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When to worry about endometrial stripe?
SandyWV68; posted:
I'm 42 years old, not menopausal, and overweight. I've haven't had children nor have ever been pregnant. I briefly was on Ortho Tri Cyclen for about 5 years, but haven't used any kind of birth control since and haven't become pregnant. Obviously, there is a fertility issue. I've had somewhat normal cycles, but recently found it to shorten somewhat by several days. I've had menstrual cramps all my life. As I recently started having GI issues, my PCP has been running extensive testing which included a pelvic ultrasound due to bladder issues as well. The first ultrasound was done day 8 of my cycle. I found out that I have a simple 2 mm ovarian cyst of my left ovary, and what she believed to be a questionable endometrial stripe. It was 5 mm which she thinks is too thick. After looking on the internet, I'm confused as one area will say it is too thick/by the cut off and others say it's not for someone that is not menopausal. BTW, she is a family doctor. Not a gynecologist. She did a follow up ultrasound 4 weeks later, which was day 9 of my cycle. The cyst is still there, and has not changed. The endometrial stripe however is now 7 mm. She is concerned as well as I am as am as I have immediate family that has had endometrial cancer. I also have an aunt that had it, and a grandmother that had it. All have recovered with a complete hysterectomy and follow up care except in the case of my grandmother. She had surgery, and thought all was well. When she died, the official diagnosis was endometrial and ovarian cancer. Should I be concerned with the size of the stripe? My PCP isn't sure what to do. She is referring me to a gynecologist that will know more what to do as in her mind, she is positive it shouldn't be at 5 mm or above. Any response would be appreciated. I just don't want to wait too long if it is a possibility of being cancer, and having a better outcome with being aggressive with it right off the bat. Obviously, the cost will be much lower too if it's caught and treated promptly.
jinmeifoo responded:
your PCP is overstepping something she does not know well. Make sure you check with specialists in their areas.
I had one kidney block, the other kidney function well, so i had no idea what went on, the urologist wanted me to do a kidney function test-- My PCP said: i do not believe you have a kidney problem--and she was wrong--my kidney was delayed treatment--and is dead now. So make sure go to a good specialist to check things out--if you suspect there is a problem. A lot of dr. are either too young--no experience or too old--no experience in new advanced Tech method--find someone who graduate after 85s, and before 2000, who had have enough experience as well as good knowledge in New medical advances.
Jane Harrison Hohner, RN, RNP responded:
Dear SandyWV: I concur, it is good that you are being referred to a GYN for evaluation. I would like to add some additional input as well.

Being heavy set can increase the risk for endometrial (uterine lining) cancer in two ways. First, body fat contributes extra estrogen while decreasing sex hormone binding protein. This means more of the biologically active estrogen is present to stimulate the lining of the uterus to grow thicker. Abnormal cells tend to grow in a very thick lining. Second, being heavy set or being in our 40's means that we may be ovulating less or producing less progesterone. Progesterone protects the lining from getting too thick.

It is hard to know if your family history of endometrial cancer is related to genetic factors, being heavy set--or both. As was mentioned, advances in medical imaging have progressed a lot in the past 30-40 years so early detection was less common.

OK, having heard all the bad stuff, there is some positive information as well. A 5 mm stripe in the week prior to ovulation is not super thick. In a woman without estrogen (eg years after menopause) the strip is usually 3 mm or less. We start getting concerned when the stripe is 13-15 mm. The thickest one I have seen was 30 mm (very heavy set women who was not ovulating regularly). If your referral GYN deems it necessary, they can do an endometrial biopsy to assess for an abnormal cells in a sample of lining tissue. Fortunately, endometrial cancer is slow growing and most cases are found in early stage.

In defense of your PCP, she has acted responsibly. If you are willing, would you kindly let us all know what happened. Write my name in the subject line so I can find you. Many women with similar concerns read this Board, so to hear about your outcome would be of benefit to many others.

jennyconriquez replied to Jane Harrison Hohner, RN, RNP's response:
Hi my name is Jenny,

I am 35 years old with seven children. I am about 10 pounds overweight, I have had problems with heavy painful periods for around 3 years now. My doctor did a D&C 2 years ago. After 6 months my uterine stripe was at a 19. Now I have the symptoms back with painful intercourse, bleeding after , and 9-10 day periods. I had an trans-vaginal ultrasound and it said my stripe is 30mm and abnormal margins. I also have been diagnosed with Anemia. What exactly does 30mm mean? with abnormal margins?

Thank you Jen
Jane Harrison Hohner, RN, RNP replied to jennyconriquez's response:
Dear Jen: A 30 mm stripe is a very thickened uterine lining. It is not a surprise that you have been having very heavy periods (possibly causing the anemia). My best GUESS is that you will be needing another D&C or perhaps a hysteroscope evaluation (fiber optic light scope which visualizes the inside of the uterine cavity).

It is less clear what is meant by "abnormal margins". It MIGHT mean that the edges are irregular or heterogenous in thickness. In that scenario irregular thickness can mean either clumps of polyps or a focal growth of abnormal cells.

I would bet that your GYN is planning some type of follow up evaluation (eg endometrial biopsy or D&C) to rule out polyps or abnormal cells. Hopefully they can give you a more definite answer about the wording of the ultrasound report. If you do find out that abnormal margins means something other than what was discussed above, would you kindly write us back (put my name in the subject line). As you have discerned, these questions can come up again via a Google search. So you could be of service to another women searching the term "abnormal margin thick endometrial stripe".

In Gratitude,
jennyconriquez replied to Jane Harrison Hohner, RN, RNP's response:

Thank you so much. I go to the Dr. Tuesday the 31st. The ultrasound mentioned echogenicity, something to that manner. I am going to post after the dr. explains all. I went to one Doctor, and she scared me. She said it was a great possibility of uterine cancer. I am hoping that is not the case.

Thank you so much,
jennyconriquez replied to jennyconriquez's response:
the ultrasound read uterus 11.5 6.9 5.3 with heterogeneous echogenicity. the endometrial stripe is 30mm w irregular attenuation and margins. the right and left ovaries with evidence of functional cysts.

impression: Abnormal appearing endo stripe w irregular echogenicity and margins. an increase since 19mm.

if this helps:)
An_242432 replied to jennyconriquez's response:
Dear Ms. Harrison,
I'm a 28 year old female, non obese, nonsmoker, never been pregnant, not sexually active. 9-12 mo ago I noticed spotting between periods. I mentioned it to my NP who did a blood test which showed normal hormone levels and I'm not anemic. It's gotten worse and now I've noticed increased white discharge as well. She sent me to a gynecologist for a consult about an IUD. They did a transvaginal ultrasound and hysterosalpingogram. They told me the endometrium was "just a little bit thicker than they'd like" and that I should come in 6-7 days after my next period starts. This is a big office with lots of people, I've never seen the same person twice and I'm not sure who is my doctor. They told me to call on the first day of my period and the receptionists woudl have my information and fit me in since my cycle is irregular. I did what they told me to and called on Day 1 of my cycle to schedule (and day 2 and day 3) but the receptionists did not get back to me and when they did they acted like I was being bratty and harassing them when I "just wanted to be fitted for birth control" (one woman said this to me). 3 different receptionists called me back and I needed to explain myself 3 different times and ultimately they told me they couldn't fit me in last minute and I should try again next month. My period is not for 2 more weeks not and is usually late. The bleeding is back and I'm starting to feel worried. I'm not sure how abnormal this situation is and if I should be takingsome kind of action right now or if it would be ok to wait 3-6 weeks. It was never made clear what they were worried about. Thank you.

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