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Ultrasound showed bulky and heterogeneous uterus. Suggested progesterone to stop periods. Should I go for biopsy or D&C?

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Hi, I have just had this ultrasound result: "Uterus was bulky and heterogeneous but no fibroids were seen. Endometrial thickness was increased at 18.7mm An echogenic lesion was seen in the anterior wall measuring 9mm ? polyp. The right ovary was blky nad contained a corpus luteum measuring 2.4cm. Left ovary appeared notmal A small amount of free fluid was seen in the pelvis"

My doctor has suggested progesterone to stop my periods for 3 months and then review. I feel that I should be referred for a biopsy or D&C. What do you think?
Posted Tue, 31 Jul 2012 in Women's Health
Answered by Dr. Timothy Raichle 30 minutes later
Hi, I would be happy to help you with your question.

You imply that your history is that of heavy and/or irregular periods which likely prompted the ultrasound and therapy with progesterone.

The ultrasound suggests that fibroids are likely present (even though they did not "see" them) and the thickening of the endometrial lining suggests the possibility of endometrial polyps (growth within the uterus associated with irregular bleeding).

I am not worried about the right ovary from what you describe from the report. Nor am I worried about a small amount of free fluid in the pelvis.

Here is what I think needs / should happen:

1. If they have not done it already, you need a biopsy of the lining of the uterus to rule out pre-cancerous changes (this is very important)
2. Using progesterone to stop the bleeding is a great idea
3. You need a follow-up ultrasound called a "sonohysterogram" where fluid is pushed into the uterus and if you have a polyp then it can easily be seen.
4. If you just have uterine polyps, then a surgery to remove them would be a good first move.
5. If there are no polyps, just a bulky uterus, then removing the uterus is likely indicated.

I hope this helps!! Please do write back for follow up queries that you may have.

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