Brief Answer:
Endotetrial histopathology indicated

Detailed Answer:
Dear XXXXXXX

I have gone through your history. I would like to know some more details from your history:
1. Were you menstruating regularly and have now an episode of continuous bleeding for one month or you are menopausal and have started bleeding for last one month.
2. What was your menstrual history throughout your life?
3. How many children you have?

I will not give any importance to the retroverted uterus; however, thick endometrium is an issue of concern. 20 mm thick endometrium is substantially thick endometrium, that too with bulky uterus associated with bleeding. All these facts together do call for the detailed investigations. The uterus is bulky, however, is it uniformly bulky or bossy suggesting the tumours in the uterus?

You have already undergone the blood hormonal profile. I would request you to upload the reports along with the ultrasonography images and reports for me to view them. I would suggest you to have your endometrium studied under microscope. Instead of traditional dilatation and curettage for collecting the endometrial sample, hysteroscopy should be preferred so that the uterine cavity also may be visualized. Then the biopsy of the endometrium should be taken and sent to the histopathology laboratory for study. Please upload that report and any hysteroscopy pictures available for my review.

Currently you are on Daflon which is venotonic (it increases venous tone) and a vasculoprotector (it increases resistance in small blood vessels)medicine. It will stop bleeding only if the bleeding is due to low venous tone. The other medicine you are taking is Pause MF which contains tranexamic acid. This is a haemostatic medicine and will stop the bleeding only if it is due to bleeding disorder. I will not opt for Femilon. Instead you may take Proluton depot. However, I would not give you any hormone till you submit yourself for endometrial histopathology, lest hormonal effect might misguide.

Your scan has clearly shown that the causative factor for your bleeding is associated with your endometrium and not the bleeding disorder. So, you may continue with these medicines for some time; however, there is no alternative to the histopathology of the endometrium.

Are you under a Gynaecologist's treatment or Family Physician's? Please report to the Gynaecologist than any one else.

Please get the suggested investigations done and report them to me ASAP. Once your endometrium is removed for microscopic study, may be your bleeding will stop for a while, giving us a breathing time to take scientific decision based on the histopathology reports.

I have guided you scientifically. Still if you want any more information, I am always available for you XXXXXXX

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Brief Answer:
Endometrial study mandatory

Detailed Answer:
Dear XXXXXXX

Thanks for providing me with your medical and menstrual history. However, at this age, bulky uterus and thick endometrium with an episode of bleeding needs to be investigated.

Usually at the age above 45 years, the uterus starts becoming smaller in size and so becomes endometrium. At this age, the oestrogen hormone is supposed to start waning down and thus the uterus starts becoming smaller, endometrium starts becoming thinner. Bulky uterus and 20 mm thick endometrium indicate that Oestrogen in you body is still predominant, hence need to investigate. Please undergo the investigations and examinations I have suggested you.

Would you inform me when was your last menstrual period before this bleeding episode started.

The medicines you are taking may bring the bleeding under control. However, the underlying cause remains undetected. It needs to be detected and treated accordingly.

I sincerely hope you follow my advice and upload the images and reports for my review. Then I shall be in a better position to advise you further.

If you want to have any more information, I am always available for you, XXXXXXX

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