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48 years old. Started heavy periods with clots. Found fibroid in uterus. Treatment to be done?

Mar 2016
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Practicing since : 2011
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Hello, I am 48 years old and up until the past year have always had somewhat normal periods....maybe skipping one or two per year prior to the last. 8 months ago, I had a period that lasted 3 weeks...pretty heavy with more clots than usual. I went to a new obgyn; they did a pap, ultrasound, vag ultrasound, office biopsy of uterus or cervix (done with long snippers in the office). They said they found 3 fibroids about 1 & 1/2" in diameter each and that my uterus was "big". I had never been told I had fibroids. They said the fibroids probably causing the excessive bleeding and that the biopsy came back normal. Said to go on with my routines unless the bleeding becomes unmanageable. I went the next 7 weeks with no period then had 3 normal months of monthly cycles. This past December, I had another period that lasted this time almost a month...heavy the first week with clots....then almost disappears, then started up again for a few days then spotted for a total of 2 more weeks...then ended again. I returned to the obgyn where he again did the ultrasound and vag ultrasound and this time ordered an FSH test. He said the size of the fibroids were unremarkable, although one of them MAY be slightly larger by 2 millimeters. The women who completed my vag ultrasound said it looked like my uterine lining was "thin". My FSH came back as 80....was repeated....still came back at 80. He said I am WELL into menopause and should NOT be bleeding at all. He said this MAY be just my bodies way of shutting down over the next year OR it may be something serious.....a leiomyosarcoma. He said he doesn't "think" it's cancer but said only way to know for sure is a hysterectomy to biopsy the fibroids, because of where the fibroids are. I am now scared to death... Can a woman still have a period with an FSH level of 80? Up until the past year my bleeding was pretty normal, cyclic, except for what I explained. Can you help?
I clicked "done" before I was done with the letter... I wanted to add that since that last "period" ending January 1st....I hadn't had any spotting or bleeding until today almost 2 months breasts have been very sore for the past week (as they used to get prior to my period coming). I also wanted to mention that I've had some discharge over the past 2 months. Sometimes it is a whitish, snotty consistancy....but most of the time clear. (Also...I HAVE had intermittent hot flashes over the past few years...nothing major)
Posted Wed, 20 Mar 2013 in Women's Health
Answered by Dr. S Patra 2 hours later

Thanks for writing to us. I am trying to solve problem according to your concern.

Above said clinical picture represents that you are in peri-menopausal age group (48 yrs). In this age group, irregular spotting to heavy bleeding occurs in some women. It may be due to hormonal imbalance, caused by dysfunction of ovary without ovulation leads to progesterone deficiency. High FSH level (80 mIU/ ml)
represents the same.

Here, possible causes of irregular heavy bleeding are as follows:

1) Multiple small uterine fibroid (as per ultrasound).
2) Endometrial atrophy (uterine lining tissue thinned out).
3) Occurrence of Dysfunctional uterine bleeding (DUB)

Complete physical examination including pelvic/ speculum/ colposcopic exam is needed to confirm the diagnosis. Thyroid disorder & clotting factors abnormality are needed to be ruled out.

Uterine fibroid or leiomyoma is mostly a benign tumor and rarely transforms into malignant changes or leiomyosarcoma. So, you don't need to be much worried and just focus on next line of management.

In your case, treatment can be initiated with haemostatic agent combined with oral progesterone tab for 3-6 months duration.

In case of failed medical therapy, total abdominal hysterectomy (removal of uterus, tube & cervix) is the ideal choice & gold standard procedure in your age group to control bleeding & future complication completely.

After that, HRT) can be given for few years to control post menopausal symptoms (like hot flushes, vasomotor changes etc).

Clear vaginal discharge is nothing to worry if it is not associated with itching/ bad smell. Maintenance of genital hygiene is the key thing.

Here, I suggest you to consult with your gynecologist for proper guidance through medication & suggestive measures.

In the interim, the following things should help:

1) Take healthy diet with iron supplements.
2) Drink more water/ juice and eat more vegetables/ fruits.
3) Avoid heavy work or strain full activity. Keep bowel habit regular
4) Avoid stress/anxiety & maintain personal hygiene properly.
5) Wear tight breast support & take prime XXXXXXX cap to get relief from breast discomfort.

Hope I have answered your query. If you have any further questions, I will be happy to help.

Wish your good health & take care yourself.

Dr Soumen
Above answer was peer-reviewed by
Follow-up: 48 years old. Started heavy periods with clots. Found fibroid in uterus. Treatment to be done? 15 hours later
Thank you for the information ! I just want to confirm that even with an FSH level of 80 you are thinking that this could be what you stated above in your answer?
Answered by Dr. S Patra 21 minutes later

Thanks for follow up query.

High FSH level is only seen near menopausal or perimenopausal stage. It indicates decreased ovarian reserve that interferes regular ovulation and leads to irregular vaginal bleeding. Co-existence of other causative factors (fibroid/ endometrial atrophy) are also associated with heavy bleeding.

Therefore, you must contact with your consulting gynecologist for next line of management and you may need to undergo abdominal hysterectomy for complete cure from current medical condition.

If you do not have any clarifications, you can close the discussion and rate the answer.

Be well and stay healthy. Just focus on next level of treatment.

Dr Soumen
Above answer was peer-reviewed by
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