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What Does High Endometrial Thickness After Medical Abortion Indicate?
Question: I had a medical abortion two weeks ago. A week after the abortion, my USG report showed an endometrium thickness of 13.3mm with internal vascularity. However, there was no sign of endometrium collection, fabroid or pelvic fluid with ovaries of normal size. Following this, my doctor administered another dose of misoprostol (200mg). I have bled very lightly after taking this dose. Do you think I would require a surgery to get rid of the remaining particles? Is the presence of internal vascularity normal in such cases? I dont want to go through a d&c,please reply.
Brief Answer:
Repeat ultrasound needed
Detailed Answer:
Hello and welcome to HCM,
I am Dr Nilajkumar a consultant gynecologist and I will be helping you in your queries.
The endometrial thickness is a bit on the higher side. Also the vascularity is an unusual finding.
The reasons for this are most likely remaining particles or another very rare cause is gestational trophoblastic disease. To confirm if the abortion process was complete or not after the misoprostol an ultrasound would need to be repeated.
I suggest that you get a pregnancy test done along with an ultrasound. If pregnancy test is negative a trophoblastic issue is ruled out. If the ultrasound is normal, nothing needs to be done. If the thickening still persists, unfortunately a D and C will be needed as it may get infected and hamper future fertility.
Please do not be scared of a D and C. It is a routine and short procedure and safe if done by a skilled person. You will be under anesthesia and so will not have any pain.
In a few cases of medical abortion this happens and so D and C is required. Do not worry. First get the USG and urine test done and this will help in deciding the future course of action.
Hope I was able to help you.
Thanks for using HCM.
Feel free to ask any more queries. I am here to provide answers always.
Have a good day.
Dr Nilajkumar Bagde
Consultant Obstetrics and Gynecology
Above answer was peer-reviewed by :
Dr. Prasad
I was asked to take the first ultra sound within seven days after taking the pills, is that normal,cos everywhere i see, it says the first test is usually done only after 10 to 14 days.. and it was in the first report that showed an endometrium thickness of 13.3mm with internal vascularity.
however, as u said "The endometrial thickness is a bit on the higher side. Also the vascularity is an unusual finding." is this a cause for Alarm?? i have been asked to repeat the ultra suond on April 1..but i am in a panicky state...as i really want to avoid a D and C!
but i have read WHO reports that say that endometrial thickness would often be on the higher side after a medical abortion and it suggested that one can do without a D n C as often the uterus is capable of rejecting the remaining products on its own!
Brief Answer:
Please do not panic.
Detailed Answer:
Hello and welcome back,
Please do not panic. I understand your concern and maybe in the next scan the endometrium will not be so thick and you may not need any intervention.
The reason I suggested the Urine pregnancy test was that in case there was a residual live tissue or a trophoblastic tissue [ considering the vascularity] it would give a positive test. In that case an intervention would be needed. If it is negative, your worries would come down by 90% as these two conditions would be ruled out with a simple test.
The WHO reports: these are based on findings in studies which may not always be applicable in individual cases. So they help but are not an absolute guarantee as medicine itself is very flexible from case to case. However they are true for most cases and I do agree that most of the time the uterus expels the products. But this usually happens immediately after the abortion and 1-2 weeks is a longer period. But you have received a misoprost and bled so that makes a difference.
If they are only products then they may be expelled spontaneously and may have been expelled by now with the misoprost [ as you did have bleeding after the tablet]. A light bleeding was expected as it was only a thick endometrium meaning that products if any were scanty. So it may be possible that the process is complete now.
Please get a pregnancy test using the early morning urine sample, if it is negative, the vascularity does not have much significance and may not be present in the next scan. If it is positive it will pave the way for another consultation with your gynecologist. So the dilemma will be cleared.
Think about the D and C after the ultrasound report as worrying now is not going to help in any way. Most likely the test will be negative and the next scan will also be negative. So do not worry. You are not having any active bleed neither vaginal discharge, no pain so why worry as chances of the procedure being complete are higher. Enjoy your weekend.
I understand your problem and the need of not wanting a D and C. Please think positive. Most of the time no intervention is needed.
Hope this helped.
I am here to help you always.
Take care and do not worry.
Dr Nilajkumar Bagde
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
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