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Galina asked...

Irregular and prolonged bleeding

Hello, I wonder if you could advise me what steps/tests I should take regards my issue. Since May this year (2016) I have started having abnormal vaginal bleeding without any breaks. Every 1-2 weeks flow would be very heavy with very painfull cramps, while for about a week or so, it would be just spotting. There have been no changes in my life. In 2013 I had copper IUD fitted and never had any issues with it. My cycle used to be +-29 days. I constantly feel irritated and anxious and not sure what specialists should I see and what tests should I request. I have seen my GP in June, and she said IUD is in place and it just looks like normal period. To add to all that, about a month ago my right hip joint started hurting, espesially at night. About 3 weeks ago my right ankle got swallen and is painful to touch (the bone). Ankles hurts to touch but not to move and there is no discolouration or temperature change. I also have a pretty large lump on my shoulder blade, but GP says it is only a lipoma. Effectively, I got no help from GP and have private medical insurance, hence wonder what are my options and who should I contact or what tests would help to establish what is going on with me. I am 30 years old, but feel like constantly bleeding, painkiller addict 90 year old...Thank you for your advice! Regards, Galina

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The answer

Thank you for contacting us with your question, we can see you have been having a difficult time. It is possible that you have two separate issues going on that are not interlinked so for the purposes of answering your question I’m going to break it down into two parts.

Firstly we will address the main issue which appears to be the irregular and prolonged bleeding you have been experiencing. The medical term for heavy painful and prolonged bleeding is metrorrhagia, you may see it referred to as this in the medical press. Experiencing heavy prolonged and painful bleeding for two weeks with a further week of spotting is not considered a normal period as you are aware. As you have previously not had problems with your IUD and the changes in your menstrual pattern only occurred recently it is less likely that the IUD is the cause, however, it is known to both increase menstrual flow and prolong it, usually this pattern settles after six months of insertion but for some women it never does. Possibly, if your own hormone levels have altered or are altering it may be the combination of this and the IUD which  has triggered the change. However, there are other potential causes which may be influencing what is happening here,  these can be conditions such as  uterine polyps- these are benign and quite commonly seen,  Endometriosis, a condition  where endometrial tissue  seeds outside of the uterus, changes in the lining of your uterus and hormonal changes, all these type of possible factors may need to be ruled out.

As you have medical insurance already and given your symptoms it would seem sensible to ask your Dr for a referral to see a Gynaecologist using your insurance. They will  be able to conduct a full physical examination of your problems, and the type of tests they perform  may include blood testing to check your current hormone levels, a manual pelvic examination, pelvic scanning, this is usually performed by ultrasound and is a painless procedure which looks at the uterus ovaries and fallopian tubes. Occasionally, depending on the test results and history of your symptoms  they may also take a small biopsy of the lining of your uterus. This can be performed on an outpatient basis and doesn’t usually require an anaesthetic.  It is also possible that your Gynaecologist may suggest removing the IUD in the first instance to see if this improves the problems you are having, if this is the case you will need to think about  discussing  and exploring other methods of contraception which can be use instead. .

With regard to the joint pains you are experiencing these are less likely to be related but with the level of bleeding you have been experiencing it may be useful to ask your GP to check your Iron levels, low iron levels can cause muscle aching in some people,  it might also be worth asking your Gp to check the inflammatory markers in your blood. These allow the Dr to see if there is any inflammation present in your body which could relate to your joints and help to aid a diagnosis. It may also be sensible to discuss with your Gp or pharmacist what you can take for pain relief for your joints, often this will be an anti- inflammatory type medication if appropriate.

Finally  less likely, but also worth bearing in mind, is that joint pains are known to occur in some women when their Oestrogen levels have lowered below what is considered normal, this would show on a blood test which either your GP or a Gynaecologist can perform.

As regards the Lipoma, this refers to a collection of fatty tissue beneath the skin and these types of lumps are entirely benign, should they become unsightly or catch on clothing for example they can be removed fairly easily usually under local anaesthetic. Many Drs now perform this procedure  in their surgeries if the facilities are available, otherwise a dermatologist would be able to do this for you should you want it removed.

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