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Post-menopausal spotting - have you had it?

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I'm about 18 months out from my last period (YAY!!), and started having some spotting a couple of weeks ago.  So I went online and found that it's definitely time to see the gyno, because it could be just endometrial atrophy, which sounds a bit depressing, really, but also there is a 10% - 15% it's cancer or pre-cancerous changes.  The good news is that if it is cancer, it's usually slow-growing (depending on the type of cell), and if that it hasn't gone through the uterine wall, a hysterectomy is the only required treatment, no chemo or radiation follow-on.

 

I saw the gyno last week, and go for an ultrasound next week.  From what I've read, if your endometrial wall thickness is less than 4 mm, there's a 99% chance that there's nothing else wrong, and you should be monitored, but that's it.  If it's greater than 4 mm, then something is probably wrong and further tests are required. 

 

Have any of you had any experience with this?

 

Here is some info I found from "Obstretrics and Gynocology International"  (link is after quote):

 

       Postmenopausal bleeding (PMB) can be defined as uterine bleeding occurring at least one year after menopause. PMB is a common clinical problem in both general and hospital settings [1, 2]. The incidence of spontaneously occurring PMB in the general population can be as high as 10% immediately after menopause [3].

 

       PMB is often caused by abnormalities of the endometrium, whether they are benign or malignant. Of postmenopausal women with vaginal bleeding, 10%–15% have endometrial carcinoma [48]. In contrast, the prevalence of endometrial polyps in patients with PMB and an increased endometrial thickness measured with transvaginal sonography (TVS) is estimated to be around 40% [9, 10].

 

       Endometrial cancer is the most common malignancy of the female genital tract in developed countries [11]. Unlike other malignancies, endometrial cancer often presents at an early stage when there is a possibility of curative treatment by hysterectomy. Survival decreases with increased staging and lower histological differentiation, thus accurate and timely diagnosis is important and should preferably be carried out by a safe, simple and minimally invasive method. Guidelines addressing PMB are therefore aimed at excluding cervical cancer, endometrial carcinoma or precancerous lesions of the endometrium. 

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821624/

 

 

{edited for typos}

Edited by Catnapper

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Posted · Report post

Did you ever find anything out? I have yet to go through official menopause. I'm still in the stage of missing a few months and then the periods start up again.

 

Hope all is well.

 

 

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My ultrasound showed a thickened endometrium, so I'm on three month's worth of progesterone to try to get it back to normal.  If the progesterone doesn't fix things, then I'll have to have additional tests and/or a hysterectomy.  Fun!  Hopefully the meds will work, but even if they do I guess I'll keep having to back for checkups a lot more often than I planned on when I hit menopause.  :glare:

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Well, at least they can do hysterectomies a lot less invasively than they used to.  It isn't the major surgery that it once was.

 

I hope the progesterone does the job.

 

I only go in once a year for a pelvic exam, but I had my hysterectomy when I was 48.  Sometimes it's okay to get rid of that uterus, particularly if it's giving you problems.

 

olga

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Well, at least they can do hysterectomies a lot less invasively than they used to.  It isn't the major surgery that it once was.

 

Yes and no.  If it's just a straight hysterectomy, they can do it laproscopically (sp?), and if there is cancer and it hasn't gone very deep into the uterus (starting from the inside), then it's probably relatively simple.  But if they suspect the cancer is deeper in the uterine wall and may have spread, they may open you up to have a good look around and sample lymph nodes.  Apparently that decision is sometimes made mid-operation depending on what they find from biopsies they do during surgery.

 

But we'll cross that bridge if and when we get there.  At this point I've read just about every article on PubMed about it, and am comfortable with the doctor's treatment plan at this point. 

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Won't they do an endometrial biopsy first?  I had abnormal bleeding a few months back (maybe closer to a year).  I had to have an ultrasound and then an endometrial biopsy.  They tried the biopsy once and evidently my cervix was shut down tight and the doc couldn't get the biopsy thingy (a technical term--lol) through my cervix to do the biopsy.  He gave me some pills to take so that my cervix would open and I went back a few days later and he was able to do the biopsy.  The biopsy was NOT fun.  Actually, it hurt like crap.  I took a pain pill beforehand but I should have taken it even earlier because it hadn't had time to work when he did the biopsy.  You might want to take something beforehand but as I recall, it can't be ibuprofen or aspirin because of the increased bleeding associated with those. 

 

Oh, and the biopsy was just fine.  I have a thinning of the skin due to the aromatase inhibitor I'm on (used to be Femara but switched recently to Arimidex).  Evidently a lack of estrogen can lead to a thinning of the skin.  Yet another wonderful thing they never tell you about getting old.  

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I had my uterus thinned out (ablation) maybe eight years ago ... was having heavy bleeding. They did it with a laser, I think. It wasn't that bad, felt like somebody had kicked me in the stomach, on and off for a few months. It did stop the heavy periods. Still had all my other lady plumbing intact ... anyway ... hope the medicine is all you need.

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Won't they do an endometrial biopsy first?  

 

They did a biopsy immediately following the bad ultrasound results, and although it came back negative, it was a "blind" biopsy, meaning that if there is a focal lesion, it may have been missed.  There's a probable polyp on the ultrasound, and it's likely that the biopsy didn't sample the probable polyp. 

 

If the follow-up ultrasound shows the lining is still thickened, then the next step will be a hysteroscopy where they put you under and look at the inside with a scope.  They can sample anything that looks odd at that time, including the polyp.

 

I can confirm that the endometrial biopsy hurt like hell!  I warned the doctor that I was going to cuss like a sailor, and then I did!  But at least it didn't last long.

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Catnapper, I had the same issues as you. How are you doing on the progesterone? I ended up having a complete laporascopic hysterectomy 6 months ago. No cancer but I was tired of all the tests and worrying.

I hope you get it all resolved soon.

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Some surgeons can do vaginal hysterectomies, they did while I was training (as a nurse).

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