyps, pre-cancerous or cancerous changes of the uterus, possible concomitant ovarian cyst rupture, appendicitis, just to name a few.

Good luck to you!!
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