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    bleeding during straining- please review
    nic14120 posted:
    Hello, I am 34 mother of 2. My youngest is 18 months old. I do have PCOS, and hashimoto's that is controlled thyroid levels. My periods have been regular. (I did post yesterday about my orgasm's being very weak and not really peaking like I am used to). After my daughter my periods seem to last roughly 7 days now. I ended it on Sun, and today I have brown spotting, so some old blood. After I used the bathroom, and I was straining myself, I had bright red blood from my vagina when I wiped. I know I have had this before, and I suffered from a friable cervix during my pregnancies. I have had normal paps every year. I had a biopsy done when I was preg with my son bc I developed what looked like warts on my cerivx, they were not, and no HPV thankfully either. Just a reaction to my hormones.

    Everything I read online suggests that the bleeding could be a sign of cervical cancer. I am due to go back to the OB for my annual dec/jan. My last pap was last Nov and was normal. Is it possible that it could have devloped since then? I pray not! I have had this before, I just never noticed if it was so close to either starting/stopping my period, or if this is a symptoms of PCOS.

    Are those with PCOS (with regular periods), at a greater risk for cervical/ovarian cancers? I am not on any BC. Thank you very much!
    Jane Harrison Hohner, RN, RNP responded:
    Dear nic: While women with PCOS and chronic missed ovulations are more at risk for cancer of the lining of the uterus, to my knowledge there is no increased risk for cervical or ovarian cancers. That you have had a negative history for HPV, and a normal PAP last November I would really doubt that your bleeding when wiping is a sign of cervical cancer.

    Spotting/bleeding shortly after (or before) menses is much more likely to have a hormonal etiology--that is a less than usually stable uterine lining. Bearing down, heavy exercise, intercourse all can increase breakthrough bleeding when the lining of the uterus is less stable. As you may have read, a less stable lining can evolve from hormonal causes, infections (eg chlamydia or gonorrhea), or the presence of "structural" problems inside the uterine cavity (eg fibroids, polyps, etc.).

    Given that your next GYN visit is not slated until December or January you might want to contact them about this new spotting and just do a consult visit. You could also ask about the change in orgasmic intensity. Hopefully you have a recently normal TSH and/or free T4 result as hypothyroidism can impact sexual function and interfere with ovulations (leading to a less stable uterine lining due to anovulations). PCOS can also be linked to more erratic bleeding patterns.

    nic14120 replied to Jane Harrison Hohner, RN, RNP's response:
    Thank you, Jane. Yes, I did have an adjustememt to my synthroid in July and had a f/up lab done just last month and my levels are within perfect range. I had my full CBC done at the same time, and all was good. From your experience, could the uterine lining that causes a less stable uterus, develop a cancerous uterus? Are there specific symptoms one would experience from uterine cancer that I should be aware of? Especially since PCOS could make one more at risk. I am not sure if I ovulate, but I have been having a regular period every 30-35 days since my thryoid levels are within range now. The red spotting has not happened since that day, and no breakthrough spotting since either. I appreciate the information! Since the spotting has stopped, would it be safe to continue with my annual scheduled in Dec/Jan? Would they even look for uterus issues unless I brought up the breakthrough bleeding?
    Jane Harrison Hohner, RN, RNP replied to nic14120's response:
    Dear nic: The cause of an unstable uterine lining that would be most likely to be linked with endometrial cancer would be an overly thickened lining. Other causes such as a very thin lining from hormonal birth control (actually protective for this type of cancer), or a Chlamydia infection are not linked with cancer.

    The most often cited symptom of uterine cancer is abnormal bleeding (eg erratic, prolonged, heavy flows). One of the hallmarks of PCOS is infrequent or absent ovulations. Getting your thyroid back into normal range removes another barrier to regular ovulations--so that is a good move.

    Unless the erratic bleeding resumes you are probably able to wait the two months until your annual exam. You are asking really good questions so I would urge you to make a list of queries to ask your GYN at your annual. Be sure to ask specifically about the breakthrough bleeding at the outset of your visit.

    nic14120 replied to Jane Harrison Hohner, RN, RNP's response:
    You know I realized something... Well, firstly, Of course the spotting started again yesterday but I realized probably 4 or a little less, yrs ago my OB did a test where she went thru my cervix and pulled a pieceof my uterus off for testing. I remember her calling me and explaining what sounds like the unstable uterus and that it was an imbalance. I remember her not being concerned, and discussing bc, but I knew I wanted a second baby so I didn't explore it. I was never told of any fibroids or polyps. I had a sono done for a follicle study about 3 yrs ago. Could an unstable uterus always be there? Are there any risks long term from this? I do appreciate all your information!!

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