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What does "no evidence of hyperplasia or malignancy" mean in a D&C report?

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Posted on Fri, 11 Jul 2014
Question: wife age 45, is having uterus size 9x7x5.5 cm . she has uterine fibroids ..3 in nos..two are small while one is of size 5.4 cmx5.1cm which is posterior intramural...she has endometrium thickness 18-19mm.. periods are every 26-28 days and are normal with more bleeding in first two days.
Also she has very small (2.4mm) size polyp in Gall bladder and a small lump(1CMX0,8CM) in left breast which has been diagnosed as benign few days back thru biopsy
We went for D&C on 26th of May(last month) . It was first day of her menses. The D&C report has come as “ no evidence of Hyperplasia or Malignancy “. However tortuous/focally fragmented Endometrial gland are there line by columnar epithelium.showing insipissated luminal secretions in some of the glands. focally star shaped glands lined by epithelium are noted set in a compact cellula stroma which is pseudodecidualised and shows focal fragmentation and haemorrhage .
She has got the first menses after D&C on 24th day .

I have queries:
- what do you make out from this report of D&C
- what should be next round of action suggested
-     Is the 24th Day menses occurrence OK ?
- Finally considering tiny polyp in Gall Bladder , a benign gland in left breast and thickened but not malignant endometrium clubbed with fibroids . What is this all suggesting . How frequent check ups and precautions to be taken ?

-     Is there any means/methods to fast increase the progesterone level. By any diet /therapy ?

Also how to measure the progesterone level in blood . Is t linked to Vitamin-D . She was having it very low some time back. Around 4. Then she started taking Vitamin D XXXXXXX and got it back to 20+.

She is 45 and menopause is around 5 more years away. These many years estrogen will continue to increase and problems will not alleviate for around 5 years and will only increase. It might be the case that less progesterone level in her is not putting check of bad impacts of high estrogen.

We propose doing Ultrasound/mammography in another 6 months time and if anything abnormal found we shall go for hysterectomy . Will that be OK ?
doctor
Answered by Dr. Rakhi Tayal (31 minutes later)
Brief Answer:
Details below.

Detailed Answer:
Hello,
Thanks for trusting us with your health concern.
I have seen the D&C report. The report is normal and is not suggestive of any malignancy.
The next line of action depends on her symptoms. If she is not having any irregular bleeding then periodic monitoring every 6 months is sufficient. In case there is a heavy bleeding with pain in lower abdomen then hysterectomy can be considered.
Having periods after 24 day is a normal variation.
Considering all the findings a check up every 6 months is sufficient.
Increase in progesterone levels is possible by taking progesterone supplements from day 15-25 of the cycle. This will help in regularizing her cycles and decrease the bleeding during periods. You can get these prescribed after consulting her gynecologist.
Progesterone levels in the blood can be measured by a simple blood test on day 3 of her cycle. It can be linked to Vitamin D 3 deficiency.
Yes your planning is correct. In case she has a menopause earlier then the fibroids will regress and the endometrial lining will also undergo atrophy due to lack of hormones.
Please feel free to discuss further. I will be glad to answer the follow up queries that you have.
Wishing you good health.
Regards.
Dr. Rakhi Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Rakhi-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakhi Tayal (27 hours later)
Doctor ,

She has her menses starting yesterday . First day was ok. but on 2nd day (today) since morning she is having severe bleeding . 5 pads changed till afternoon. Is is normal during first menses post D&C ? What are the suggestions to control the bleeding
doctor
Answered by Dr. Rakhi Tayal (4 hours later)
Brief Answer:
Needs treatment.

Detailed Answer:
Hello.
Thanks for writing again.
A heavy bleeding after D&C can happen if there is a hormonal disturbance. The management of this condition would require treatment with progesterone to stabilize the endometrium and reduce bleeding along with hemostatic agents like ethamsylate or tranexaemic acid .
You might consult your gynecologist who can initiate the proper therapy.
Meanwhile start taking iron supplements to combat excessive blood loss from your body.

Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakhi Tayal (31 minutes later)
Thanks Doctor for advice

Actually this bleeeding is not imm after D&C . It is rather during ocurence of first menses cycle after D&C(which actually started 4 days earlier than normal). she is into 2nd day of first menses after D&c. She has started taking the hemostatic agent as suggested by her doctor. Do you think it will stop as this mnses cycle is complete.

Does this harmonsal imbalance after D&C subside after 1-2 menses cycle of menses
doctor
Answered by Dr. Rakhi Tayal (1 hour later)
Brief Answer:
Hormonal imbalance is not due to D&C.

Detailed Answer:
Hello.
The D&C itself does not cause or correct a hormonal imbalance. The bleeding will stop in next few days with the medicine given. Along with this a hormonal therapy - progesterone supplementation for next 2-3 months will help in controlling the bleeding.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Rakhi Tayal (13 hours later)
Thanks Again Doctor.

Pl suggest food items, fruits, herbs which help increase in Progesterone level. Heard that cranberries are good in such cases when Estrogen is high and Progesterone is less.

doctor
Answered by Dr. Rakhi Tayal (14 minutes later)
Brief Answer:
written below.

Detailed Answer:
Hello.
She can take a cooked banana flower with yogurt to increase the progesterone levels in the blood. Also she can boil coriander seeds -20 gms in 200 ml of water till the water reduces to a quarter. Drinking this water daily will also help.
All these treatments are effective for a mild problem only. External supplementation is necessary in the bleeding is very heavy.
Take care.
Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Rakhi Tayal

OBGYN

Practicing since :2001

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What does "no evidence of hyperplasia or malignancy" mean in a D&C report?

Brief Answer: Details below. Detailed Answer: Hello, Thanks for trusting us with your health concern. I have seen the D&C report. The report is normal and is not suggestive of any malignancy. The next line of action depends on her symptoms. If she is not having any irregular bleeding then periodic monitoring every 6 months is sufficient. In case there is a heavy bleeding with pain in lower abdomen then hysterectomy can be considered. Having periods after 24 day is a normal variation. Considering all the findings a check up every 6 months is sufficient. Increase in progesterone levels is possible by taking progesterone supplements from day 15-25 of the cycle. This will help in regularizing her cycles and decrease the bleeding during periods. You can get these prescribed after consulting her gynecologist. Progesterone levels in the blood can be measured by a simple blood test on day 3 of her cycle. It can be linked to Vitamin D 3 deficiency. Yes your planning is correct. In case she has a menopause earlier then the fibroids will regress and the endometrial lining will also undergo atrophy due to lack of hormones. Please feel free to discuss further. I will be glad to answer the follow up queries that you have. Wishing you good health. Regards. Dr. Rakhi Tayal. For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Rakhi-Tayal