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Hi, I Am 53 Years Old And I Started On

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Posted on Sat, 28 Nov 2020
Question: Hi, I am 53 years old and I started on HRT's in 2018. The one I take is Activella o.5/01mg which is estrogen and progestin. Every year I have my mammogram and they have come back negative and my pap smear as well. On Oct 16, 2018 my breast were feeling very heavy and hurting so much. I went to the doctor and they did another breast ultrasound that showed nothing. I was so stressed out and worried and then 2 days later, I started bleeding. Not alot of blood but enough for someone who is 53 years old. The blood last for a like 3 days and then stopped completely. I went back to the doctor and she did a transvaginal ultrasound was done on 10/2/20, that showed: my uterus is anterverted and measures 8.9 x 4.7 x 4.8. the myometrium is homogeneous. a small solitary submucosal stable fibroid in the fundus measuring 1.7 x 1.6 x 1.5 cm previously in 2017 it was 1.5 x 1.3 x 1.5 cm. The endometrium measures 12.0 mm. The endometrium is unremarkable. the right ovary could not be visualized. The left ovary measures 2.4 x 1.5 x 1.9 cm. No ovary abnormalities are identified. There is no free fluid in the cul-de-sac. No adnexal masses are identified. Please keep in mind in 10/02/2018 I had another trans-abdominal exam done and then my endometrium was 4 mm but they claim to have seen both ovaries at that time of exam and measured them. The fibroid was shown then as well and measure 1.5 x 1.5 x 1.3. Of course I have a concern about cancer but my doctor is trying to tell me I should not be worried. He's thinks the thickness is coming from the HRT and not cancer. I don't know what to do and need some guidance??? Could it be correct what he is saying? Also, my prolatin level came back a little elevated at 29.3 when normal range is 26.3. If I need to get a biopsy done what type should it be? Meaning a hysteroscopy and myosure or just a DNC or what to cover both situations meaning the fibroid and the endometrium lining and do I need to consider a hysterectomy or what? Also, based on the removal procedure , do I need to worry if it is cancer once they cut it to remove it, will it spread? I am lost and need guidance... Also, should I stop taking the Activella now or go ahead and continue it until I can decide the next step in the process. I know as soon as I stop taking Activella all of my menopausal system will return immediately... I need a response asap, Please advise.... Thanks
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Hi, I am 53 years old and I started on HRT's in 2018. The one I take is Activella o.5/01mg which is estrogen and progestin. Every year I have my mammogram and they have come back negative and my pap smear as well. On Oct 16, 2018 my breast were feeling very heavy and hurting so much. I went to the doctor and they did another breast ultrasound that showed nothing. I was so stressed out and worried and then 2 days later, I started bleeding. Not alot of blood but enough for someone who is 53 years old. The blood last for a like 3 days and then stopped completely. I went back to the doctor and she did a transvaginal ultrasound was done on 10/2/20, that showed: my uterus is anterverted and measures 8.9 x 4.7 x 4.8. the myometrium is homogeneous. a small solitary submucosal stable fibroid in the fundus measuring 1.7 x 1.6 x 1.5 cm previously in 2017 it was 1.5 x 1.3 x 1.5 cm. The endometrium measures 12.0 mm. The endometrium is unremarkable. the right ovary could not be visualized. The left ovary measures 2.4 x 1.5 x 1.9 cm. No ovary abnormalities are identified. There is no free fluid in the cul-de-sac. No adnexal masses are identified. Please keep in mind in 10/02/2018 I had another trans-abdominal exam done and then my endometrium was 4 mm but they claim to have seen both ovaries at that time of exam and measured them. The fibroid was shown then as well and measure 1.5 x 1.5 x 1.3. Of course I have a concern about cancer but my doctor is trying to tell me I should not be worried. He's thinks the thickness is coming from the HRT and not cancer. I don't know what to do and need some guidance??? Could it be correct what he is saying? Also, my prolatin level came back a little elevated at 29.3 when normal range is 26.3. If I need to get a biopsy done what type should it be? Meaning a hysteroscopy and myosure or just a DNC or what to cover both situations meaning the fibroid and the endometrium lining and do I need to consider a hysterectomy or what? Also, based on the removal procedure , do I need to worry if it is cancer once they cut it to remove it, will it spread? I am lost and need guidance... Also, should I stop taking the Activella now or go ahead and continue it until I can decide the next step in the process. I know as soon as I stop taking Activella all of my menopausal system will return immediately... I need a response asap, Please advise.... Thanks
doctor
Answered by Dr. Dr. Rakhi Tayal (4 hours later)
Brief Answer:
Endometrial biopsy is needed.

Detailed Answer:
Hello.
I understand your concern.
You have a very small fibroid that has a minimal variation in size. This is a benign swelling and is not worrisome. The thick endometrium that has caused the bleeding can be related to the HRT you are taking. Stopping the tablet can reverse these changes. Hysterectomy is not needed as of now. Endometrial biopsy will rule out cancer. You can go for D and C for that.
The minor rise in prolactin levels is not related to this.
You can stop taking Activella till the biopsy is done after consulting with your gynecologist.
Hope this answer is helpful.
Looking forward to any more queries that you have.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Endometrial biopsy is needed.

Detailed Answer:
Hello.
I understand your concern.
You have a very small fibroid that has a minimal variation in size. This is a benign swelling and is not worrisome. The thick endometrium that has caused the bleeding can be related to the HRT you are taking. Stopping the tablet can reverse these changes. Hysterectomy is not needed as of now. Endometrial biopsy will rule out cancer. You can go for D and C for that.
The minor rise in prolactin levels is not related to this.
You can stop taking Activella till the biopsy is done after consulting with your gynecologist.
Hope this answer is helpful.
Looking forward to any more queries that you have.
Regards.
Dr. Rakhi Tayal.

Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dr. Rakhi Tayal (12 hours later)
Dr. Tayal, My doctor is starting to truly piss me off because I feel like he is just not taking this serious. I am planning to contact another doctor today and start as a new patient with their office. I am trying to understand from you why do feel that Cancer is unlikely in my case as you stated in previous email? Please explain why you have that thought....... Also,, the other Dr said they only do hysterscopy biopsy and not D and C, so now I'm lost with do I need to find another Dr hat does a D and C or what? Why do you feel a D and C is better? Please explain. I'm waiting for his office to get back to me about whether I need to stop taking this Activella now or what? I'm started to become sick and frustrated with no help now.........Do I stop this stupid medicine now or what and what's going to happen when I stop it? Will I start bleeding or what should I expect? Big question, if I stop taking the medicine and my endometrium lining go back to normal range does that mean I'm clear of CANCER or it can't be determined by that? If I'm frustrating you I am so sorry and I promise to give you an awesome rating for your patience alone. Thanks
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Dr. Tayal, My doctor is starting to truly piss me off because I feel like he is just not taking this serious. I am planning to contact another doctor today and start as a new patient with their office. I am trying to understand from you why do feel that Cancer is unlikely in my case as you stated in previous email? Please explain why you have that thought....... Also,, the other Dr said they only do hysterscopy biopsy and not D and C, so now I'm lost with do I need to find another Dr hat does a D and C or what? Why do you feel a D and C is better? Please explain. I'm waiting for his office to get back to me about whether I need to stop taking this Activella now or what? I'm started to become sick and frustrated with no help now.........Do I stop this stupid medicine now or what and what's going to happen when I stop it? Will I start bleeding or what should I expect? Big question, if I stop taking the medicine and my endometrium lining go back to normal range does that mean I'm clear of CANCER or it can't be determined by that? If I'm frustrating you I am so sorry and I promise to give you an awesome rating for your patience alone. Thanks
doctor
Answered by Dr. Dr. Rakhi Tayal (6 hours later)
Brief Answer:
Details below .

Detailed Answer:
In a postmenopausal woman, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures ≤ 11 mm a biopsy is not needed as the risk of cancer is extremely low. Without a family history and with a history of taking hormonal tablets, this risk is even much lower.
D and C is a simpler smaller procedure while hysteroscopy is a more detailed one. If your doctor feels that it is better for you then it is best to go with him.
Even if you stop taking Activella and endometrial thickening decreases that does not rule out cancer. It is best to go for biopsy for screening as chances of cancer with thin endometrium and no vaginal bleeding are still around 4 per cent.
Hope you found this helpful.
Thanks and regards.
Dr. Rakhi Tayal.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Details below .

Detailed Answer:
In a postmenopausal woman, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures ≤ 11 mm a biopsy is not needed as the risk of cancer is extremely low. Without a family history and with a history of taking hormonal tablets, this risk is even much lower.
D and C is a simpler smaller procedure while hysteroscopy is a more detailed one. If your doctor feels that it is better for you then it is best to go with him.
Even if you stop taking Activella and endometrial thickening decreases that does not rule out cancer. It is best to go for biopsy for screening as chances of cancer with thin endometrium and no vaginal bleeding are still around 4 per cent.
Hope you found this helpful.
Thanks and regards.
Dr. Rakhi Tayal.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Rakhi Tayal (36 hours later)
Dr. Tayal,
I went yesterday to my appt and a endometrium biopsy was conducted but the Dr seemed very concerned about not being able to get all the cells and the possibility of the test being inconclusive. I pray that's not the case because she did alot of motions while inside of me trying to get the samples. She did say that she felt I should have a D and C for a total clean out. Whatever that means?? She tends to feel that the thicken is because of hormones. I was advised to stop the Activella and I did as of yesterday. I have some cramping still nothing major as of today. The fibroid, I don't think was biopsyed because they would have had to put me under our use some form of anesthesia for that correct?? I'm truly torn about what I'll be able to do about my menopausal symptoms since I'm not on an HRT now. Being that my lining was at 12mm how long do you think i will bleed for when and if I start? I'm asking alot of questions because I'm trying to stay ahead of the game and know what to kinda expect before I get there. I thought I sent you a message yesterday but you never responded so I looked and did not see it so I sent this one today.
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Dr. Tayal,
I went yesterday to my appt and a endometrium biopsy was conducted but the Dr seemed very concerned about not being able to get all the cells and the possibility of the test being inconclusive. I pray that's not the case because she did alot of motions while inside of me trying to get the samples. She did say that she felt I should have a D and C for a total clean out. Whatever that means?? She tends to feel that the thicken is because of hormones. I was advised to stop the Activella and I did as of yesterday. I have some cramping still nothing major as of today. The fibroid, I don't think was biopsyed because they would have had to put me under our use some form of anesthesia for that correct?? I'm truly torn about what I'll be able to do about my menopausal symptoms since I'm not on an HRT now. Being that my lining was at 12mm how long do you think i will bleed for when and if I start? I'm asking alot of questions because I'm trying to stay ahead of the game and know what to kinda expect before I get there. I thought I sent you a message yesterday but you never responded so I looked and did not see it so I sent this one today.
doctor
Answered by Dr. Dr. Rakhi Tayal (2 hours later)
Brief Answer:
Fibroid removal needs anaesthesia.

Detailed Answer:
Removal of fibroid would have needed a general anaesthesia. It seems that only endometrial biopsy is done.
The amount of bleeding after a biopsy is variable. It can be a mild spotting for few days or moderate bleeding for 5-7days.
The menopausal symptoms are also variable. These will be evident after 2-3 weeks.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Fibroid removal needs anaesthesia.

Detailed Answer:
Removal of fibroid would have needed a general anaesthesia. It seems that only endometrial biopsy is done.
The amount of bleeding after a biopsy is variable. It can be a mild spotting for few days or moderate bleeding for 5-7days.
The menopausal symptoms are also variable. These will be evident after 2-3 weeks.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dr. Rakhi Tayal (35 minutes later)
Thanks for response. I will keep you posted as we go along. You have been so helpful. I don't know if it's normal or not but so far I have had no real bleeding since yesterday procedure at all. I stopped Activella then as well so could it be possible that I may not get any bleeding from stopping the hormones? If for some strange reason I don't bleed since stopping Activella would that be normal or a concern for further testing?
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Thanks for response. I will keep you posted as we go along. You have been so helpful. I don't know if it's normal or not but so far I have had no real bleeding since yesterday procedure at all. I stopped Activella then as well so could it be possible that I may not get any bleeding from stopping the hormones? If for some strange reason I don't bleed since stopping Activella would that be normal or a concern for further testing?
doctor
Answered by Dr. Dr. Rakhi Tayal (20 minutes later)
Brief Answer:
There may not be any bleeding.

Detailed Answer:
After stopping hormones and after biopsy, there may not be any bleeding in some cases. It is just normal and is not suggestive of any further pathology.
Let us wait for the biopsy results.
Do recommend our services to your friends too if you found it helpful.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
There may not be any bleeding.

Detailed Answer:
After stopping hormones and after biopsy, there may not be any bleeding in some cases. It is just normal and is not suggestive of any further pathology.
Let us wait for the biopsy results.
Do recommend our services to your friends too if you found it helpful.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dr. Rakhi Tayal (1 hour later)
I will forward your information to my other friends and I'll keep you posted on my outcome. Once again, thank you so much for everything. I truly appreciate your extensive medical knowledge.
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
I will forward your information to my other friends and I'll keep you posted on my outcome. Once again, thank you so much for everything. I truly appreciate your extensive medical knowledge.
doctor
Answered by Dr. Dr. Rakhi Tayal (6 hours later)
Brief Answer:
You are welcome.

Detailed Answer:
Hello.
Thank you.

Any further discussion is always welcome.
.
Best regards
Dr. Rakhi Tayal.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
You are welcome.

Detailed Answer:
Hello.
Thank you.

Any further discussion is always welcome.
.
Best regards
Dr. Rakhi Tayal.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Rakhi Tayal (44 hours later)
Dr. Tayal,
How are you doing? I wanted to know can I take a douche with just pure clear water or salt water because I'm not actually bleeding but when i pee there is a little brownish blood particles coming out? Also, can I drink herbal teas because I was told certain foods and drinks are high in estrogen and I probably should not be intaking high levels of estrogen now. Is that right? I left a call for the dr since yesterday with no response. Any info and advise you can give would be great. Thanks
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Dr. Tayal,
How are you doing? I wanted to know can I take a douche with just pure clear water or salt water because I'm not actually bleeding but when i pee there is a little brownish blood particles coming out? Also, can I drink herbal teas because I was told certain foods and drinks are high in estrogen and I probably should not be intaking high levels of estrogen now. Is that right? I left a call for the dr since yesterday with no response. Any info and advise you can give would be great. Thanks
doctor
Answered by Dr. Dr. Rakhi Tayal (4 hours later)
Brief Answer:
You can douche with clear water.

Detailed Answer:
Hello.
You can douche with clear water to remove any left over brownish blood. Green tea or herbal tea is also alright in moderation. Don't have more than two cups a day.
Regards.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
You can douche with clear water.

Detailed Answer:
Hello.
You can douche with clear water to remove any left over brownish blood. Green tea or herbal tea is also alright in moderation. Don't have more than two cups a day.
Regards.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr. Rakhi Tayal (40 minutes later)
Dr. Tayal,
I must admit everything that you have written to me, I used it when I went to see the Dr and she was amazed that I knew the things that I knew. The thanks to to you.... the nurse got back to me tonight and had the nerve to tell me that they don't recommend you using any firm of a douche because they don't want you to get an infection but I want this nasty stuff out of me. There is one thing that I don't understand. Since at the time of my biopsy my endometrium lining was thick and I have an obvious fibroid, what is going to stop the biopsy from coming back saying that I don't have some form of hyperplasia? I get the impression that it is easy for the doctor just to perform a hysterectomy than to go another route with me so that things work out better for me in the end... that is a big concern for me. What order do you think I need to go about things? Like Next, D and C, hysterectomy or what can be my options? I want to be well informed so next week when I go to see the Dr again I want to be able to know exactly what to say. I need to stay educated and informed and with your knowledge and help I can do just that. What type of water should I use in the douce? Like filtered, spring, purified water or what? Please look up this product and tell me if it's ok for me to eat it daily because I'm trying to lose weight to help my situation as well. The product is Nutrim Oats. I mix a scoop on my black tea or peppermint tea. I just wish the biopsy results hurry up and come back so I will know what to do next.
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Dr. Tayal,
I must admit everything that you have written to me, I used it when I went to see the Dr and she was amazed that I knew the things that I knew. The thanks to to you.... the nurse got back to me tonight and had the nerve to tell me that they don't recommend you using any firm of a douche because they don't want you to get an infection but I want this nasty stuff out of me. There is one thing that I don't understand. Since at the time of my biopsy my endometrium lining was thick and I have an obvious fibroid, what is going to stop the biopsy from coming back saying that I don't have some form of hyperplasia? I get the impression that it is easy for the doctor just to perform a hysterectomy than to go another route with me so that things work out better for me in the end... that is a big concern for me. What order do you think I need to go about things? Like Next, D and C, hysterectomy or what can be my options? I want to be well informed so next week when I go to see the Dr again I want to be able to know exactly what to say. I need to stay educated and informed and with your knowledge and help I can do just that. What type of water should I use in the douce? Like filtered, spring, purified water or what? Please look up this product and tell me if it's ok for me to eat it daily because I'm trying to lose weight to help my situation as well. The product is Nutrim Oats. I mix a scoop on my black tea or peppermint tea. I just wish the biopsy results hurry up and come back so I will know what to do next.
doctor
Answered by Dr. Dr. Rakhi Tayal (3 hours later)
Brief Answer:
Details below .

Detailed Answer:
Regarding the next procedure, it all depends on the biopsy report. May be you won't need anything if it is just a simple Hyperplasia. It is too early to decide.
You can use filtered or purified water for douching only once.
You can use nutrim oats. It seems safe to me.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Details below .

Detailed Answer:
Regarding the next procedure, it all depends on the biopsy report. May be you won't need anything if it is just a simple Hyperplasia. It is too early to decide.
You can use filtered or purified water for douching only once.
You can use nutrim oats. It seems safe to me.
Regards.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Dr. Rakhi Tayal (13 hours later)
Doc, my sister did not listen to me when I told her to fill my douche bag with filtered or purified water and she filled it with regular faucet water. I see about 24 ounces of water to flush out all that nasty brownish stuff. Was that too much water? I pray I have not exposed myself to any infection by doing the douche. My girlfriend said by douching even with clear water it can throw my hormones off. Is this true? Do I need an antibiotics of any sort now? Is there anything I can take or do because now today, I'm feeling very weak and drained.... thanks
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Doc, my sister did not listen to me when I told her to fill my douche bag with filtered or purified water and she filled it with regular faucet water. I see about 24 ounces of water to flush out all that nasty brownish stuff. Was that too much water? I pray I have not exposed myself to any infection by doing the douche. My girlfriend said by douching even with clear water it can throw my hormones off. Is this true? Do I need an antibiotics of any sort now? Is there anything I can take or do because now today, I'm feeling very weak and drained.... thanks
doctor
Answered by Dr. Dr. Rakhi Tayal (6 hours later)
Brief Answer:
Watch out for fever.

Detailed Answer:
24 ounces of water is not too much.
If there is no fever then antibiotics are not needed. Just take rest and have a healthy diet. You will recover in next 3-4days.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Watch out for fever.

Detailed Answer:
24 ounces of water is not too much.
If there is no fever then antibiotics are not needed. Just take rest and have a healthy diet. You will recover in next 3-4days.
Regards.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Rakhi Tayal (1 hour later)
Great. Listen since coming off the HRTs I'm starting to feel a little different in my body. Like a little anxious and my blood pressure has been starting to creep up. What should I do?
Also, I had a MRI of my brain and pituitary and it showed:
1.) No significant atrophy or obstructive hydrocephalus.
2.) Mild supratentorial chronic white matter changes consistent with gliosis/chronic small vessel ischemia. No Recent ischemic findings or acute abnormality.
3.) Intact posterior fossa and brainstem. Patent major flow voids.
4.) No pituitary hemorrhage or macroadenoma. No visible microadenoma.
5.) Acute superimposed upon chronic maxillary sinusitis. No mastoiditis.

What does all this mean please?

It seems like one thing after another but I pray I get through it all safely..

Thanks again,
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Follow up: Dr. Dr. Rakhi Tayal (0 minute later)
Great. Listen since coming off the HRTs I'm starting to feel a little different in my body. Like a little anxious and my blood pressure has been starting to creep up. What should I do?
Also, I had a MRI of my brain and pituitary and it showed:
1.) No significant atrophy or obstructive hydrocephalus.
2.) Mild supratentorial chronic white matter changes consistent with gliosis/chronic small vessel ischemia. No Recent ischemic findings or acute abnormality.
3.) Intact posterior fossa and brainstem. Patent major flow voids.
4.) No pituitary hemorrhage or macroadenoma. No visible microadenoma.
5.) Acute superimposed upon chronic maxillary sinusitis. No mastoiditis.

What does all this mean please?

It seems like one thing after another but I pray I get through it all safely..

Thanks again,
doctor
Answered by Dr. Dr. Rakhi Tayal (12 hours later)
Brief Answer:
Nothing to worry.

Detailed Answer:
I have read the MRI report. Tis is an almost normal report. The mild small vessel ischaemia can be related to hypertension or small vessel changes related to age.
There is mild maxillary sinusitis. Rest all findings are normal.
Anxiety adds to rise in blood pressure. Deep breathing exercises will help in relaxation.
Regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Dr. Rakhi Tayal (0 minute later)
Brief Answer:
Nothing to worry.

Detailed Answer:
I have read the MRI report. Tis is an almost normal report. The mild small vessel ischaemia can be related to hypertension or small vessel changes related to age.
There is mild maxillary sinusitis. Rest all findings are normal.
Anxiety adds to rise in blood pressure. Deep breathing exercises will help in relaxation.
Regards.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Hi, I Am 53 Years Old And I Started On

Hi, I am 53 years old and I started on HRT's in 2018. The one I take is Activella o.5/01mg which is estrogen and progestin. Every year I have my mammogram and they have come back negative and my pap smear as well. On Oct 16, 2018 my breast were feeling very heavy and hurting so much. I went to the doctor and they did another breast ultrasound that showed nothing. I was so stressed out and worried and then 2 days later, I started bleeding. Not alot of blood but enough for someone who is 53 years old. The blood last for a like 3 days and then stopped completely. I went back to the doctor and she did a transvaginal ultrasound was done on 10/2/20, that showed: my uterus is anterverted and measures 8.9 x 4.7 x 4.8. the myometrium is homogeneous. a small solitary submucosal stable fibroid in the fundus measuring 1.7 x 1.6 x 1.5 cm previously in 2017 it was 1.5 x 1.3 x 1.5 cm. The endometrium measures 12.0 mm. The endometrium is unremarkable. the right ovary could not be visualized. The left ovary measures 2.4 x 1.5 x 1.9 cm. No ovary abnormalities are identified. There is no free fluid in the cul-de-sac. No adnexal masses are identified. Please keep in mind in 10/02/2018 I had another trans-abdominal exam done and then my endometrium was 4 mm but they claim to have seen both ovaries at that time of exam and measured them. The fibroid was shown then as well and measure 1.5 x 1.5 x 1.3. Of course I have a concern about cancer but my doctor is trying to tell me I should not be worried. He's thinks the thickness is coming from the HRT and not cancer. I don't know what to do and need some guidance??? Could it be correct what he is saying? Also, my prolatin level came back a little elevated at 29.3 when normal range is 26.3. If I need to get a biopsy done what type should it be? Meaning a hysteroscopy and myosure or just a DNC or what to cover both situations meaning the fibroid and the endometrium lining and do I need to consider a hysterectomy or what? Also, based on the removal procedure , do I need to worry if it is cancer once they cut it to remove it, will it spread? I am lost and need guidance... Also, should I stop taking the Activella now or go ahead and continue it until I can decide the next step in the process. I know as soon as I stop taking Activella all of my menopausal system will return immediately... I need a response asap, Please advise.... Thanks