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Is An Ultrasound Needed To Diagnose Unexpected Bleeding While Using Combipatch For Menopausal Symptoms?

Posted on Tue, 18 Jun 2024

Question: I need my question answered asap...........I'm 55 years young and I started on Combipatch about 2 months ago for hot flashes and night sweats. Keep in mind that I have all of my internal parts. I've never had a hysterectomy or any real major surgery. But on May 6 I started bleeding it's like brownish dark blood and sometimes its regular looking red blood. I feel this change in my body has something to do with my hormones and menopause. Do you think that I should ask my doctor to conduct an ultrasound because there could be something wrong? I'm very concerned about endometrium cancer, Do you think that could be a possibility this quickly or am I becoming paranoid. Please advise me on what I should do because I truly want this bleeding/spotting to stop especially since I have not had a period for over 4 years now.

Answered by Dr. Richa Agarwal (14 hours later)

Brief Answer:
Post menopausal bleeding needs evaluation

Detailed Answer:

Hello,

As per your description these symptoms could be due to hormonal imbalance but Endometrial Cancer should be rule out. Get your pelvic ultrasound to see the endometrial thickness and other causes of your symptoms.

Get your thyroid profile and hemoglobin test also. For excessive bleeding you can use medication. you have to take high protein diet and lots of vegetables and fruits, you can take iron and calcium supplements. It is not normal at your age to bleed like this due to hormonal changes.

You have to go for hysteroscopy and endometrial biopsy to rule out endometrial carcinoma.

Hope you found this useful, feel free to ask more information. Good luck.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (9 hours later)

Doc, I need to clarify it is not alot of blood and I'm not in pain just cramping. It's more annoying than anything because I have not had a period in like over 4 years but I did have an ultrasound today and please see the attached report. I'm wondering since the results of the ultrasound should I take the patch off effective today or does it not matter at this point. I need to know your honest opinion of what I should do moving forward and what do you honestly think this is at this point? do you think the CombiPatch or a hormone imbalance could have caused this report to be as it is or is it probably something else? thanks

Answered by Dr. Richa Agarwal (7 hours later)

Brief Answer:
You should go for ultrasound now.

Detailed Answer:

Hi,

In your ultrasound report it shows endometrial thickness too high.
It needs further evaluation. Have you done hysteroscopy and endometrial biopsy? If yes kindly share your report because it is important to rule out other causes of your problem like polyp, fibroid which sometimes missed in ultrasound only. My suggestion for you hysteroscopy with endometrial biopsy and MRI pelvis to rule out pathology of your symptoms.

Hope you found this useful.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (13 hours later)

They say they see a 18mm mass so could that be a submucal fibroid that could be the issue or no, its definitely something dealing with my endometrium lining. I'm just not understanding this completely. That's all.

Answered by Dr. Richa Agarwal (29 hours later)

Brief Answer:
Yes, possibility of fibroid is there.

Detailed Answer:

Hi,

Endometrial thickness is more and there is some mass near Endometrial lining it could be fibroid but to confirm it you have to go for further evaluation. So do the test and show me your results.

Hope you found the response useful.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Richa Agarwal (12 hours later)

If it does show a fibroid or endometrium cancer what would be the best treatment epithet way at my age and what's the survival rate?

The one thing that is troubling to me, I have not had any spotting or bleeding in over 4 years but soon as I started the COMBIPATCH after almost 2 months of use then I started with the spotting etc.. Is that normal???? So, if I would have never started bleeding then the I would have never been faced with the question of is this a fibroid or cancer etc. Correct????

Thanks!

Answered by Dr. Richa Agarwal (10 hours later)

Brief Answer:
Removal is the better option.

Detailed Answer:

Hi,

The treatment in your case would be surgery. There is a possibility of bleeding due to hormonal imbalance caused by combipatch. If you are not having any symptoms before use of combipatch, possibility of endometrial carcinoma is less, but in my opinion before starting combipatch also your endometrial thickness is more.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Richa Agarwal (5 hours later)

Doc, listen I did not have any signs or symptoms of any problems before I started the patch about 2.5 months ago. Nothing at all. But, this did happen to me before Stoneham when I was on Mimvey HRT. After using it for awhile all of a sudden I started bleeding and an ultrasound revealed that I had a submucal fibroid and at that time they were telling me that my endometrium lining was very thick as well like 15mm etc. But, my OBGYN dr at the time decided not to do anything about it. So, now I have moved and I'm so confused now since this crap is happening all over again. I'm so sure that if I stopped taking the COMBIPATCH then the bleeding would stop and my. Endometrium lining would eventually go back down to less than 4mm. If so, what would that tell you?

Answered by Dr. Richa Agarwal (18 hours later)

Brief Answer:
It is due to hormonal imbalance

Detailed Answer:

Hi,

It is clear that every time you bleed once you used some hormonal supplements, so endometrial thickness increases. But still in my opinion you should go for endometrial biopsy to rule out the exact cause of your symptoms.

Regards

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Richa Agarwal (1 hour later)

Doc, I am told that an endometrium biopsy is very painful, and I do not want to go through a tremendous amount of pain. I was told that I should do either a Saline Infusion Sono hysterogram or Disposable Office Hysteroscopy. Which one should I do because I'm being told that an endometrium biopsy is not the best thing to confirm if it's cancer or not because by doing the biopsy, they could miss the exact area that needs to be biopsied as well as it has negative probabilities as well. What do you honestly feel? I'm not trying to do this over and over again and I want accurate results. This thickening has happened every time I have used an HRT. I go to the doctor on Thursday evening, and I need to have all my ducks in order about what I want and need to do to resolve this issue.

Thanks

Answered by Dr. Richa Agarwal (21 hours later)

Brief Answer:
Get your hysteroscopy guided biopsy

Detailed Answer:

Hi,

In your case hysteroscopy guided endometrial biopsy is recommended.
You can do the test under anesthesia.

Regards

Above answer was peer-reviewed by : Dr. Saisudha Kotla