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Found endometrial hyperplasia. Started bleeding with cramps. Pain relief medicine and treatment?

Mar 2013
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50 yo G1P1 ; 22 days s/p D&C, hyteroscopy, LEEP (imaging had been suspicious for a mass in cervix inside the uterus; finding was a polyp with blood clot attached; pt also w/ h/o cervical stenosis, ASCUS pap, APS on coumadin and ASA). Now presents with 4 days bleeding (since 1/21), moderate (pad change q 3 hours) some clot, no odor, cramping constant but increasing. Passed a section of endometrum 2 cm x 12 cm x 2 cm on 1/23. Pelvic on 1/24 WNL at my gyn's office (gyn onc wouldn't see me, turfed me back there after the r/o) other than crampy pain, Pain during transvaginal u/s on 1/25, now with increased bilateral adenexal pain but of most concern is new sharp umbilical pain. (I am the patient, I'm also a hospice nurse with gyn onc experience, the gyn onc as I said won't see me back because path was clear of cancer, didn't get the wet read on the u/s this afternoon - not my hospital..., I'm afebrile, tachy but in pain and have nothing for it and can't take motrin because of the coumadin and I'm stumped...)
Posted Fri, 15 Feb 2013 in Women's Health
Answered by Dr. Aarti Abraham 39 minutes later
Thanks for the query.
Findings seem to be consistent with endometrial pathology, most probably endometrial hyperplasia / polyp.
I would like to know what your gynecologist said.. also when was your last period, was it regular before this 21st ?
I would also like to have the findings of the transvaginal ultrasound.
Try taking Tylenol for the pain meanwhile, as you await the scan results.
Take care.
Would be happy too have further discussion too.
Above answer was peer-reviewed by
Follow-up: Found endometrial hyperplasia. Started bleeding with cramps. Pain relief medicine and treatment? 19 minutes later
Sorry, my periods were regular even given my age (my 56 year old sister is finally through menopause); my PMP was 11/17 followed by abnormal bleeding, the 'mass' was discovered 12/14; due to the holidays the D&C/LEEP/hysteroscopy was 1/3/13 and what I assumed was the resumption of a normal cycle was 1/21/13. The only other piece I forgot to mention was that I had been put on Megace 80 mg BID on 12/17 and it was d/c'd on 1/17. I had side effects from that (edema, DOE) which had been attributed to the large, 'advancing' tumor... at least that's resolving!!!

The pain is quite impressive, much worse than after the D&C but I can gut through that; My concern was what could that large piece of tissue have been (I finally said to the gyn/onc point blank that no it was not a clot, I still had it, and to humor me and pretend I'm the home hospice nurse and not the patient calling you, so what is going on?... he still turfed me back to the regular gyn, which is fine, but they are boggled as to why he wouldn't do f/u on this....) could it be a partial perf? the fundus/umbilical pain is getting worse... at this point would we look out for early signs/sx of any pelvic infxn? I was not given antibiotics during the procedure in spite of a primary immune deficiency (Immunodeficiency due to selective anti-polysaccharide antibody deficiency) which he was well aware.

I'm thrilled it wasn't this huge odd CXCA or an EndoCA, but if I can't cope with this level of follow up with my training, who can? I'm so used to be respected in my field and this guy treated me like a loon; I just didn't end up at my hospital; I guess I should have.
Answered by Dr. Aarti Abraham 2 hours later
You are so very right, the history was not clear to me earlier, its much more elaborate now.
It CAN very well be a partial perforation, but given your history of the cervical polyps, I wouldnt be surprised if it turned out to be endometrial hyperplasia/polyp also.
The excruciating pain is not explained by the polyp or hyperplasia though.
You definitely should have been given antibiotics given your medical history.
The piece of tissue also should ideally have been sent for histopathology.
Meanwhile, since there is a history of abnormal bleeding, AND you are having regular cycles even at 50, are you sure there was no possibility of a pregnancy, which the D and C could not completely evacuate, and some retained tissue was passed out? That could explain the pain too.
What was the exact histopathology finding of the D and C ?
Some kind of endometrial hyperplasias ( the ones with atypia ) DO predispose to endometrial carcinoma.
I strongly feel your onco gynecologist should have followed you up, but meanwhile, you need to avail the ultrasound report at the earliest, in order to know what exactly the problem is.
Awaiting further discussions.
Take care.
Above answer was peer-reviewed by
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