Post-menopausal period calls for further investigation

Dear Dr. Roach: I am a postmenopausal woman (12 years since my last cycle). Last month, I had a light period that lasted more than a week. I have seen my gynecologist, who sent me for a pelvic ultrasound and a transvaginal ultrasound. The only thing it showed was a thickening of the lining. I then had a biopsy, and the results came back showing normal cells. He seems stumped, and said that if it happens again, he’d

suggest a D and C. But, as he acknowledged, a 66-year-old woman isn’t supposed to be having periods. Obviously, he and I both know something isn’t right but just don’t know what it might be.

Any thoughts?

D.H. Any bleeding after menopause needs to be evaluated, since it can represent uterine cancer about 10 per cent of the time. Fortunately, that is very unlikely with a normal biopsy.

Since you did have a thickened endometrium, it is possible that you have endometrial hyperplasia, though this should have shown up on the biopsy. An ultrasound should have picked up a polyp.

If it does happen again, you should certainly have further evaluation. Even though a negative biopsy is very good evidence that there isn’t a cancer, no test is

perfect. About 20 per cent of women with persistent bleeding after a normal biopsy had cancer or a precancerous lesion.

This occasionally happens when the uterine cancer is in one focal place, rather than present throughout the lining of the uterus.

Dear Dr. Roach: My 23-year-old son is a bodybuilder, and much to my dismay, he takes steroids. I know he takes testosterone, and I don’t know what else. How will this affect him?

Anon. Testosterone has many bad long-term effects and he really should stop it. As a resident, I took care of a seemingly very healthy, very muscular 30-year-old man with terrible heart failure due to a heart attack. Many similar reports have led to suspicion that steroids taken for bodybuilding increase risk of heart attack and even sudden death. There appear to be many other long-term effects, including neuropsychiatric effects of anger and aggressive behaviour. They also may reduce sperm count and affect fertility.

I don’t know what else he may be taking, but I would strongly urge him to evaluate all supplements carefully.

Dr. Roach Writes: Last November, I asked readers for suggestions on swallowing pills, and I got many helpful answers. I particularly liked this pharmacist’s advice, since it combines physics and common sense:

“Because capsules float and tablets sink, two ways are helpful. For capsules this works for me: place the capsule on your tongue, then take a big swallow of water through a straw, keeping your chin neutral. For tablets, put water in your mouth first, then tilt your head back and drop the tablet into your mouth and gulp.”

Using a straw was the most frequent advice I heard. Thicker liquids were the key for other readers, while one reminded me that an inexpensive pill crusher can turn a pill to powder, which can then be mixed into yogurt or applesauce. However, always check with your pharmacist, since some pills, such as long-acting formulations, should not be crushed, and a few should not be mixed with foods. Another person found that swallowing some ice chips for a few minutes prevented the gag reflex that kept her from swallowing medicines.