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Ask Dr. Norm S. Your Own Question
Dr. Norm S.
Dr. Norm S., Board Certified OB/GYN
Category: OB GYN
Satisfied Customers: 11252
Experience:  Over 30 years of experience in OB/GYN practice, including teaching students. Fellow of American Board of Obstetrics and Gynecology.
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I have a question about unusual spotting in between periods.

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I have a question about unusual brown spotting in between periods. I've been to see the doctor (I was seen by a nurse practitioner) and was examined, but she wasn't very reassuring and I'm left with more questions than answers.
JA: Are you in any pain? How regular are your periods?
Customer: No pain. I'm 40 years old. My periods have always been a little inconsistent, with my cycles spanning from 30-36 days. I am not on birth control. The spotting begins approximately 5-6 days after I think my period ends, and comes in the form of brown mixed in with my normal discharge for that time of the month. I first noticed this happening in September. I was seen for a routine GYN visit in December and my pap was normal. I was told at the time it could just be my body adjusting to a new phase in life, or just shedding of remaining blood. My periods vary from month to month in terms of how heavy they are. The heavier the month, the longer this second round of spotting seems to be. The nurse did a full exam yesterday and said she could not see or feel anything irregular (except the discharge). They took blood to check for thyroid function and hormone levels, and they took cultures to check for infections. They did a pregnancy test which was negative.
JA: Anything else in your medical history you think the doctor should know?
Customer: My mother had breast cancer at 38. My last mammo five months ago was normal.
Customer: replied 4 months ago.
She said it could range from anything from my body "resetting" to fibroids, to polyps, to cancer (that's when I freaked out). Then she said that they look for the easy things first, and then worry about testing for the bad stuff later. They want me to come in one week after my next period when my lining is thinner to check for fibroids or polyps by ultrasound. I'm freaking out and have convinced myself I have uterine cancer. I don't know if she was truly alarmed or just had bad bedside manner, but I'm looking for any medical opinion to reassure me its likely nothing serious.
Customer: replied 4 months ago.
I do not yet know the results of the blood test or culture they took.

How many months has the spotting between periods been going on? Thank you.

Customer: replied 4 months ago.
The first time it happened was Sept. 2016... it has not been every month since, but has happened probably half the time since then.

I think that cancer is quite unlikely, and the spotting is more likely due to the hormonal changes that are not unusual at age 40.

However, just to be sure that you're not developing any pre-cancerous changes inside the uterus (which can also occur related to the hormonal changes), we would usually recommend an endometrial biopsy, where a thin tube is inserted through the cervix to sample the uterine lining. It's a procedure not often done by nurse practitioners, but very commonly done by OB/GYN doctors. Assuming that was normal or only showed mild changes, then usually we can resolve the bleeding between periods and changes by using some progesterone pills.

Fibroids and polyps are also possible causes, but I think less likely. Best wishes.

Customer: replied 4 months ago.
what would I be experiencing if there were a stronger chance of cancer that I am not seeing now?

There would be a stronger chance of cancer if the bleeding between periods had been going on for a longer period of time, such as more than a year.

Customer: replied 4 months ago.
If your suspicion is correct, will I get those answers once the bloodwork comes back, or do I have to suffer with not knowing all the way till I can have the ultrasound? What makes you suspect hormones instead of fibroids or polyps?
Customer: replied 4 months ago.
Sorry -- our answers got crossed -- If your suspicion is correct, will I get those answers once the bloodwork comes back, or do I have to suffer with not knowing all the way till I can have the ultrasound? What makes you suspect hormones instead of fibroids or polyps? So if my hormone levels come back as off and they recommend progesterone, and the bleeding resolves, then that would be a good sign?
Customer: replied 4 months ago.
spotting... not bleeding... also - is it a good sign that it is brown and not red, or is that irrelevant?

Hormonal changes are so common at age 40. Fibroids are common also, but are more likely to cause heavier periods rather than bleeding between periods.

I'm afraid the blood work won't really give any answers. Your hormone levels may be normal on any given day, but that doesn't mean that the bleeding is not due to hormonal changes. And the ultrasound likely won't either. It may show fibroids, but won't be able to say that the fibroids are the cause of the spotting.

I don't think you really need to suffer. Cancer is quite unlikely.

Customer: replied 4 months ago.
then the progesterone would just be a shot in the dark? If I did nothing at all (presuming it's hormone related), would this become the new normal, or would this subside soon?

The progesterone would likely resolve the spotting, assuming that it is due to hormonal changes. If the spotting disappeared after progesterone, that would be quite reassuring.

If you took progesterone and the spotting did not resolve, that would be a little more worrisome, and then a biopsy would be needed.

I would not recommend doing nothing, since this has been going on off and on since September.

Customer: replied 4 months ago.
If you had to "guess" the percentage of chance that this is cancer, what would you say?
What percentage of women need this kind of treatment as they pass Age 40?
Is there any reassurance in the type of spotting it is (brown vs. red), or the fact that it seems to fluctuate based on how heavy the period is? Or that it hasn't happened every month?

i would guess you have 2-3% chance of cancer, but it's only a guess.

Many women need this kind of treatment in the late 30's and 40's.

The type of spotting is not helpful, nor the fact that it fluctuates based on how heavy the period is.

It's a good sign that it hasn't happened every month.

Please click the rating stars. Thank you.

Customer: replied 4 months ago.
You've been very patient thank you.
Why does this only happen in the time after my period? Is that what is leading you to think it's likely hormone related?

Any bleeding between periods at age 40 is likely to be due to hormonal changes. That it happens in the time after your period makes it more likely to be hormonal.

I have to leave for a while. If you have further questions, I'll be back in a couple of hours. Sorry.

Customer: replied 4 months ago.
is the progesterone a forever thing, or temporary? How long would I be on it?

It's temporary. There are various ways to take it, but perhaps you would take it for 2 weeks, off 2 weeks, then again for 2 weeks. Each time you stop, you'd have a period. That would help any extra buildup of the uterine lining to clean off. Most likely there is some build up of the lining due to insufficient progesterone. Then I think the spotting would stop.

Dr. Norm S. and other OB GYN Specialists are ready to help you
Customer: replied 4 months ago.
The spotting I wrote you about stopped after about five days. I've had over 2 weeks of no unusual discharge. Today I woke up to what looks like the start of my period. It is Day 34 (I have always been in 30-36 range, so for me this is normal). Under any other circumstances I would think this is perfectly normal -- but I realized I didn't have any of the normal telltale signs (specifically sore breasts) that I usually get in the week or so before my period. I know in my lifetime this has probably happened before, but I find myself questioning everything now. I know from my doctor that fluctuating btwn heavy and light months is normal at my age. But Is it normal to get a period on time without any noticeable PMS symptoms?
Customer: replied 4 months ago.
Basically I'm asking if this is my period or another "irregular bleeding episode".

I suspect that this is more irregular bleeding. It might turn into a normal period, but probably not.

Customer: replied 4 months ago.
Why else would I get bleeding exactly when my period is due? What would likely be the cause? Still hormones? (The bloodwork revealed nothing alarming. Waiting for period to schedule ultrasound). I do have a history of having months where I don't ovulate, but can't remember if those months were with or without symptoms. I don't understand why my body is behaving so strangely all of a sudden, but it's really unnerving.

It may be coincidence. Cause is always hormones, whether normal or abnormal.

Women's bodies and hormones often behave strangely when they get past age 40.

Customer: replied 4 months ago.
Still unlikely cancer?