Brief Answer:
Endometrial study indicated

Detailed Answer:
Dear XXXXX,

Your menstrual problems just cannot be ignored labelling them as perimenopausal syndrome. You have to look at the issues rather seriously.

As it is you have started suffering from cramps and bloating associated with prolonged menstrual bleeding. So the possibility of some tumour in the uterus has to be considered. Do you ever get bleeding in between the menstruation or your menses are only prolonged? Is the amount of bleeding more during the menstruation? The diagnosis will change accordingly.

At present I am considering that you do not have any intermenstrual bleeding; however your menses are prolonged and the bleeding is on heavier side. If I have understood different, please correct me.

Such extended bleeding over last few months must have rendered you anaemic. Please get your haemoglobin, rather complete haematocrit values checked. Please upload the reports. Please start daily iron tablets to cover up your blood loss. Along with, consume high protein diet.

To find out the cause of prolonged bleeding, you will have to undergo some investigations like ultrasonography, hysteroscopy/Hysteromicroscopy and histopathology examination of the uterine lining (endometrium), initially.

Undue thickening of the endometrium (endometrial hyperplasia) may cause such bleeding at the perimenopausal age. Such hyperplasia may be benign or may be cancerous also. Ultrasonography will provide us preliminary information regarding the endometrial thickness. If the thickness is more than 4 mm, it summons for the further work up. Ultrasonography further will give information about any tumour present in the uterus and about the size of the uterus.

Hysteroscopy/Hysteromicroscopy will give us a direct view of the endometrium and then a guided biopsy can be taken from suspicious endometrium. Depending upon the histopathology report, further plan of action can be decided. I would appreciate if you upload all these reports and images.

Whether you need any further hormonal work up and/or how to manage the issue will be decided only on these reports.

I would advise you not to start any hormonal treatment before your endometrial work up is complete. If there is no cancer, you may take some Progesterone preparation to minimize the bleeding, with the advice of your Gynaecologist.

Please revert back with the information I had asked for. Later on, please upload the reports and the images, as and when ready. This will help me to short list from the differential diagnosis and offer you advice for permanent relief.

I am always available for you for any more information and advice, XXXXX.

Dr. Nishikant Shrotri

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