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Post menopause. Started getting sore breast, back pain, stomachache and bleeding. Reason?

Mar 2016
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Practicing since : 2011
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Why 11 years after complete menopause would I start a period? I take hormones, vivelle dot patch 7.5 and 200mg of prometrium. I had sore breasts last week, severe lower back ache and stomach cramping the last couple of days.
Sat, 23 Feb 2013 in Menstruation and Miscarriage
Answered by Dr. S Patra 1 hour later

Thanks for writing to us. I am happy to help you.

It seems that you are in post menopausal age group (62 yrs) and in this stage, vaginal bleeding (similar to period) is very much suggestive of underlying uterine pathology. Long term use of hormonal medication has several ill health effects.

Therefore, we have to rule out the possible causes of post menopausal bleeding in this context. These are as follows:

1) Endometrial or cervical polyp.
2) Endometrial atrophy (thinned out).
3) Endometrial hyperplasia- by estradiol patch (vivelle) for long time.
4) Endometrial cancer (uterine cancer)- more risk with postmenopausal bleeding.
5) Others- infection, adenomyosis, certain medication etc.

Here, complete physical examination including pelvic/ speculum /colposcopic exam is needed to rule out underlying pathology.

Possibilities can be narrowed by several investigations like blood test for thyroid profile & clotting factor abnormality, Trans Vaginal Sonography (TVS) scan, Pap smear test to detect cancerous changes and endometrial biopsy (may be needed).

There is certain treatment protocol with initiation of haemostatic agent combined with progesterone if the case is endometrial atrophy or hyperplasia. Though periodic monitoring of Endometrial Thickness (ET) is needed.

If above medical treatment fails to control bleeding, then approach would be surgical by the means of Dilation and curettage (D&C), Operative hysteroscopy to remove polyp if any, endometrial ablation in case of hyperplasia.

Lastly, total hysterectomy (removal of entire uterus) is the ideal choice to control bleeding & other complication in your age group. Radiotherapy or chemotherapy may be needed in case of cancerous changes.

Treatment depends on underlying etiology. So please consult with gynecologist for proper guidance through investigation, physical examination and medication with suggestive measures.

In addition, sore breast is possibly due to long term intake of progesterone medication. Though you need to examine your breast by your doctor to rule out any type of pathology.

Low back pain is associated with calcium/ vitamin-D deficiency or degenerative changes of nerve tissue/ vertebral disc. You should take calcium supplements with diet, use hot bag compression and do regular light exercise. Regarding this, you may consult with physiotherapist & orthopedic surgeon.

Stomach cramp may indicate acidity or gastritis/ ulcer or indigestion problem etc. Proper medication like antacid may help in this condition.

Follow some basic measures that will be helpful:

1) take healthy diet with iron supplements and avoid salty food stuff.
2) drink more water and eat XXXXXXX vegetables & fresh fruits.
3) avoid stress/tension by XXXXXXX breathing with adequate sleeping.
4) maintain genital hygiene properly and check up for BP.

Hope I have answered your query. If you have any further questions, I will be happy to help. Please accept my answer if you do not have other query.

Wish your good health in future.

Dr Soumen
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