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    Scarred Cervix
    KathleenB46 posted:
    I had an endometrial ablation in 2002 - no periods until 1 year ago approx. Now its random spotting... TV US shows fibroids and an area of concern in uterus Doctor said needs further exam. Saline Sonohysterogram - didn't go well. Cervix Scarred Shut, Hysteroscopy D&C. Again - cannot enter even under general anesthesia. Cervical Biopsy negative. She is talking hysterectomy. Is there any other way to enter and biopsy the uterus other than via the cervix? Thank you. My follow up in in another week post the failed hysteroscopy.....
    Mary Jane Minkin, MD responded:
    Dear Kathleen,
    You bring up an interesting question-occasionally there can be scarring from an ablation procedure, which makes further investigation difficult; regular ultrasounds can be very difficult to interpret in some situations. One other modality which could be of assistance here is an MRI, done at a really good place and read by a really good radiologist, who specializes in gyn MRI (don't do a CAT scan, it won't tell you much at all.)-if the MRI folks feel comfortable in ruling out pathology, you may be able to sit tight, and just repeat the study in a while. But this is a difficult situation to give you a definitive answer.
    Good luck,
    Mary Jane
    Anon_6061 responded:
    Dr. Minkin - I came across this the other day -
    Ultrasonography-guided transvaginal endometrial biopsy: a useful technique in patients with cervical stenosis.

    Is this a viable option if she can't get an MRI? Is it a simple enough technique that most gynecologists could do it?

    Also, it doesn't seem uncommon for bleeding or spotting to start many years after an ablation. It sounds though like there aren't any studies to show what percentage are caused by hyperplasia versus no abnormality.

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