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D & C, In office biopsy, or hysterectomy.
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Jean1979 posted:
Starting in January I had a heavy month long period. I was diagnosed with simple hyperplasia. I had a transfusion then a D & C. Three months later I had a period. In office biopsy showed no hyperplasia. Then again 3 months later another period. Now three months later I had very light spotting for 5 days. My uterus measures 8 now and the doctor wants to do another D & C. I am so confused. My general physician asked me why they are not considering a hysterectomy. She is concerned about uterine cancer. ( I have not taken progesterone so far. ) Would an in office biopsy be sufficient now? They all seem a little baffled by me since I am nearly 59. Up to January my periods have been fairly normal except a heavy bleeding episode last hear January that stopped after 10 days or so. To make things worse I am now suffering from post concussion syndrome and wondering if it is OK to go under sedation.
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Anon_6061 responded:
Since you aren't yet menopausal (despite your being past the average age of menopause), the hormonal fluctuations of peri-menopause can cause the lining to thicken due to lack of ovulations and missed periods. This generally settles down and your lining thins by the time you become menopausal (one full year without a period).

Since your last biopsy showed no hyperplasia, I don't understand why your general physician would be pushing hysterectomy (the most overused surgery after c-section). Plus the first line treatment for hyperplasia is a progestin not surgery.

This link is helpful in understanding the various degrees of hyperplasia and their regression and progression rates by degree/type (table 2). Progression rates for simple hyperplasia are a tiny 1% - wouldn't seem to justify the removal of a vital organ.

Hope you found this helpful.
 
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Anon_6061 responded:
Oops! Here's that link -
http://www.jfponline.com/Pages.asp?AID=3184
 
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Jean1979 replied to Anon_6061's response:
Thank you so much for your reply. The measurement of "8" now came from an ultrasound recently. Now my doctor wants to do a D & C rather than a biopsy, even that felt extreme to me. Do you see a benefit in that? And I have been so hesitant of starting progesterone wondering if I really had to. Looks like it has had good results from the link, just hate thinking about side affects.
 
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fcl replied to Jean1979's response:
If I were you and felt as uncomfortable as you do about the advice you're getting from your gyn, I think I'd be looking for a second opinion.

Good luck.
 
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Anon_6061 responded:
I agree with FCL - You can always get another opinion(s). It's generally helpful to get a copy of your medical records (including any pathology reports) to take to other doctors for consultation. When you copy them, you may want to hide the doctor's name. Your doctor doesn't even need to know you're getting another opinion.

This link may be helpful in understanding the changes to the endometrial stripe - http://radiographics.rsna.org/content/21/6/1409.full.

Not all women have side effects from progesterone or progestin. They use a vaginal form for maintaining pregnancy - don't know if a vaginal form is ever used for inducing a bleed. But it may have fewer side effects than oral. Of course, you don't want to take a med if it isn't necessary either. But at least it can be stopped if you have side effects.


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