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Irregular periods
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ConcernedHealth29 posted:
I'm 29 years old and since all my childhood up to now, i've had irregular, heavy periods. I have never had kids. Being older now my periods are spotting between periods with brown discharge as well. The doctor ordered a Trans Vaginal pelvic exam. My tests came back that I am not menopausal, no cysts or abnormalities. The only thing found was that I had a thick uterus 7chm or mm I cannot remember which one they go by, but I have read being on a period will make it thick and when they did the exam, I was on my period. My hormone level was okay as well. I was diagnosed with Metromenorrhagia. This was last month. The doctor had wanted to do an endometrial biopsy to see why my uterus was thick. Having gotten there, I told him I was so nervous that at one point I thought I was gonna faint. He told me about the procedure and asked if I had ever had kids. I told him no and said because of that my cervix would be closed and it would hurt all to much for him to do it, there. Then he said we'll get a better idea of you monthly period. But after that, I might need a D&C. Is this correct? I mean, if nothing was found by the Transvaginal exam, then why not just give me birth control to help my period? Do I really need a D&C? What could be making my period like this? Spotting and Discharged, coming and going? One moment i'm spotting the next i'm not.
Please help. I'm scared of having a D&C. And I feel that I don't need it, cause the irregular period has been doing that for so long. But he wants the D&C just to see why my uterus is thick. Is that normal?
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Jane Harrison Hohner, RN, RNP responded:
Dear ConcernedHealth: The most clear answer first, OK? With a lifetime of irregular and heavy periods chances are good that you have a pattern of irregular or absent ovulations.

Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining ), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for a too thick lining and endometrial cancer. My youngest patient to have cancer of the uterine lining was 26 and she had a menstrual history similar to yours.

A too thick lining ("endometrial hypertrophy") is a common cause of heavy and prolonged bleeding. The diagnosis can be made by ultrasound or endometrial biopsy. The ultrasound image measures the thickness of the lining ("endometrial stripe"); with hypertrophy it is usually more than 12-15 mm. I had another patient once with a stripe of 30mm! The endometrial biopsy takes a sample of lining tissue and the pathologist can then make a very accurate diagnosis base upon the cells seen under the microscope. The treatment for simple hyperplasia/hypertrophy which does not contain abnormal cells is synthetic progesterone pills or shots. This shrinks down the too thick lining.

My best GUESS Is that the lining of your uterus is thick (not the actual muscular wall of the uterus). Your GYN is being very thorough and showing careful concern about a thick lining in the presence of your menstrual history. As you have read above, one need to rule out any abnormal or precancerous cells in a too-thick lining. This requires a sample of tissue (eg in office endometrial biopsy or D&C). If there are no abnormal cells use of birth control pills or other hormones is appropriate. But if abnormal cells are present (hopefully not in your case) then other treatments may be indicated. In my clinical OPINION, I would concur with your GYN. You might be able to find another GYN who would give birth control pills---but wouldn't rather have any abnormal cells ruled out?

In Support,
Jane
 
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ConcernedHealth29 replied to Jane Harrison Hohner, RN, RNP's response:
Thank you for the reply.

I went to see a different GYN and had a pap test done, in 4 weeks I have another appointment, if the pap test doesn't show anything abnormal, then the same day they'll do the endometrial biopsy.

I'm more scared about the pain of the biopsy, for now. When it's over then i'll be more worried with what they find. God forbid there be anything wrong with me at all.


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