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Post-menopausal stage. Biopsy showed complex endometrial hyperplasia with atypia and a endometrial polyp. Suggestions?

Mar 2016
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Practicing since : 2011
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I am a 54 year old white post-menopausal woman who had a d&c 3 weeks ago. The biopsy showed complex endometrial hyperplasia with atypia and a endometrial polyp. F
(Four years ago I also underwent a d&c for endometrial hyperplasia but the biopsy was fine.) Now my gyn is recommending a total abdominal hysterectomy of the cervix, uterus, both ovaries and fallopian tubes. I had a slow recovery from the d&c and I am 120 lbs. overweight, so my doctor advises that a laproscopic hysterectomy would not be viable. I understand that the endometrial hyperplasia that I have can be a pre-cursor of endometrial cancer and that unless this hysterectomy is done the doctor will not know if I already have cancer. There is a lot of cancer in my family. My 83 year old dad has survived sigmoid colon cancer, bladder and prostrate cancer, and my younger brother had had stage 1 stomach cancer. Yes, I'm very concerned about the possibility of having cancer and I want to do everything I can to be proactive. What would you advise regarding having the operation and if I do have it what side effects and recovery can I expect as a post-menopausal woman? Most of the research that I have seen deals with non-menopausal women so I don't have info on the risks for being post-menopausal. Thanks in advance for your help. (p.s. I am living with Major Depressive Disorder recurring since the age of 13.
Posted Fri, 23 Aug 2013 in Women's Health
Answered by Dr. S Patra 1 hour later

Thanks for posting your additional query.

I have already mentioned that total abdominal hysterectomy with removal of both side ovaries (TAH + BSO) is the best treatment option in your age to eliminate certain risk of endometrial carcinoma in future. This will also reduce additional risk of cervical & ovarian cancer. You will be in safe place by undergoing the operation.

Side effects during or following the operation varies from women to women and some are as follows:

1) Brownish red vaginal discharge up to 4 weeks. 2) Painful winds for few weeks and you will be better gradually with medications. 3) Slight weight gain due to less physical activity in recovery period. 4) Severe menopausal symptoms after 3-4 days due to remove of ovaries. 5) Other risks include venous thrombosis, bleeding during & after surgery, urinary tract or bladder injury, less bowel movement, infection, problem with spinal/ general anesthesia etc.

However, these can be treated with proper medication and Hormone Replacement Therapy (HRT). Most women (postmenopausal and non-menopausal) will recover within 6 to 8 weeks following abdominal hysterectomy. In this time period, you need to avoid heavy household work, shopping, too much bending or strenuous activity, keep bowel habit regular by using laxative, take healthy diet, drink more water & maintain genital hygiene.

Both type of women (postmenopausal & non-menopausal) will be presented with severe postmenopausal symptoms like hot flushes, sweating, anxiety, mental confusion, desire to cry etc following the operation with removal of ovary.

In such case, HRT (either estrogen or progesterone) is the good choice for few years. Phytoestrogens can be used alternatively. It is plant derived and quite effective in postmenopausal symptoms with some extra benefits.

Additionally, you need to take calcium supplements (to prevent osteoporosis) & anti depressive medication. Please consult with your doctor for proper guidance regarding this.

Hope, I have answered your query. If you need any clarification, you can freely ask me.

Wish your good health and take care yourself.

Dr Soumen
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