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Ultrasound showed thickening of the womb. On hysteroscopy. Missing periods. Looking for advice

May 2013
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Hi. I have just been to the hospital to have a scan inside the womb. They saw a fibroid of size 4.5-5.3 cm , and the lining of the womb of 11 mm, and a retroverted uterus.About 1.5 years ago, I had another scan then and they saw a polyp(size 1.5 cm), but haven't said anything just then, about the lining of the womb.The doctor seems to think, as a possibility , that the polyp could have caused the thickening of the womb(today they haven't actually seen any polyp, that was seen over a year ago). I am 50 years old, in general excellent health,I currently take Indapamine(water tablets) to monitor BP, as well as a few herbal and other vitamin supplements but am really scared about the hysteroscopy and the endometrial biopsy procedure under general aesthetic that they are suggesting, simply because of my BP instability(still) and in addition, to rule out any endometrial cancer option and i always thought that surgery should be the last thing to do, unless it's absolutely necessary. the last period I had was at the start of March 2012, then had no bleeding at all until sometimes in XXXXXXX when I had random traces of blood, sometimes more or less ,accompanied by period pains, but generally less. Today at the hospital,I was bleeding like a period, after the pielle attempt, it was impossible to perform the pipelle test, to insert a tube into the uterus, as it was completely non-negotiable. I didn't have the menopause yet.Can you get a normal result with the lining of the uterus of that thickness(11 mm), at my age? I have 2 healthy children, one delivered by caesarian section and the other one by normal birth. How is 11 mm thickness of the lining of the womb considered in someone who's 50.5 years old, with no health issues, no menopause? Please advise
Posted Fri, 3 Aug 2012 in Women's Health
Answered by Dr. Sree Gouri SR 1 hour later

Thanks for the query.

Normally endometrium thickness ranges from 1mm to 8mm during different phases of menstrual cycle,
11mm thickness of endometrium at your age is somewhat uncommon and requires careful investigations. As you are having irregular bleeding episodes this can flag your doctor to take endometrial biopsy.

Increased endometrial thickness may be because of hormonal fluctuation at perimenopausal age.

Usually fibroids will regress after menopause. Since they did not regress and having symptomatic fibroids doctors might have thought about the option of hysterectomy.

Regarding polyp, may be in the first scan they interpreted small fibroid as polyp or it may came out during menstrual bleeding in subsequent months. If at all endometrial thickness is noted because of polyp you can see only in one place.

If doctors perform hysteroscopy they will take all precautions, first physician will examine and give fitness for general anesthesia then only they will do the procedure and during the procedure also you will be under anesthetic coverage with strict monitoring of vitals, so you don't worry about the procedure.

The underlying problem is to be recognized early so that necessary treatment can be given.
You can discuss these things with your family and take their support which will allay your anxiety. Keep all your fears at bay till the biopsy reports come out.

Hope I have answered your query. I will be available to answer your follow up queries. If you are satisfied with all my answer, please rate the answer after closing the discussion.

Take care.
Above answer was peer-reviewed by
Follow-up: Ultrasound showed thickening of the womb. On hysteroscopy. Missing periods. Looking for advice 19 hours later
Ok. Thanks for your answer. Obviously one of my concerns is that doctors do rush into immediately performing a hysterectomy, which surely is not needed if it's only a fluctuation of hormones that is causing the thickening of the lining of the womb. Unless it's absolutely necessary, a hysterectomy is not something that women should have, considering all the problems associated with after the procedure, unless it's an endometrial cancer danger or a prolapsed uterus etc.
I read that it's mainly postmenopausal women(in other words they haven't had a period for 12 months)that are of concern to doctors if the y have a greater thickness of the womb, especially if they had a sudden bleeding after 12 months. So why is it so unusual for perimenopausal women like myself to have a thickness of 11 mm? I found out the description of my scan results and the fibroid of 4.5-5.3 cm was actually calcified. Any difference? Can you please explain in detail what you meant earlier by"if at all endometrial thickness is noted, you can see it all in one place"? Problem is at the moment, I am a single mum, with 2 children, no family here so no one really here to support me so I am in a very delicate situation, no wonder I feel very stressed and worried, because of that I am not sure whether I withstand a general aesthetic or the forthcoming pressure!Just wondered though, why you thought so quickly even before taking an endometrial sample, that you would immediately perform a hysterectomy?All I want to know is whether there is any other possible reason for this"spotting" or traces of blood that I sometimes get and whether this is connected to the thickness of 11 mm?And would that count towards having any periods in the 12 month period before diagnosing the menopause or not?Thank you.
Answered by Dr. Sree Gouri SR 7 hours later

to detect the nature of the endometrium you have to undergo hysteroscopy and endometrial biopsy under general anesthesia which your doctors recommended to you as you are hesitating about the procedure I just explained what are the precautions they will take generally before procedure.

fluctuation of hormones sometimes may be responsible for endometrial thickness, you can take pills containing hormones for that but taking hormonal pills as this age can increase other problems like endometrial or breast malignancy etc,
so your doctors might have recommended hysterectomy as one of the choices of treatment.

if you are not willing for hysterectomy, after undergoing endometral biopsy if the reports comes as normal you can ask for pills or intrauterine device, as your doctors examined you they will be much aware of the condition so if they agree you can take one of them,

as I told what is the the normal thickness of endometrium, generally with progression of age endometrium thins out, and also possibility of other risks like malignancies increases so this should be thoroughly evaluated,

I am using the word malignancy not to frighten you but just for discussion sake, don't worry that is not common.

regarding polyp what I mean was if polyp was responsible for endometrial thickness that should be present at that point only and remaining thickness should be normal.

fibroids with progression of of time can undergo different changes calcification is one of them, that is not XXXXXXX

I want to tell you that I just explained what they will do if at all you go for hysterectomy and tried to decrease your fear, it is not like that I recommended hysterectomy with out taking biopsy.

as I told hormones needed to maintain the growth and shedding of endometrium because of their fluctuation the endometrium can grow thicker and it will shed irregularly, that may be responsible for your spotting.

I can understand your personal problem but what I want to tell is because of that you should not skip the necessary treatment, hope I am clear.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.

Above answer was peer-reviewed by
Follow-up: Ultrasound showed thickening of the womb. On hysteroscopy. Missing periods. Looking for advice 16 hours later
thanks for your answer. I just wanted to also say that in the doctor's reports, it was mentioned that a XXXXXXX coil was going to be inserted(+/-) though, as a possibility, as well as a polypectomy(+/-)(if they see a polyp during the procedure, even though the scan
didn't show the polyp that was observed last year), and an endometrial biopsy.So my question is if my BP is quite instable, going like a yo-yo(mainly caused by stress and worry,on water tablets at the moment) , is it still possible for doctors to give me an injection to control the BP during the procedure?Because, as we know, during a general anaesthesia, the BP and heart must be in good condition.The other question is how do the doctors know at the time of the biopsy procedure, if to insert the XXXXXXX coil inside me or not? Is the result of the biopsy going to be during the procedure or after? And is there any threshold for the thickness of the lining of the womb that worry doctors? And would a calcified fibroid give any symptoms at all, like this irregular bleeding or is it the end of its life?(although at the moment I started my period just after the unsuccessful pipelle test at the hospital on Monday), and it shows proper red colour, sometimes in different quantities). Problem is I feel a bit anaemic due to the blood loss, so i'm back on iron tablets that the doctor gave me about 3 months ago. many thanks

Answered by Dr. Sree Gouri SR 3 hours later

-anesthetists can manage fluctuations of blood pressure during procedure with anesthetic drugs usually, for more information,
reference: WWW.WWWW.WW
-if immediate result of biopsy needed they can go for frozen section biopsy which will give result in 15 to 20 minutes while patient is still on operation table, so may be your doctors use this and rule out the possibility of malignancy and may insert XXXXXXX coil. usually just because of thickness of endometrium we cannot come to conclusion regarding nature of the problem.

-usually the symptoms of calcified fibroids are less compared with normal fibroids, but if ulceration occurs on the surface it can give irregular bleeding, normally calcified fibroid will not progress further.

-you can take iron tablets for the treatment of anemia, after calculating your hemoglobin level only they will consider the procedure.

Wish you Good Health, If you are satisfied with my response please rate the answer after closing the discussion.
Take care.
Above answer was peer-reviewed by
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