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History of fibroids and endometriosis. Experiencing hot flashes. Biopsy reports normal. what to do?

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I am 56 years old with a history of fibroids and endometriosis. I had my last real period in October 2010. In December 2010 I experienced some brief hot flashes then all symptoms disappeared. In the last two years I have several abnormal pap smears, as well as abnormal bleeding, cramping, nausea, and back pain. I have had several endometrial biopsies which came back normal and most recent inconclusive. I had had htsteroscopies, ultrasounds, and colposcopies which have been normal. My uterine lining measures a little over 4m. I have been told to take provera for 30 days and do a repeat biopsy. I have DVT in both lega and not comfortable taking this. what else can I do?
Posted Fri, 2 Nov 2012 in Vaginal and Uterus Health
Answered by Dr. Asra Ishtiaq Ahmed 2 hours later
Hello there..

Thanks for writing to us.
Any bleeding after menopause is considered abnormal and should be strictly evalauted and managed.
Its good to know your biopsy and colposcopy reports were normal. BUt wanted to know what exactly was the abnormality in your papsmear. If there was dysplasia then you should have underwent colposcopy directed biospy of cervix. In case you got it and it was normal then there is nothing to worry. Postmenopausal atrophy due to lack of hormones can also result in vaginal bleeding.
You said your ultrasound was normal but you also mentioned that you have history of fibroids and endometriosis. So kindly clarify this point.
Both fibroids and endometriosis can cause abnormal bleeding. But fibroids regress after menopause and should not be the cause.
Your endometrial thickness should be less than 4mm , so if its slightly more it means you have endometrial hyperplasia. For simple endometrial hyperplasia , provera(progesterone) helps in controlling abnormal bleeding and is considered a treatment for simple hyperplasia. These tablets should be continued for 3 months and get a repeat endometrial biopsy after 3 months of their use. In case its normal or no further malignant (cancerous) changes are seen, it has to be continued for 6 months to one year.
But since you have a history of DVT, I suggest you XXXXXXX up a physician before starting the Provera tablets. This is because Long term Progesterone therapy increases the risk of Blood clots which is hazardous in DVT.
If its not advisable for you, I suggest you should go for a definite treatment which is hysterectomy. Endometrial ablation is also an alternative and conservative procedure if there are no atypical changes in your endometrial biospy.

Hope I have satisfied your query.
take care.
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