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In Menopause, Having Bleeding. Pap Smear Test Showed Atypical Squamous Cells. Endometrial Thickness Is Abnormal. Advise?

Posted on Mon, 27 May 2013

Question: Hi,
I am a 49 year old post menopausal worman. I believe my last period was in 2008 but do not remember exactly. I have had couple of occasions of spotting since my menopause, but they went away pretty quickly. This time the spotting was converted to bleeding and it almost looks like a period. Its been 5 days, but now i think it is slowly subsiding. I have my pap smears done every year. Last year in Dec 2011 it was normal, but this year in Dec 2012 it was abnormal and the report said that there were ATYPICAL SQUAMOUS CELLS OF UNDEFINED SIGNIFICANCE, however my doctor advised for a routine pap smear next year and said everything was normal. Now it has been 4 months since my pap smear and I have started bleeding. I went to the gynecologist and got my pelvic ultrasound done. The endometrial thickness is 5.9mm. The doctor has advised an endometrial biopsy, but he also said that this would just be a sampling and results are not perfect. The gynecologist also said that the bleeding can be caused by weight problems. I am 5 feet 2 inches and 160 pounds. I am just worried that this whole thing started when I first had the spotting. Please advise

Answered by Dr. Manjunath L Ramarajapalli (6 hours later)

Hello XXXXXXX
The endometrial thickness is abnormal in your case and has to be investigated. You can opt for endometrial biopsy, and depending on the histopathological report, treatment can be planned. Your doctor has said the results of biopsy may not be perfect. If the biopsy report is inconclusive, you may opt for hysteroscopic guided endometrial curettage to rule out pathology.
The Pap smear report of ASCUS may be followed up as advised and it is not the cause of bleeding at present.
I am not sure that this much bleeding is caused by weight problems, better to rule out endometrial pathology.
Let me know if you have more concerns.
Good luck

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Manjunath L Ramarajapalli (8 hours later)

Thanks so much Dr. Manjunath! I am also concerned about the spotting that occured in the past. Do you think that must have been related in anyway to the bleeding now? Also I am jumping to the worst conclusion and am really scared. When you say endometrial pathology you mean Endometrial hyperplasia as well right? I have also heard infection, stress can cause these problems. Please advise.

Answered by Dr. Manjunath L Ramarajapalli (18 minutes later)

Hello,
Possible that the spotting was related.
Endometrial pathology means infection,hyperplasia,cancer etc.
But please understad that all these can be cured by proper treatment.
Please consult the doctor and undergo necessary tests as advised.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Manjunath L Ramarajapalli (31 minutes later)

Thanks so much Dr. Manjunathan! The reason for my worry is that if the spotting was related then I am hoping that whatever it is has not progressed. Also last couple of months I have been under extreme stress and I am hoping that the stress must have induced this. Recently after this bleeding started I have also been experiencing some loose bowels. Sorry for asking such stupid questions, but do you think the loose bowels are related? Also endometrial lining of 5.9mm can be due to hyperplasia, infection etc and not just cancer right? Thanks so much! God bless!

Answered by Dr. Manjunath L Ramarajapalli (36 minutes later)

Hello,

I am not sure that the loose bowel is related to this.

All the above possibilities you specified can be a cause of 5.9 endometrium. Only histopathological study of the sample can scientifically identify the correct possibility.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Manjunath L Ramarajapalli (25 hours later)

I have a bloating and uncomfortable feeling in my stomach/abdomen and occasional nauseated feeling. Now the bleeding has almost stopped (occasionally I see some very miniscule discharge that is red). Just wanted to let you know, to see if you can identify the most probable scenario in my case. Also my gynecologist is 69 years old. I have never gone to him before, but he was recommended by my both these doctors work in the same clinic. Also the gynecologist is hearing impaired (I think it is because of his age). This doctor will be doing the endometrial biopsy in his office. That should be ok right? I am just concerned because of his age and his hearing disorder. I know hearing has nothing to do with this, but I am hoping all his other senses are working fine.

Answered by Dr. Manjunath L Ramarajapalli (8 minutes later)

Hello,

Doing endometrial biopsy is a routine surgical procedure for any experienced gynecologist.

Can you engage another gynecologist to do the procedure if you are not confident?

Good luck

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Manjunath L Ramarajapalli (10 days later)

Hi Dr. XXXXXXX

I got my endometrial biopsy results last week and the result was negative for both hyperplasia and malignancy. However the endometrium was "proliferative phase endometrium" and the doctor has prescribed Medroxyprogesterone acetate (provera) 10 mg OR tabs for 4 months. One pill of 10 mg should be taken from the 1st to 14th of each month. He said that he wants the endometrial thickenss to be below 4 mm. However since one of my aunt has breast cancer and the other has ovarian cancer on my dads side I am really worried about the side effects of this high dose for 4 months. Can you please provide your feedback? Thanks so much!

Answered by Dr. Manjunath L Ramarajapalli (19 minutes later)

Hello,

The endometrium shows proliferative phase, this means there is no ovulation (egg production) every month which is normal in women of your age group.
This is usually treated by supplementary progesterone as your doctor has prescribed.
The risk of increasing the chance of hereditary cancers by these hormones is very small.
However by regular medical check ups you may be re-assured of your health.
Follow your doctor's advise.

Good luck

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Manjunath L Ramarajapalli (13 hours later)

Thanks Dr XXXXXXX I am a post menopausal woman and had some vaginal bleeding similar to a period. I had my ultrasound done and the endometrail stripe thickness was 5.9 mm. The Endometrial Biopsy was negative for hyperplasia or malignancy. However the endometrium was proliferative phase endometrium. The doctor has prescribed Medroxyprogesterone acetate (provera) 10 mg OR tabs once a day for the first 14 days of a month and this medicine should be continued for 4 months. However what I have heard is that normally progestrone is not prescribed for post menopausal women since this medication cannot be continued for ever. Since once the medication stops the endometrium will start growing again. They say that a better way of handling this is to reduce weigth. Also I had taken some birth control pills in the past and had to stop them due to excessive bleeding. Can you please advise? Thanks!

Thanks,
XXXXXX

Answered by Dr. Manjunath L Ramarajapalli (7 hours later)

Hello,

1. Yes, you are correct that progesterone is prescribed for a short duration. However this is the medication which will prevent the action of unopposed estrogen (causes proliferative phase, hyperplasia and cancer).
Probably you have been prescribed this medication to arrest the progress of unopposed estrogen effects.

2. Reducing weight is good idea, do it.

3. Birth control pills taken in the past have no effect at present.

Good luck

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Manjunath L Ramarajapalli (15 hours later)

Thanks Dr. XXXXXXX I am more worried about what should I do after 4 months once I stop taking the medicine. I will still not be producing progestrone. What then? That is what I do not understand.

Also I was not able to handle birth control pills which as I understand have progestrone. So will I have the same issues with provera?

Thanks,
XXXXXX

Answered by Dr. Manjunath L Ramarajapalli (6 hours later)

Hello,
By 4 months your endometrium would have reverted back to normal.Also you may attain menopause and bleeding may not come back.
Prover is not birth control pill.
Good luck

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Raju A.T