Post-menopausal discharge is cause for doctor discussion

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: I am a 66-year-old woman. I had a hysterectomy and removal of one ovary. For the past six months, I have had brown vaginal discharge. Should I be concerned? — L.M. ANSWER: Any change in vaginal symptoms after years is probably worth a discussion with your doctor. Certainly, this one is. In most post-menopausal women, a new bloody or brown discharge would be a concern for an abnormality in the uterus, especially uterine cancer. However, you have had a hysterectomy (surgical removal of the uterus), so the most common causes in you would include infection and vaginal atrophy. A tear in the vaginal cuff (the scar in the deep vagina from where the uterus was removed) would be a more serious but less common event. All of these should be evaluated, ideally by the gynecologist who performed the hysterectomy. Waiting six months is too long. *** DEAR DR. ROACH: Is there such a thing as irritable male syndrome, similar to PMS in women? If it is real, does it cycle yearly or monthly? My husband is negative and blames others for things at some times more than others. Also, is there a cure or ways to manage it? — Anon. ANSWER: The term “irritable male syndrome” was coined in 2002 in a review of animal behavior, among male animals with a strictly seasonal breeding pattern. After mating season in these animals, testosterone levels drop markedly, and the animals exhibited symptoms of nervousness and irrationality. In humans, low testosterone has a set of common symptoms, including low libido and low overall energy. Loss of body hair and decreased muscle mass happen after prolonged time without testosterone. Psychiatric symptoms, such as depressed mood and anxiety, are less strongly tied to low testosterone levels. Most experts do not believe that the findings in animals are analogous to what healthy men experience. While it is possible that your husband has low testosterone, and that this level may be causing a degree of irritability, it is much more likely that his behavior has a different underlying cause than loss of testosterone. By contrast, premenstrual syndrome, where there are dramatic shifts in hormones, is clearly associated with mood swings, irritability, anxiety and depression. As the hormone changes are cyclical, so the symptoms are cyclical as well. No such cycles exist in men for testosterone. I have certainly known many irritable males, however, and anybody can be more irritable one day compared with another. I would note that, especially in men, irritability and being easily angered can be a sign of depression, among many other possibilities. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.