What causes heavy vaginal bleeding and cramps in a person with history of breast cancer?

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Posted on Sat, 20 Jun 2015 in Women's Health
Question: I am on day 3 of my period. It use to be very long and heavy with cramps and general pms symptoms but I could function fine. this month Ive had an intense heavy flow and its almost done on day 3, but I have had these crazy intense scary emotional feelings. I feel out of control, cannot focus, concentrate on tasks and had lots of crying/sadness/gloom. Ive never felt like this and feel I am sliding into some horrible mental emotional place. I also had some intense feelings of tightness in throat and around my chest, like I cannot breath or am drowning in these awful feelings. Anxious and panicky feeling, though better today than 2 days ago. this is not me at all, I am not a crier and usually feel quite happy, busy and productive. I am 45, fit and have a great family and good life(despite breast cancer in the past, I have completed reconstruction last winter, mastectomy after 2nd dci non-invasive,her2 neg, no chemo or meds) I don't think these are related although I am absent breast tissue that may help regulate some hormones. I really need help, Im worried and want to get myself back. I feel lonely even with my family around and really do not want to be alone even I another room. This is so weird, please help me sort it out.
doctor
Answered by Dr. Nishikant Shrotri 1 hour later
Brief Answer:
? Fibroid, Endometrial Hyperplasia snd Menopausal syndrome.

Detailed Answer:
Dear XXXX,
I have got full empathy for your sufferings. I have gone through all your history and would like to categorize your symptoms into two main groups:
1. With history of Cancer breast and now heavy prolonged bleeding with abdominal pain and cramps during menses I would like to evaluate you for Fibroid of the Uterus and/or Thickening of the uterine lining (Endometrial Hyperplasia). Both these conditions are known to coexist with cancer of breast and Cancer of uterine lining. Please get your ultrasonography and hysteroscopy done for the proper diagnosis. Pap smear also may help. Then if required, you may have to undergo further investigations.
2. The depression, feeling of loneliness and emotional turmoil at this age is definitely pointing towards the menopausal syndrome. Moreover, your prolonged period might have lead you to be anaemic. This adds to these symptoms. Otherwise I would have suggested you to go for hormone replacement therapy for a short period to overcome these symptoms. However, your history of cancer breast is refraining me from doing this.
Please report the heavy bleeding, pain during menstruation and menopausal syndrome to your Gynaecologist. He/she will evaluate you for effective management.
I would like to have your following reports:
1. Complete haemogramme
2. Ultrasonography of abdomen
3. Hysteroscopy and Laparoscopy
Please upload them for further discussion.
My dear XXXXX, please do not loose your heart. I have seen and managed successfully many such patients. This age around 45 is indeed highly vulnerable period in women's life for menopausal syndrome. You are so lucky that your family is with and behind you. To overcome this, you need to have full support from your spouse. Confide your health problems with him.
Please remember the beautiful poem by Wirdsworth - 'Daffodils', in which he explains their situation as 'Bliss of Solitude'. You are trying to experience that even while amongst the family.
I hope this advice will offer you much relief and proper guidance. I shall be more than happy to help you out further after going through your reports.
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Nishikant Shrotri 3 hours later
Dear Doc Shrotri, thank you for your kind and thoughtful insight on my health concenrns. Last year I did express these problems to my gynecologist, she did a uterine scraping and found nothing abnormal, also we did an vaginal ultrasound and found only a thickened uterus lining, but no fibroids. I went to long heavy periods(after going off birth control pills after the breast cancer diagnosis) then the last 2 months have been short but very intense in pain and bleeding. (lasting only 3 days). However I was really knocked out/surprised by these crushing roller coaster of sadness, panick,drowning feelings. I do wonder if im in the peri-menopause stage(last gyno visit she said she did not think so) So these gyno testes did clear my mind of uterine cancers which with my history was of high concern.
I am heartfelt in my thanks for your attentive/details answer, which makes me feel validated. I had one prior answer from another Doc on this board who just said flat out anxiety, period, no help no management ideas. thank goodness I decided to get a second opinion and found you. How can I safely add iron into my diet, I know it is one you can overdo if not careful. I also would like to get a hormone panel done but am not sure who to persue that with, Family doc or gyno Doc.
I would consider natural hormone replacement or herbal compounded just for me, but this can be hard to find in the Midwest. Thank you again, XXXXXXX
doctor
Answered by Dr. Nishikant Shrotri 9 hours later
Brief Answer:
It is perimenopausal syndrome : No HRT at all for you

Detailed Answer:
Dear XXXXXXX
I am indeed pleased to note that my previous answer to your query has given you some guidance and some confidence. I am more happy to note that you do not have fibroid(s) in your uterus. However, the uterine lining (endometrium) is thickened which I do not like. What is its thickness? Still, since histopathology study of your endometrium has revealed no alarming changes in the endometrium, it is a good sign. However, keeping the history of cancer breast, please keep the uterine lining under close watch of your Gynaecologist. Hysteroscopy is a good option. Please do not ignore it.
Regarding your mood changes and depression, I am more than convinced that this is a perimenopausal syndrome which most likely is associated with anaemia/iron deficiency. However, again considering the history of cancer of breast, Hormone Replacement Therapy is absolutely out of consideration for you. Your option of herbal replacement is good idea. Also you may think of phyto-oestrogen containing compounds with the help of a Gynaecologist and Holistic Medical practitioners. I feel you will have to consult your Gynaecologist for alternative medicines for you which should include Vit. B12, folic acid, Vit. B6, Vit C etc. I am repeating again, please do not consume hormones like progesterone considering the history of cancer breast and oestrogen considering heavy menses. Your Gynaecologist should take the balanced decision. I do not want to give you testosterone preparation keeping in mind its virilising effects. Please forget about the natural hormones.
And of course Iron in plenty. I have suggested you to get your haemogram done for your haemoglobin levels and other indices. You have a history of prolonged and heavy menses. Please do not ignore it. I would like you to upload the reports for visualization.
Iron deficiency even before taking you to anaemia starts showing its effects by listlessness, apathy, tiredness, fatigue like vague symptoms. Your mood changes and depressive feelings can be attributed to this also. This is due to the iron deficiency effect on the cytochrome enzymes.
In short, you have very intelligently decided to go for iron. You have to remember that use of antacids hamper iron absorption. Iron medicines should be consumed on empty stomach to enhance its absorption.
If you eat meat and fish, I believe you should not have any problem of dietary iron. Muscle contains a lot of iron. Liver, spleen and kidneys are good sources of iron.
For vegetarian people, the iron source is mainly from green leafy vegetables, more in cilantro. Chillies (green pepper) and Jaggery are good sources of iron. Cow's milk will be good for you.
Haemoglobin contains haem (formed by iron) and globin (protein). Hence iron consumption should necessarily be supplemented by high protein diet. For meat eating people, usually its not a problem. For vegetarians, pulses, legumes, nuts, milk, cheese are good protein sources. Peanuts with jaggery is a good recipe for iron and protein supplementation through diet.
Unless your heavy menses are controlled, your anaemia (if it is there) and iron deficiency cannot be controlled. Since oestrogen and progesterone hormones' therapy is out of consideration for you, you may think of thermal ablation of the endometrium if bleeding cannot be brought in control by conservative treatment. That will take care of your hyperplastic (overgrown) endometrium without disturbing the ovarian function.
I hope you have got guidance and got your queries resolved. However, I would like to have a look at your ALL laboratory and imaging reports. Haemogram please. For your hormone panel please consult Gynaecologist only.
Keep the courage XXXXXXX and follow the medical advice religiously; I am sure you will start living a healthy and zestful life again.
With all the best wishes for your health!
Above answer was peer-reviewed by : Dr. Shanthi.E
doctor
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Follow up: Dr. Nishikant Shrotri 2 days later
Dear Dr Shroti, You are my only lifeline at this time reguarding my complex emotional feelings. I saw my gynecologist on Tuesday and I feel even more deflated. I was given the standard, oh well it could just be your age blanket statement. She did not want to do a hormone panel as she says even natural hormone replacement/balance is not founded in any science, so not affective. She suggested again an ablation, which I am leary of doing to my body, perhaps causing myself even more troubles. The only help she offered for my anxiety,despair, out of control feeling was a mild anti-depressant to take at ovulation and continue through period to even out brain chemistry and serotonin. Im very reluctant to tamper with brain chemicals using pharmaceutical drugs.

I feel the need to talk to someone that will really truly listen to my symptoms and offer real help, not drugs. So to update, since the onset of period and these awful emotions, I have gotten some relief, im not so sad or crying, but still not feeling normal. I had anxiety spell yesterday causing me the urge to hurry and get home, tightness in throat and chest. I could not concentrate on anything and forgetful of current tasks, like my brain was just going way to fast, pouring over every unfounded thought. I forced myself to get family needs taken care of, worked out and had decent sleep. My symptoms feel more mild but I awake and have to hurry and get out of bed, I have grave feeling about closing my eyes and not awaking and feel a blanket of being smothered, hard to breathe. Sounds very weird and hard to put to words, but I must get moving and doing to distract myself from these odd feelings . Feeling lighter but not like old happy self yet. Does peri-menopause symptoms come and go? How long do they stay around post period? Should I supplement with iron, as I do eat plenty of meat protein? I thinking of going to family doc and having them draw a blood panel looking for thyroid, iron, hormones. My womens 40 + multivitamin has higher amounts of all
your mentioned mag,b6,b12 but no iron? I had a friend of the same age suggest b12 shot to help. Im trying to figure it out, still need guidance. Thank you again for your kindness. forgot one thing- Can a double mastectomy cause any of these hormonal symptoms? 2013 masectomy from reoccurring breast cancer. 2010 right side radiation and lumpectomy. I thought breast tissue stored several hormones, just a thought. I take no meds, never had chemo or any breast cancer drugs thank goodness. XXXXXXX
doctor
Answered by Dr. Nishikant Shrotri 1 hour later
Brief Answer:
No

Detailed Answer:
Dear XXXXXXX
Nice to listen from you again.
Mastectomy per se should not cause all these symptoms. However, the follow up radiations you have taken do lower the immunity and tolerance. Still I would not blame mastectomy and the relevant treatment for your breast cancer for the symptoms you are having.
One thing is possible that due to recurrence of breast cancer requiring repeat surgery and radiation is putting you under continuous stress. That stress might aggravate the symptoms. Chemotherapy might have cause such symptoms, however you never had it.
Dear XXXXXXX if you again go through my answers carefully, you will find that I have specifically written a separate paragraph on iron for you. You DO need iron. Please refer to the previous answers.
Your Gynaecologist was cent per cent right in declining hormonal replacement therapy for you, which I had previously told you. In fact I had suggested you that if the bleeding continues, thermal ablation of your endometrium is a fair option - the same is suggested by your Gynaecologist also. Ablation therapy is comparatively easier procedure. It will stop your regular blood loss and you will start feeling much better.
Yes, XXXXXXX all these emotional symptoms do fit into peri-menopausal syndrome. The hitch in your management is that hormone replacement therapy is out of question for you. If you try to compose yourself, this is a temporary phase in the life and depending up on the will power of the individual it gets over after varied period of time.
You need to talk to someone as you have expressed. You are most welcome to call me up. Also take help of some counsellor at this stage. You need a counsellor and mentor vary badly. A counsellor cum mentor will definitely be useful to take you through such a nasty difficult period of the life. If possible, please learn CBT from counsellor. Practising it will help you conquer over the mood swings.
In fact you have mentioned that now your moods are much better though not absolutely right. XXXXXXX it will require some time; Rome was not built in eight days. The good news is that you are on a right improving path.
I may suggest you some natural mood elevators to take care of your serotonin: Banaras or plantain, honey, rice, curds (yogurt), apple and all citrus fruits. Have plenty of fruits.
In fact I would have been happier to be your mentor but for the difficulty in being in continuous contact due to the distance. Still, whenever you feel, you can call me up keeping in mind that I am from XXXXXXX about 9:30 hours ahead of EST and 12 hours ahead of West Cost Time.
I am repeating again XXXXXXX please do not loose your heart, be composed. Be sure that there is someone like me in this world who is having concern for your health, is caring for your good health and is awaiting a good news from you saying, "Doctor I am OK now, healthy now." I am sure you will send me such message sometimes in near future.
So cheer up now! The GOD is always with you!

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Answered by
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Dr. Nishikant Shrotri

OBGYN

Practicing since :1968

Answered : 2916 Questions

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