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Gynecology

Possible uterine cancer

10/24/2008

Question:

I am a 26 year old female diagnosed with PCOS in the past year (elevated level of testosterone, hirtuism, male pattern baldness, but normal weight, no acne). I was on birth control 2 years ago for one year, then went off it in the past year. While I was off of it, I had about 8 periods a year, until the past 3 months, where I have not had a period, and instead have bright red/pink discharge (blood in mucous) for 1-3 days about every 2.5 weeks. Before my last period, I had the same thing for about 2 months, and I thought I might have been pregnant, but I was not.

I am going back to the gyno in 2 days to ask her to do tests. I was wondering, do you think this is the type of abnormal bleeding associated with uterine cancer, or is this simply anovulatory bleeding? I have read that "chronic anovulation" leads to uterine cancer, but it seems like my periods have been relatively regular for the past 2 years or longer, up until these last 5 months. Within the past 3 years (and longer) I would say I have a period at least every 3 months, if not every 5 weeks. Do I classify as chronically anovulatory, with an increased risk for uterine cancer? That is, would 3 months of no period be enough time to develop endometrial hyperplasia and/or cancer?

I will ask for a endometrial biopsy, but was wondering if a hysteroscopy (?) is a better idea.

A bit more info: in the past couple of periods, I had mid-cycle spotting with cramps around ovulation. Recently, the bright red spotting is without any cramps or pain. Also, in the past 2 years I occasionally bleed after sex, and I find sex very painful because my boyfriend is large and I am small. Not sure if this is significant. In the past month normal pap, no STDs as part of a routine exam. I would not characterize my periods as heavy, in general, even though they sometimes take a long time to come.

I am basically wondering if this bleeding is a cause for concern for cancer, or simply a wake-up call that I need to be put back on birth control to have a regular monthly period to prevent the endometrial lining from growing to thick.

Thank you very much for your help!

Answer:

You asked a very well informed and thought out question. You have done your homework! There is no real typical abnormal bleeding pattern for endometrial cancer other than post menopausal bleeding. Any abnormal bleeding could be a sign. You are predisposed because of your chronic anovulation and lack of monthly progesterone. The risk doesn't start to increase until about 6 months of chronic estrogen exposure, but I don't think an endometrial biopsy is unreasonable. I don't think you need a hysteroscopy to rule out endometrial cancer or hyperplasia (precancerous). Your Pap smear and culture have ruled out cervical cancer or infection as the cause. I think you have made the appropriate steps for evaluation. If you cycles aren't regular, you definitely should consider returning to using birth control pills.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated