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Dr. Andrew Rynne

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How can an uterine fibroid be treated?

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Dr. Timothy Raichle

OBGYN

Practicing since :1999

Answered : 1681 Questions

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Posted on Wed, 22 Mar 2017 in Women's Health
Question: I am a female, 73 years old. Had an transabdominal and transvaginsl scans on 2/16/2017. Pelvic ultrasound indicated I had endometrial thickness that measures 1.2cm. The endometrium has a heterogenous appearance. Also, there is one solid mass in the anterior wall of the uterus. . This most likely represents a small fibroid. I had a previous ultrasound 5 years ago withe same problems. Nothing has changed in 5 years. The obgyn performed a biopsy on me 12 days ago. The biopsy was negative. This morning I had to see my obgyn because I bleed. He discovered it coming from my uterus, he cleaned out the area and said it stopped. But now later in the day. It started to bleed again. Not to much blood though. The doc said if it bleeds agains I am to take progesterone for 5 days. Do you agree that I shud start the progesterone, considering also my period stopped at age 43 and I am now 73.
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Answered by Dr. Timothy Raichle 15 minutes later
Brief Answer:
You need an additional procedure to sample the uterus

Detailed Answer:
In a postmenopausal woman (defined as no period for 12 months), the presence of bleeding could represent pre-cancerous or cancerous changes. The endometrial biopsy was an excellent first step and very reassuring that this was negative, but it does not rule out cancer 100%. It also does not resolve the issue that the uterine lining was thickened at 12mm and you are still bleeding. Throwing hormones at this is NOT the next most appropriate step. You need:

1. A procedure called a hysteroscopy with D&C
2. This is the best way to get a THOROUGH sample of the uterine lining
3. It is also a time when things like polyps can be removed (which would likely explain the thickening of the uterine lining which should be no more than 4mm at your age)

Here is my ultimate suggestiion - get a second opinion! You need a procedure to evaluate the uterine lining in a more thorough manner and managed by an OB/GYN. My only question for you is why they are not pursuing this in a more aggressive manner??

Dr. Tim
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Follow up: Dr. Timothy Raichle 3 hours later
Dr. Raichle, Five years ago, I also had a biopsy and that was also negative. In 5 years, the uterine lining hasn't gotten any thicker. And after my period stopped, at age 43, there was no bleeding. But now this being my 2nd biopsy, 11 days after that I started bleeding. I had no pain or bleeding before the biopsy. The reason for seeing my obgyn after 5 years was to see if any cancer would be found even though the uterus lining stayed the same thickness as 5 years ago. I feel if I had not gotten a biopsy there would be no bleeding. I am hesitant to get a hysteroscopy with D&C at my age and must add scared.
doctor
Answered by Dr. Timothy Raichle 1 hour later
Brief Answer:
You likely have a uterine polyp

Detailed Answer:
I can completely appreciate where you are coming from. You do not have cancer obviously. But, the fact remains:

1. The lining of the uterus remains thickened
2. You have recurrent bleeding
3. You keep going through the same workup because of the bleeding

I would suggest to a patient such as you that, in all likelihood, you have uterine polyps that, if removed, would get you out of this cycle of visits / ultrasound / biopsies that WILL continue if I am correct. As I sometimes tell patients - "let's end the madness". This is a simple procedure that you will tolerate just fine! And then you will know, once and for all, that it is not cancer or pre-cancerous changes.

Dr. Raichle
Above answer was peer-reviewed by : Dr. Kampana
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