Hello and thanks for the query. It seems from your query that your wife most probably has some issues related to bleeding. The size of the uterus is enlarged for her age. The myometrium and endometrium are normal on sonography. However sonography will not detect and microscopic abnormalities. It detects only abnormalities in appearance. The cervix is thick. This may be due to infection or some other condition that can be evaluated only after examination of the cervix. For patients of this age coming to my clinic the first line treatment in India is a surgery to remove the uterus as she is already nearing menopause and the cervix is also thick. The ovaries may be left behind so that acute menopausal symptoms are avoided. The advantages are that immediate relief to bleeding related issues as well as decreased chances of cancers of the cervix and uterus as they are removed. Also sometimes there is a hidden cancer in the tissue that is detected only after surgery [not very common] but as these are not missed and the patients are benefited. For women who do not want surgery, other options are drugs like progestogens for long term, Gn RH analogues, therapeutic curettage, endometrial ablation procedure [involves anesthesia but does not require removing the uterus, only the inner lining of the uterus is destroyed by heat]. Drug therapy has a higher failure rate. But if you want to avoid surgery, drugs may be used. For women in my clinic who want to use drugs, I first do an office endometrial biopsy and cervical pap smear to rule out any cancer in both the areas. These are a must. Drugs may be used for 3-6 months depending upon the response. I suggest you discuss these issues with your gynecologist and try using medicines for a few cycles after doing an endometrial biopsy and cervical smear. Hope I was able to answer your queries. Thanks for using HCM. Dr Madhuri Bagde Consultant Obgy