Response to reader

Could this be cancer or fibroids?

Dear Dr Rainford,

I am a 33-year-old. I started menstruating at age 11, and heavy bleeding and cramps began from day one. I am on the low-dose oral contraceptive (usually Perle, occasionally Minigynon) for a few years now (from about age 18 or 19), and my heavy bleeding and cramps were all gone until now, thanks to the Pill.

I sometimes skip a month or two on the Pill, as I do not want the externally-administered hormones building up in my body (I abstain from sex, so missing some months won't make me get pregnant). Usually the cramps and heavy bleeding do not return if I miss only one or two months, while taking the Pill for about three consecutive months.

Suddenly, now, after returning to the Pill after missing a month, as usual, I have bleeding for almost three weeks, only not with cramps. Could this be cancer or fibroids? A friend of mine had fibroids a few years ago and had a myomectomy. Do doctors in Jamaica most often do hysterectomies or myomectomies for fibroids? I am yet to marry and have any children.

Dear Reader,

Let me first reassure you that it is very unlikely that the abnormal bleeding after restarting the pill has anything to do with cancer and while it may be related to fibroids, this problem can occur whether or not you have fibroids. You describe two conditions that you had experienced since the onset of your periods, cramps or pain with periods and heavy menses. The oral contraceptive pill is an effective treatment for both of these conditions and, fortunately, that was true in your case.

You also mentioned that you take breaks from the Pill. There is no scientific evidence that it is necessary to take breaks from the Pill and the abnormal bleeding could be related to stopping and starting the Pill, since irregular bleeding is common during the first few months of treatment with birth control pills.

While I am unable to comment on which is the more popular treatment for fibroids among Jamaican doctors, myomectomies ( surgical removal of fibroids from a uterus) are a very common surgery locally, and certainly all the doctors I have worked with are mindful of the wishes of their patients when choosing a surgical option. Therefore, given your age and the fact that you have not had any children, it is very likely that doctors would recommend a myomectomy if you required surgery for the treatment of fibroids.

However, any surgery has the possibility of complications, and in some cases when a myomectomy is planned, a patient may need a hysterectomy (surgical removal of the uterus) if they have excessive life-threatening blood loss during the operation. My advice to anyone who has been told that their fibroids require surgical removal is to be satisfied that they agree with the doctor's recommendation and be aware of the small risk of a hysterectomy.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.