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Skipping periods. Ultrasound showed simple cyst and small intramural fibroids. Is D and C necessary?

Mar 2013
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Practicing since : 1998
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50 years old. Regular periods till 48, then started skipping. What I thought was my last period at 49 years and 1 month. Them last year(2012) some light spotting. March 2012 FSH 149. January 2013, starting spotting and a light period for 5 days. Ultrasound shows a small simple cyst(1cm) and small(Largest 1cm) intramural fibroids. Another 4 to 5 days period about 35 days later. Had biopsy in March during my period and results state no hyperplasia, no cancer, inactive endometrium. The lab results from the biopsy date are FSH 98 and Estrogen 32. After the period, about 4 weeks later, another light period for about 4 to 5 days. Saw Dr. today and he want to do a D & C even though biopsy was negative. Is that necessary? Maybe I'm not post menopausal yet?
Posted Tue, 18 Jun 2013 in Women's Health
Answered by Dr. Aarti Abraham 30 minutes later
Thanks for your query.
Your reports definitely indicate menopause.
However, these levels start appearin during the perimenopausal transition also, which is when you gradually go into actual menopause.
You still continue to have erratic menstrual bleeding, so you are technically not menopausal, which by definition, means complete absence of periods for a year.
Your biopsy is normal, hence a D and C doesnt add much information to that.
It is common for women to experience irregular bleeding / spotting during the peri menopausal period, which is what is happening in your case.
Multiple fibroids also might be causing the spotting, but generally fibroids regress after menopause.
I would advise you to wait and watch for a few months, if the bleeding is not heavy or troublesome.
If the spotting continues, you might consider hormonal therapy.
you might do so even now if the irregular spotting bothers you.
All the best.
Take care
Above answer was peer-reviewed by
Follow-up: Skipping periods. Ultrasound showed simple cyst and small intramural fibroids. Is D and C necessary? 9 minutes later
Thank you for your reply, Dr.

Would there be anything possible missed in the biopsy that could appear in the D & C?
Answered by Dr. Aarti Abraham 20 minutes later
Well, the only possibility is that the earlier biopsy wasnt performed or interpreted by somebody competent enough.
Or the rare instance, that something developed after March.
The D and C now, would , at worse, serve as a second opinion.
Above answer was peer-reviewed by
Follow-up: Skipping periods. Ultrasound showed simple cyst and small intramural fibroids. Is D and C necessary? 31 minutes later
Thank you again for the prompt response, Dr. One last question(I think). In your experience, my situtation(High fsh for a least a year, inactive endometrium, low estrogen , no real periods for about a year, then apparently 3 normally timed periods) have you seen other patients with similar?
Answered by Dr. Aarti Abraham 11 minutes later
Well you did have off and on bleeding during the year that you reckon as no real periods for a year.
The 3 apparently normally timed periods also included months with spotting ( no real menstrual bleeding ).
Thats why I feel that you are approaching menopause , which corresponds with the hormonal profile also.
Plus the normal biopsy further confirms that the occurence is physiological and nothing to worry about.
Above answer was peer-reviewed by
Follow-up: Skipping periods. Ultrasound showed simple cyst and small intramural fibroids. Is D and C necessary? 16 minutes later
Thank you again Dr. for your prompt response. Just for my understanding and please understand, I am an engineer by profession so I like to fully understand what seems unclear to me. If my endometrium is "inactive", how is it I'm am have periods now.

Thank you.
Answered by Dr. Aarti Abraham 11 minutes later
An inactive endometrium means one which is no more functional, and hence yes, as per your logic ( albeit, engineering logic !! ), it should not more contribute to menstruation.
However, a biopsy is taken at a point of time.
For example, during the entire menstrual cycle, the endometrium is inactive immediately following menstrual bleed, then it grows under hormonal stimulation and peaks just before a woman has the next period.
If your biopsy was taken during the inactive days, it would show an inactive endometrium.
That does not mean that it would not grow in subsequent days under whatever little hormonal activity is intact, to bleed at a later date.
I hope this clears the picture.
if it doesnt, feel free to grill me further.
I am only happy to answer a very obviously intelligent and perceptive lady.
All the best.
Above answer was peer-reviewed by
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