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Anon_10343 posted:
am fifty two, post menopause, been without period for two years, went for my yearly pap and it came back abnormal, went to have my three month folllow up but my gyno couldnt do the pap because of abnormal bleeding for a month, she did a endometrial biopsy and sent me for an ultrasound, the results came in today, the biopsy was ok but the ultrasound showed high thickening of the lining and fibroids, the bleeding is off and on, lots of pelvic pain, if the biopsy came back ok then why is he saying i need surgery???? i donot understand about the uterine lining and i thought when you were post menopause then the fibroids went away, i am also on hrt, but havent been taking it but for seven months, i hope someone can explain
2 Replies |Watch This Discussion | Report This| Share this:possible surgery<i>am fifty two, post menopause, been without period for two years, went for my yearly pap and it came back abnormal, went to have my three month folllow up but my gyno couldnt do the pap because of abnormal bleeding for a month, she did a endometrial biopsy and sent me for an ultrasound, the results came in today, the biopsy was ok but the ultrasound showed high thickening of the lining and fibroids, the bleeding is off and on, lots of pelvic pain, if the biopsy came back ok then why is he saying i need surgery???? i donot understand about the uterine lining and i thought when you were post menopause then the fibroids went away, i am also on hrt, but havent been taking it but for seven months, i hope someone can explain</i>
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Anon_6061 responded:
Hopefully, Dr. Minkin will respond. I would have the same question since the biopsy was normal. What surgery does she want to do? A D&C can be done to treat a thickened lining and the tissue can then be tested for hyperplasia. But oftentimes, meds are used as the first-line treatment to stop heavy bleeding and/or treat hyperplasia. And then another ultrasound can be done to check the thickness.

You mentioned that you're on HRT. Unopposed estrogen can cause fibroids to grow and the uterine lining to thicken. I believe this can also happen with combined HRT but it takes longer for the lining to proliferate. It seems like there would be options to reduce this risk, one being to force a bleed periodically such as by cycling progesterone.

It's important to have a diagnosis and then research the various treatment options for the benefits and risks before proceeding. We as patients deserve to understand the reasoning behind every diagnostic and treatment recommendation. And if we're not getting that or we're leery of the recommendation, we need to speak up or move on to another doctor. At least that's what I've learned.
Report This| Share this:possible surgeryHopefully, Dr. Minkin will respond. I would have the same question since the biopsy was normal. What surgery does she want to do? A D&amp;C can be done to treat a thickened lining and the tissue can then be tested for hyperplasia. But oftentimes, meds are used as the first-line treatment to stop heavy bleeding and/or treat hyperplasia. And then another ultrasound can be done to check the thickness. <br /> <br />You mentioned that you're on HRT. Unopposed estrogen can cause fibroids to grow and the uterine lining to thicken. I believe this can also happen with combined HRT but it takes longer for the lining to proliferate. It seems like there would be options to reduce this risk, one being to force a bleed periodically such as by cycling progesterone.<br /> <br />It's important to have a diagnosis and then research the various treatment options for the benefits and risks before proceeding. We as patients deserve to understand the reasoning behind every diagnostic and treatment recommendation. And if we're not getting that or we're leery of the recommendation, we need to speak up or move on to another doctor. At least that's what I've learned.
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Mary Jane Minkin, MD responded:
Dear Anon_10343 and 6061,
Good question and response. A couple of thoughts. was the Pap abnormal because it had some cells from the lining of the uterus on it? or was it abnormal cells from the cervix itself. A biopsy of the lining is certainly a good start; but depending on the ultrasound and pap findings, one might want to do a full D and C, which is more thorough; a biopsy can miss things in the lining; so if the doc is suspicious, a D and C is more thorough. Fibroids can be stimulated by estrogen therapy, even with progestin on board. So one totally benign explanation for what is happening is that the estrogen is stimulating the lining of the uterus and the fibroids, which is leading to the bleeding. My guess is that your doc is concerned there may be something they didn't see with the biopsy; but of course, do discuss it with him-you certainly should know what is being suggested, and why.
Good luck,
Mary Jane
Report This| Share this:possible surgeryDear Anon_10343 and 6061,<br />Good question and response. A couple of thoughts. was the Pap abnormal because it had some cells from the lining of the uterus on it? or was it abnormal cells from the cervix itself. A biopsy of the lining is certainly a good start; but depending on the ultrasound and pap findings, one might want to do a full D and C, which is more thorough; a biopsy can miss things in the lining; so if the doc is suspicious, a D and C is more thorough. Fibroids can be stimulated by estrogen therapy, even with progestin on board. So one totally benign explanation for what is happening is that the estrogen is stimulating the lining of the uterus and the fibroids, which is leading to the bleeding. My guess is that your doc is concerned there may be something they didn't see with the biopsy; but of course, do discuss it with him-you certainly should know what is being suggested, and why.<br />Good luck,<br />Mary Jane
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