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Have bicornuate uterus. What does it mean? Chances of endometrial cancer?

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I have bicornuate uterus with one having 23mm endometrial thickness. What does that mean? How do you biopsy if one is fine and the other needs endometrial biopsy? Do I need a D & C to be sure? Can you do the biopsy and a D & C at the same time? Two years post menopausal. 50 yr old white female. What are the chances of endometrial cancer? Does a transvaginal ultrasound show any polyps or fibroids? Not taking hormone replacement. What other tests are needed to be sure?
Posted Mon, 1 Oct 2012 in Vaginal and Uterus Health
Answered by Dr. Monika Choudhary 40 minutes later
Thanks for posting your query.

Normally endometrial thickness is of 8-10 mm & yours is of 23 mm, that is hyperplastic endometrium. Transvaginal scan is very sensitive, it can detect even polyp of some milimeters.

As you are white female, having hyperplastic endometrium & postmenopausal bleeding, chances of endometrial carcinoma are 2.5-3.5%. Therefore, you must go for D&C followed by biopsy.

First D&C is done under local or general anaesthesia depending on the need, endometrial tissue saved & sent for biopsy. Both D&C & biopsy are done simultaneously.

To rule out endometrial carcinoma, biopsy is the confirmatory test & you must go for it.

I hope your query has been answered. I will be available for your follow up queries.


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Follow-up: Have bicornuate uterus. What does it mean? Chances of endometrial cancer? 50 minutes later
What else could be the cause of 23 mm thickness? The percentage seems low for endometrial carcinoma. I have heard the percentage is higher. How about fibroids? Do they show up on transvaginal scan? What do they do for polyps or fibroids? Is a hysterectomy a good possiblity? and what kind would be done I am worried about the post menopausal bleeding as a sign of something serious. Should I get a 2nd opinion?
Answered by Dr. Monika Choudhary 2 hours later

Endometrial hyperplasia usually occurs after menopause, when ovulation stops and progesterone is no longer produced. It also can occur during perimenopause, when ovulation may not occur regularly. Listed as follows are other situations in which women may have high levels of estrogen and not enough progesterone:

• Use of medications that act like estrogen
• Long-term use of high doses of estrogen after menopause (in women who have not had a hysterectomy)
• Obesity

Endometrial hyperplasia is classified as simple or complex. It also is classified by whether certain cell changes are present or absent. If abnormal changes are present, it is called atypical. The terms are combined to describe the exact kind of hyperplasia:

• Simple hyperplasia
• Complex hyperplasia
• Simple atypical hyperplasia
• Complex atypical hyperplasia

The most common sign of hyperplasia is abnormal uterine bleeding, that you are having (postmenopausal bleeding).

If you have atypical hyperplasia, especially complex atypical hyperplasia, the risk of cancer is increased. Hysterectomy usually is the best treatment option in that case.

Normally percentage of endometrial carcinoma at age of 50 is 1.5%, but you are having hyperplasia also, so it has increased to 3.5%.

Transvaginal scan can detect fibroid & polyp both.

Do not worry, first get your biopsy done; then it will be decided whether you are in need of Hysterectomy or not.

I hope your query has been answered.

All the Best.
Above answer was peer-reviewed by
Follow-up: Have bicornuate uterus. What does it mean? Chances of endometrial cancer? 35 minutes later
Would taking progesterone or other type of hormones help the problem after the biopsy & D & C ? I also have an ovarian cyst which I heard can lead to ovarian cancer later. How do I know if it is ovarian cancer? What should I do about that? Have them removed as preventative measure?
Thank you
Answered by Dr. Monika Choudhary 29 minutes later
Thanks for writing back.

If you were having cyst & endometrial hyperplasia at age of 30-35, then you could thing about conservative management like taking progesterone.

However, you are having ovarian cyst with endometrial hyperplasia at menopausal stage (uterus & ovaries are not having any significant role at this stage); it is better that you go for hysterectomy with bilateral ovaries removal for prophylactic purpose.

There are so many latest scar less operative procedures like total laparoscopic hysterectomy, that you will start walking since next day.

I hope you will be satisfied with my answer.

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