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Noticed change in bleeding pattern. Small fibroid seen in ultrasound. Could it be a sign of cancer?

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I am 38 mother of 2, and have very regular 6 days periods.

However, my last period lasted longer - 9 days (last 3 days, blood only seen when I wipe, bright red )
This cycle came 2 days early, and looks like it will be the same, I am on day 7 still seeing this blood when I wipe.
What can be wrong with me? Is this bleeding typically a sign of cancer , ovarian or uterine?

One more thing, 5 month ago I had an ultrasound for an unrelated issue, and the doctor "thought" he saw a "21 mm*39 mm hyperechoic lesion at lower posterior myometrium". Said probably a small fibroid. Can fibroids this small cause symptoms so suddenly? Or maybe it was something more serious mistaken for a fibroid?

Apprecitae your help!

Posted Fri, 30 Nov 2012 in Menstruation and Miscarriage
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Hello there.

Thanks for writing.

No this bleeding is not necessarily due to cancer.

There are many reasons for a change in bleeding pattern, one of which is cancer.

First you should keep the most benign and common possibilities.

When the spotting lasts for a long time or starts to happen every month, it should be of concern.

Since it is first month you had this problem it could be due changes in hormonal levels this month. These changes can occur due to stress, recent changes in weight or emotional disposition.

Also low levels of progesterone hormone due to lesser release after ovulation can cause prolonged spotting.

If you have spotting with dark brown blood that is fairly scant, it signifies that this is older blood. Sometimes the uterus does not expel all of the menstrual tissue during normal menstruation, and it comes out a week or so later.
If it only happens once in a while there is probably no reason for alarm. But if in every cycle you have this problem then causes preventing uterus from complete expulsion of endometrial tissue should be evaluated like fibroids.

Also fibroid itself can cause irregular bleeding, heavy bleeding, prolonged bleeding or spotting. Though you have a small fibroid it can become symptomatic any time.

Cervical erosions (cervicitis) can also result in prolonged spotting or spotting after intercourse.

There is no harm in being vigilant in the first episode itself.

So you can visit your gynecologist for an XXXXXXX examination to rule out local causes of bleeding like polyps, cervical erosions or infection. A PAP smear and endometrial biopsy is also beneficial.

A Pap smear is a must in all sexually active females so if you have not got it done in the past one year, you require it.

Abnormal bleeding is best evaluated by an endometrial biopsy.
Also the confusion you have of your fibroid being a cancer and not a fibroid can be cleared with a biopsy.

Definitive diagnosis of cancer can be made only on tissue study which is done in biopsy.

Also biopsy can also interpret changes of low progesterone levels which if present can be treated with progesterone supplements in the later half of cycle.

I hope I have answered your queries.

Kindly revert back with any further doubts.

Take care.

Above answer was peer-reviewed by
Follow-up: Noticed change in bleeding pattern. Small fibroid seen in ultrasound. Could it be a sign of cancer? 20 minutes later
Thank you. Obviously I have googled this extensively, and I can recite all the reasons for bleeding by now - this is not what I need.

Your reply has me concerned.. what are the chances this is cancer, is it farfetched or likely? In my case, what is the most likely of these conditions? This is my second cycle with issues, not the first. I mentioned the blood is not a flow, rather only appears when wiping. it is red not brown, is this a warning sign?

My question, as an expert, is this worrisome, should I be concerned? Is this a typical sign of something serious? What are the chances this is cancer? What are the chances what the gyn thought is a fibroid is not a fibroid? Should I go for a biopsy now, is it standard procedure when a bleed happens? Is it typical for a small fibroid to cause symptoms suddenly, or is it unlikely this is the cause of the symptoms?

Appreciate your help.
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Hello there.

Thnaks for writing back.

Yes you should be concerned.

It may be a typical sign of something serious like cancer. This can be said with confirmation only after an endometrial biopsy.

The diagnosis of fibroid on ultrasound was made by your gynecolgist and it depends on his expertise if it was really a fibroid.
Chances of fibroid turning into a cancer is less than 1%.
Misdiagnosing a mass depends on the expertise.

Biopsy is a standard procedure when your bleeding persists despite treatment with medications to control bleeding or is abnormally heavy or persists for more than 3 cycles.
It also depends on your choice to go for a biopsy in the first setting.

No it is not typical for a fibroid to cause bleeding suddenly.
Changes in fibroid like increase in size or number and infection can result in your fibroids being symptomatic.

So I suggest you visit your gynecologist. Let her examine you and decide what all she needs to do based on your examination findings.
An endometrial biopsy can be planned later if you do not respond to medication.
Also if you are so anxious about ruling out cancer totally, then biopsy is a way which can better tell you.

Whenever a consultation is sought, it is our onus to provide you the common possibilities in the field of Medicine, nothing can be said categorically unless history is supported with investigations.

Take care.
Above answer was peer-reviewed by
Follow-up: Noticed change in bleeding pattern. Small fibroid seen in ultrasound. Could it be a sign of cancer? 8 hours later
I went to my doctor and had an u/s today. everything looks normal in shape and size, uterus, endometrium, and ovaries. fibroid hasn't grown. there are minute cysts on one ovary, which my doctor said are seen a lot and not a cause for concern.
should I be still concerned at this point?
Answered by Dr. Asra Ishtiaq Ahmed 1 hour later
Thanks for updating on the report.

The report should allay your concern.

Minute cysts usually resolve in subsequent cycles on their own.

Ovarian cysts do explain the menstrual problem you had in your recent cycles.

So you may follow them up with a repeat consultation if your problem persists.

Take care.
Above answer was peer-reviewed by
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