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Ask the doctor By Dr. Shamanique Bodie: Question: Dear Dr. Bodie, My wife who is 46 years old and has been having irregular period since 2009. Sometime it occurs after 40 to 42 days. On Dec. 28, 2009, she started bleeding frequently for eight days (after 58 days) and stopped when the doctor gave her hormonal medicine, but started again when she stopped the medicine. The doctor again gave her hormonal medicine which stopped the bleeding. She took an ultrasound and nothing was found except a bulky uterus. She is a mother of two male children, 20 and 14. Both were born via Caesarian. What is the best line of treatment? Answer: I will preface this answer by saying more information is needed for the best line of treatment. Although the information you have given is somewhat limited, I will begin to give you a differential diagnosis of uterine causes of bleeding including: * Fibroids (benign tumors of the uterus). * Adenomyosis (growth of the lining of the uterus into the uterine muscle). * Perimenopausal bleeding (onset of irregular bleeding prior to the permanent stopping of menses). * Endometrial hyperplasia (thickening of the lining of the uterus). * Endometrial polyps (outgrowth of the lining of the uterus). Laboratory studies that I would order would most likely include a red count test to ensure that she is not anemic. I would also check her thyroid function. A pelvic exam would reveal information about her uterus possibly undetected with imaging studies. I would also recommend obtaining a copy of the ultrasound for discussion with your gynecologist as additional details would be needed in determining the next step in the treatment plan. Such details would include the thickness of the lining of the uterus, the size of the uterus, and the shape of the uterus. Given her age, one of the studies that I would recommend would be a sampling of the endometrial lining in the form of an endometrial biopsy (over 90 percent sensitive in diagnosing endometrial cancer) or taking a look inside her uterus with a camera (hysteroscopy). Other studies may be requested at the discretion of your gynecologist. Once a thorough evaluation has been completed and cancer is not the cause of the bleeding, the options are medical versus surgical management. * Expectant management (observation and close monitoring but withholding treatment for a time) * Continuing hormonal therapy: the oral contraceptives (in a non-smoker)/Intrauterine Contraceptive Device with hormones/ injectable hormone therapy. * An endometrial ablation (destroying the lining of the uterus) with or without hysteroscopy and curettage (scraping of the uterus). * A hysterectomy (removal of the uterus). In addition, I would recommend that she continues the multi-vitamin and consider adding a supplement iron as indicated. The best line of treatment would be best determined after consultation with a gynecologist, review of medical and surgical history (some of which you have so graciously included), a physical exam, and review of the imaging studies. At this point, a treatment plan can be developed that suits her and your individual needs. Dr. Shamanique Bodie Obstetrician/Gynecologist Do you have a medical question that needs answering? We would love to hear from you. Send us your question and look out for the next "Ask the Doctor" column. You can send your question via e-mail to askthedoctor@doctorshosp.com, or to Doctors Hospital P.O. Box N 3018, Nassau, Bahamas or The Nassau Guardian. This informative column is intended to educate the community about important issues regarding their health and is not intended as a substitute for consultation with a primary physician. For more information or for a physician referral, please call 302-4707. Monday February 08, 2010