Still ongoing and today with clots passing and great rushes of discharge. Over the age of 40, the steps to go through are to diagnose the cause of the bleeding and then treat according to the suspected cause. In general, it is a mistake to treat with any hormonal therapy to slow or stop the bleeding until cancer of the endometrium has been eliminated as a possible cause. If the biopsy is negative for hyperplasia or cancer, start hormonal treatment. Occasionally endometrial polyps may recur but it takes several years before they do and produce abnormal bleeding again.
Fibroids are a somewhat different problem.
They can cause bleeding in two different ways. Submucosal fibroids actually protrude into the endometrial cavity and bleed just like a polyp would - usually due to direct irritation of a vascular protuberance that rubs on the surfaces of the endometrial cavity with everyday normal activity. They grow big enough to bulge under the endometrial lining where the blood vessels feed the endometrial lining. They interfere with the ability of the blood vessels to contract to stop bleeding after the normal menstrual sloughing. If the fibroids are removed by myomectomy using a major abdominal incision, the procedure is extensive as an entire hysterectomy.