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Suggest Treatment To Cure Endometrial Hyperplasia

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Posted on Mon, 5 May 2014
Question: I took unopposed phytoestrogen to treat severe postmenopausal symptoms and got relief. In the process I developed a thickened lining of the womb (non cancerous). Had a smear done and had no bleeding. I am now suffering terribly and must have HRT. What should I do? Can I get rid of the thickened lining without removal of my uterus?
doctor
Answered by Dr. Madhuri N Bagde (1 hour later)
Brief Answer: detailed answer below. Detailed Answer: Hello and welcome, I completely understand your problem. Estrogen is very important for our life and function. But then life goes on even without it. You have mentioned that you had a late menopause and also a thick endometrium. The late menopause, thick endometrium and polyps indicate that you have been exposed to estrogen for a longer time. You have not mentioned as to how it was determined for the lining to be non cancerous. Was a procedure like dilatation and curettage or biopsy or hysteroscopy done? Also how much was the thickness? Kindly provide these answers so that I may help you better. All said and done, you must understand that after menopause, hormones are supposed to be given just to tide over the symptoms of menopause like hot flashes and bone loss. Research has proved that long term use of hormone replacement therapy is associated with various cancers like cancer uterus, breast and so on. Also women that receive long term hormone replacement are shown to have decline in brain function and are at higher risk of developing Alzheimers disease [ disease with decline in mental function, memory loss and so on]. I completely understand that your body is used to estrogen effects and is finding it difficult to adjust without it. However nature has designed woman in such a way that she would be exposed to this hormone for this limited period of time. After which we must train our body to work without the hormone as it will have harmful effects later. So remember that HRT will make you feel better but will not actually be good for you if used for long periods. At the age of 67 and with thick uterine lining I would not advise HRT. Please eat a healthy diet and daily exercise and it will help you tide over the symptoms of menopause nicely. Now about getting rid of thick endometrium without removing the uterus: If after D and C or any of the above mentioned procedure it is found that there is no malignancy, you may go for an endometrial ablation [ burning the uterine lining with cold or hot current or microwave etc] procedure or a therapeutic curettage [ where most of the lining is curetted and removed]. Most of the time I do not advise this in women that are more than 60. The procedures are mainly used to manage heavy bleeding and are not used to manage a suspected thick endometrium that may be cancerous. We do not know if these procedures may increase the risk of missing a cancer should one develop in the future. So hysterectomy is a better option. If there is no cancer then a curettage and follow up with endometrial biopsy and ultrasound are better options. So you can keep the uterus if you want provided you have a regular follow up, stop estrogens, may use progesterone [according to the biopsy report on the advise of your doctor]. Hysterectomy with keeping the cervix is another option. It is supposed to not hamper the sexual function as well as decrease the risk of uterine cancer as uterus is removed. So please discuss this with your doctor. So the options are that if you want HRT, better get the uterus removed and then take it for better safety profile. If you want the uterus, then do not go for hormones as already the lining is thick. I understand that you want both the uterus and the hormones. But please remember that it places you at risk and no amount of hormones and the uterus is worth more than a happy life. I completely understand and share the concern. But unfortunately we must work within our available options. So think about the options, take help of your healthcare provider and then decide. I am sure you will choose wisely. I am always here to help so feel free to ask me. Hope this satisfies your query. Thanks for using HCM. Feel free to ask any more questions that you may have. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde (6 hours later)
I am making very slow progress at this end, especially with my GP. I see you are in India. I go there every year. Any chance I can come over and see you for treatment immediately? I am obviously very concerned about all this. Hysterectomy with keeping the cervix seems a good idea. Can you recommend a progesterone only therapy till I get things moving? I am suffering terribly on a daily basis and would like to come to India for treatment. As early as the end of next week when I will have the biopsy results to back the endoscopy. If you cannot treat me then I would like you to recommend me to someone who can or a hospital in India for the hysterectomy. The National Health here is under staffed and there is a considerable waiting time. The doctors are excellent but waiting time is shocking. I am in too much discomfort to hang around. Please reply to this email as I need to take urgent action
doctor
Answered by Dr. Madhuri N Bagde (1 hour later)
Brief Answer: Please do not tensed at all. Detailed Answer: Hello and welcome back, Please do not worry so much. Endometrial hyperplasia does not always mean a carcinoma. So there is no need to worry so much at all. Devery 10 mg twice daily can be used. However it will need a prescription most likely so you will need to see your doctor for this. About the surgery: You are most welcome to see me for it. I have a very good idea about the health care system outside India as I was in USA myself for 2 years and understand that the quality is excellent but it takes a bit of time. However kindly inform me before hand if you intend to come. I am based at Nagpur in central India. We do laparoscopy, vaginal hysterectomy as well as open surgery depending upon the case. We have a team here and work together. My husband is also an Ob Gyn specialist and we work together for optimal patient care. So please do not get tensed at all. Maybe the report will be normal as simple hyperplasia is more common rather than cancer. Hope that this answers your query. Thanks and do not worry. Regards, Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde (1 hour later)
Cannot find contact details for you on the internet. Can you giveme a contact address, phone number or email address so that we can keep in touch re my visit to india
doctor
Answered by Dr. Madhuri N Bagde (25 minutes later)
Brief Answer: I am not sure about the site policy Detailed Answer: Hello and welcome back, I am not sure if I am allowed to give my contact details at this site. However I will post it in the answer and please let me know if you are able to see it. Also when you search google it displays results for Badge instead of Bagde so please check this. My email is YYYY@YYYY and phone is 0000. My address is for my clinic Genesis Hospital Opposite Lokmat Building Dhantoli Nagpur, Maharashtra, India. I will also get in touch with the health care magic team and inform them about this. They will help in sorting this out but this will take at least a day more. So I suggest that you re search my name along with the name of my city 'Nagpur' after another 48 hours for better results. I will be looking forward to hearing from you and provide any help that may be possible. Please feel free to contact me. Take care and please do not worry. I understand that you are having issues due to hormones. I also suggest that you modify your diet to include fresh green leafy vegetables and take walks in the morning and evening [ if you are already exercising regularly then this is not needed]. These help in restoring the natural hormonal balance and tone up the system so that hormonal effects become less prominent. Hope this was helpful.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Madhuri N Bagde (6 hours later)
Thanks got your email and contact info. Will be in touch tomorrow or later today and then close this dialogue.
doctor
Answered by Dr. Madhuri N Bagde (4 hours later)
Brief Answer: You are welcome. Detailed Answer: You are welcome. Dr Madhuri
Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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Suggest Treatment To Cure Endometrial Hyperplasia

Brief Answer: detailed answer below. Detailed Answer: Hello and welcome, I completely understand your problem. Estrogen is very important for our life and function. But then life goes on even without it. You have mentioned that you had a late menopause and also a thick endometrium. The late menopause, thick endometrium and polyps indicate that you have been exposed to estrogen for a longer time. You have not mentioned as to how it was determined for the lining to be non cancerous. Was a procedure like dilatation and curettage or biopsy or hysteroscopy done? Also how much was the thickness? Kindly provide these answers so that I may help you better. All said and done, you must understand that after menopause, hormones are supposed to be given just to tide over the symptoms of menopause like hot flashes and bone loss. Research has proved that long term use of hormone replacement therapy is associated with various cancers like cancer uterus, breast and so on. Also women that receive long term hormone replacement are shown to have decline in brain function and are at higher risk of developing Alzheimers disease [ disease with decline in mental function, memory loss and so on]. I completely understand that your body is used to estrogen effects and is finding it difficult to adjust without it. However nature has designed woman in such a way that she would be exposed to this hormone for this limited period of time. After which we must train our body to work without the hormone as it will have harmful effects later. So remember that HRT will make you feel better but will not actually be good for you if used for long periods. At the age of 67 and with thick uterine lining I would not advise HRT. Please eat a healthy diet and daily exercise and it will help you tide over the symptoms of menopause nicely. Now about getting rid of thick endometrium without removing the uterus: If after D and C or any of the above mentioned procedure it is found that there is no malignancy, you may go for an endometrial ablation [ burning the uterine lining with cold or hot current or microwave etc] procedure or a therapeutic curettage [ where most of the lining is curetted and removed]. Most of the time I do not advise this in women that are more than 60. The procedures are mainly used to manage heavy bleeding and are not used to manage a suspected thick endometrium that may be cancerous. We do not know if these procedures may increase the risk of missing a cancer should one develop in the future. So hysterectomy is a better option. If there is no cancer then a curettage and follow up with endometrial biopsy and ultrasound are better options. So you can keep the uterus if you want provided you have a regular follow up, stop estrogens, may use progesterone [according to the biopsy report on the advise of your doctor]. Hysterectomy with keeping the cervix is another option. It is supposed to not hamper the sexual function as well as decrease the risk of uterine cancer as uterus is removed. So please discuss this with your doctor. So the options are that if you want HRT, better get the uterus removed and then take it for better safety profile. If you want the uterus, then do not go for hormones as already the lining is thick. I understand that you want both the uterus and the hormones. But please remember that it places you at risk and no amount of hormones and the uterus is worth more than a happy life. I completely understand and share the concern. But unfortunately we must work within our available options. So think about the options, take help of your healthcare provider and then decide. I am sure you will choose wisely. I am always here to help so feel free to ask me. Hope this satisfies your query. Thanks for using HCM. Feel free to ask any more questions that you may have. Dr Madhuri Bagde Consultant Obstetrician and Gynecologist