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Vagifem, post menopause, endometrial thickening, cervix opening closed

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Post Menopause, Endometrial Thickening, Cervix opening closed :

I am 60, in menopause @10 years, a year ago my doctor prescribed Vagifem because my vagina was dry and thin and she couldn't do a papsmear. A year later all went relatively easy. The problem is I had some pressure that she thought would be worth checking so I had a vaginal ultrasound, which wasn't comfortable for obvious reason. They found thickening of the endometrial lining and when she tried to do a biopsy in the office, found that my cervix opening was closed so now I am scheduled for a hysteroscopy & D & C. She said sometimes a thick endometrial lining can be normal for an individual, sometimes it came mean something else and the fact that my cervix is not open, she is concerned there could be trapped blood (I have no bleeding) and it would be worth getting in there to see what's going on.
My question is if it turns out this thickening is just normal for me, is a D & C problematic or is it a good idea to go ahead and get whatever is causing the thickening out of there? Will I always need a hospital procedure to get into my cervix in the future to make sure everything is OK if my opening is closed, or at the same time is there a procedure that can surgically open it for future access?
Posted Sat, 5 May 2012 in Vaginal and Uterus Health
Answered by Dr. Meenakshi Titoria Sahu 14 hours later

Thanks for posting your query.

You are having asymptomatic endometrial thickening.

To rule out abnormality, your doctor is planning endometrial tissue assessment by hysteroscopy and D&C (dilatation and curettage).

When she will insert hysteroscope, your cervix will be open before that, so you do not need seperate surgery to open cervix. Cervix can be opened with the help of dilators just before any procedure and does not require a surgery. There is no need to keep cervix open always for future access.

D&C is not problematic if done by expertise and at good centre.

Most common cause of endometrial thickening in postmenopausal women is proliferative endometrium, polyp and hyperplasia. All these are treatable, so do not worry and go ahead.

I hope, I have answered your query. Please accept my answer in case you have no follow up queries.

Above answer was peer-reviewed by
Follow-up: Vagifem, post menopause, endometrial thickening, cervix opening closed 2 days later
I'm still not clear about your response regarding my closed cervix opening. How in the future will my doctor be able to do a pap exam in the office if my cervix opening is closed? Also, is there any issue to keep taking the Vagi Fem given the possibilities you mentioned: proliferative endometrium, polyp and hyperplasia?
Answered by Dr. Meenakshi Titoria Sahu 8 hours later

I apologise for not being clear in my previous response. Let me try it now.

Cervix is the lower end of uterus which is 2.5 cm long with XXXXXXX and external opening. Cervical stenosis is the medical term used to refer a closed cervix. Most of the time it is the XXXXXXX opening which remains closed. In cervical stenosis (closed cervix), instrument cannot go inside uterus but microscopic cells can easily come out.

Based on your report earlier, my opinions are as follows:

1. Pap smear is taken from cervical cells which are shed off in upper part of vagina (fornices). So I do not think cervical stenosis could pose any problem while performing Pap smear in the future.

2. As far as cervical stenosis is concerned, it doesn’t cause much problem in the future. If I am not wrong, your doctor is planning to perform hysteroscopy and D&C to rule out other pathologies such as polyps / hyperplasia. As explained in my previous reply, polyps, hyperplasia or proliferative endometrium may be the cause of thickened endometrium in your case.

3. A closed cervix can be opened using an instrument called dilator. It is a simple procedure. It does not involve surgery as you feel. As I am trying to explain, you do not need to undergo the procedure every other day to keep them opened. Your doctors could choose to perform it when needed.

4. Regarding vagifem, it should be taken under supervision of Gynecologist. Your gynecologist could be able to suggest it the further use of vagifem after hysteroscopy and D&C that is planned now.

5. Lastly, the conditions mentioned above (last reply) are mere possibilities, not necessary that you are having them.

Hope I have answered all your queries to your satisfaction this time.

Wish you good luck!!

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