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Have fibroid uterus. History of heavy bleeding and anemia. Ultrasound done. Any risk for cancer?

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Practicing since : 1999
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My pathology report from my endometrial biopsy says I have a disordered proliferative endometrium without atypia with some dilated glands and minimal mitotic activity and no definite polyp fragments. It also says the endocervical fragments are large enough to suggest possible polyps. I understand this means no cancer and that's great but is there anything else useful here? I am 51, perimenopausal, with long-term iron anemia, heavy bleeding and my doc says I have a "cantaloupe" sized fibroid. Discouraged, was hoping the biopsy would be helpful in some way but it didn't seem to indicate a clear treatment path for me.
Fri, 28 Dec 2012 in Women's Health
Answered by Dr. Timothy Raichle 54 minutes later
Hello, I would be happy to help you with your question.

Actually, you should not be discourage because I find that the biopsy is actually quite helpful. Here is what I am hearing:

You are a 52 year old female with a fibroid uterus, a history of heavy uterine bleeding, ultrasound (I assume) and an evaluation of the endometrial lining for pre-cancerous or cancerous changes. The endometrial biopsy is usually looking for "hyperplasia" and the presence of "atypical cells". Your result indicates neither of these, but it does suggest some changes related to excess growth (probably related to irregular peri-menopausal bleeding) and possibly the presence of polyp-like changes.

If the biopsy had been abnormal in some concerning way, then a hysterectomy would have been an appropriate choice. Even though it is normal, I still think that this should be a strong consideration. The benefit of the biopsy is that you basically know that you are NOT dealing with a cancer. The indication for a hysterectomy include:

1. A uterine fibroid that is extremely large
2. Heavy bleeding
3. Anemia
4. Probably other symptoms (pelvic pressure, rectal pressure, frequency of urination)

If there has been any recent change in the size of the uterus or a significant change in your bleeding pattern, then a hysterectomy is even MORE indicated. Don't underestimate how much better you are likely to feel by having it removed! Finally, if you are not sure what to do, get a second opinion from another OB/GYN. Here are questions to ask:

1. Do you think that a hysterectomy is indicated?
2. How would you remove the uterus (an open incision or laparoscopy)?
3. What would I anticipate to be my recovery?
4. If I choose to wait, what would be the appropriate followup?

Lastly, never assume that anemia is related to a GYN source (though it seems obvious). Make sure your colonoscopy is uptodate as well. Good luck and please let me know if you have followup questions!
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Follow-up: Have fibroid uterus. History of heavy bleeding and anemia. Ultrasound done. Any risk for cancer? 43 minutes later
Thank you very much. That was helpful. You don't need to reply to this but for your patients' benefit, I have been taking Lysteda for over a year and it's a great medication. For me, zero side effects and I felt better and had way less bleeding. Without it, I'm sure I would have been in the ER a few times. It bought me some time but after I heard the word cantaloupe from my doctor, I thought it was time to throw in the towel. Now, I will seriously consider the hyst. I was hoping for some option other than hysterectomy or more hormones but I have been focusing only on the bleeding and anemia and I have other problems -pressure, etc. I always thought unless I was totally miserable and couldn't work, I should avoid it but my work is suffering and my quality of life and I need to consider how much I have rearranged my life for this problem and balance it against the risks of a surgery and a month away from my business.

Again, thank you.

Answered by Dr. Timothy Raichle 5 hours later
Based on my experience, your uterus will probably present a recurrent problem over time. Quality of life is one thing, but do not underestimate the long-term health consequences of chronic anemia - your heart has to work that much harder.

I wish you the best of luck. I have not prescribed Lysteda yet but I am going to look into this the next time I am in clinic - thank you!
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