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Menopause and overgrowth lining
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An_253352 posted:
I am 54 and my last period was in Oct 2012. It was very heavy and for the next 3 weeks I lightly spotted and nothing since. I had an endometrial biopsy in Nov12 which was negative. At that time my FSH test indicated I'm postmenopausal though I was having regular periods until Oct12. My GYN recommended a total hysterectomy. Since there was nothing wrong I decided to hold off. A recent ultrasound revealed that my uterus lining is thick. I feel fine and as I said I have had no bleeding. In the past I have had D&Cs (Aug09 and Oct11), each to remove a benign polyp. I have lupus for 30 yrs with stage3 CKD (50% renal function) and ITP. I've been on low dose prednisone for 30yrs. I'm also on cellcept and plaquenil. Since it hasn't been a year since my last period, will my lining go back to normal? Should I expect another bleed — is that the only way to shed the excess lining aside of a D&C or hormones? I'm hesitant to have a hysterectomy unless there is anything precancerous. Does a thick uterine lining warrant a hysterectomy?
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Anon_6061 responded:
Even though your lining is thick, it doesn't make sense that a hysterectomy was recommended since the biopsy was negative. Even if you had endometrial hyperplasia (which you don't), hysterectomy is NOT the first-line treatment (medication is).

Also, it's best that an ultrasound be done 1 or 2 days after a period ends when the lining is thinnest.

Since you haven't gone a full year without a period, you aren't in menopause yet. FSH can be elevated during perimenopause due to the wild fluctuations in hormones. The missed ovulations typically cause the lining to get thicker during this transition to menopause but it usually thins out on its own. It not, a progestin will typically do the trick.

According to a study, 76% of hysterectomies don't meet ACOG criteria. Only 2% are done for cancer. Knowing what I now know (after having an unwarranted hysterectomy with ovary removal), I'd be looking for another doctor. I wish I'd listened to my intuition instead of my long time gynecologist.
 
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An_253352 replied to Anon_6061's response:
Thanks - I appreciate your insight! I believe our bodies are in a state of flux during perimanapause and there is no urgency to have surgery.
 
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Mary Jane Minkin, MD replied to An_253352's response:
Dear An_253352,
I agree; I think you do not have any urgency to have surgery. What I would suggest is taking a round of progesterone (something like Aygestin 5 mg a day for 12 days) and what will likely happen is that you will then shed the built up lining of your uterus; and I would probably repeat it in another month or two, and then I probably would suggest an endometrial biopsy just to make sure there isn't any residual hyperplasia or something like that in the lining of your uterus. Even if you didn't have all those medical problems, I'd hold off on the hysterectomy; and again, if you need further advice from a local menopause specialist, go to menopause.org, and you can find a menopause expert near you.
Good luck,
Mary Jane


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