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History of ovarian cysts and uterine polyps. Getting irregular and heavy periods. Should I be concerned?

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41 y.o. history of ovarian cysts, uterine polyps, cycles vary from 21 days to over 50 days apart, current cycle of bleeding lasting 12+ days passed large clot last night with heavy bleeding afterwards that is continuing with clot formation. What should I do? Should I be concerned or just wait and see what happens.
Posted Thu, 15 Nov 2012 in Women's Health
Answered by Dr. Timothy Raichle 2 hours later
Hello, I would be happy to help you with your question today.

With your age, it is not unusual to have cycle irregularity elated to irregularity in terms of when you ovulate. This explains the cycle variation of 21-50 days. If this has been your history over your lifetime, then there might be concern about the formation of something called "hyperplasia" or pre-cancerous changes within the uterus that should be evaluated.

This leads me to the answer to your question. A history of endometrial polyps with bleeding that now goes beyond irregular bleeding related to irregular ovulation probably indicates a return of the polyps. Here is what needs to happen:

1. You need to visit your OB/GYN
2. You need a repeat ultrasound performed as a sonohysterogram (better way to visualize for polyps)
3. You need an endometrial biopsy (to evaluate for hyperplasia)
4. You need to discuss options for more definitive treatment (e.g. an ablation)

I hope this helps. Please ask if you have more questions!
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Follow-up: History of ovarian cysts and uterine polyps. Getting irregular and heavy periods. Should I be concerned? 33 minutes later
Considering the multiple issues I am having (ovarian cysts, polyps, fibroids, irregular and heavy cycles), would ablation be the most appropriate treatment? Could it potentially mask endometrial cancer (positive family history) at some point? Would a hysterectomy be a better choice? Or even removing the remaining ovary (which would still induce medical menopause) while leaving the uterus intact? It seems that most of these issues are related to an imbalance of hormones and endometriosis which if I understand correctly will all subside once I enter menopause. But that could still be years away, right.
Answered by Dr. Timothy Raichle 2 hours later
Thanks for the followup. You did not mention the fibroids in your initial question. If you just had polyps, then yes, a polypectomy and ablation would be appropriate.

If you in fact have fibroids, then the chance that an ablation might not work as an issue and a hysterectomy would probably be more appropriate.

You also did not mention that there was a family history of endometrial cancer. This does not change the management because in almost all cases, this is not an inherited cancer.

It is not appopriate to remove an ovary just to "shut down" the uterus. This would do more harm than good by putting you into menopause at 41 years of age!! Not a good choice.

And yes, your problems are likely related to a combination of recurrent polyps, irregular cycles related to hormonal "imbalance", fibroids, and endometriosis. A hysterectomy is definitely sounding like an appropriate choice AFTER a repeat ultrasound AND an endometrial biopsy!

I hope this helps.
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