Brief Answer: You need a larger work up... Detailed Answer: Thank you for the question! Did your doctor recommend a biopsy of the uterine lining? Thank you!

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Brief Answer: thank you for the followup information! Detailed Answer: The definition of menopause is no period for one year. Your bleeding should be considered post menopausal bleeding. In most cases this is related to a thinning of the uterine lining and certainly in your case this could be exacerbated by the fibroids. The standard work up includes an exam, an ultrasound and an endometrial biopsy. The biopsy is important to rule out pre-cancerous changes that are also a cause of post menopausal bleeding. While this is uncommon, it is obviously important to rule out. Any lining over 4 mm should be biopsied. I would not be too concerned and also know that this is a relatively painless procedure. Does this help?

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Brief Answer: Thank you for the followup! Detailed Answer: I think that the biopsy with the GP doctor is appropriate. They are supposedly at a Womens Health Center where these must be done with some regularity. Also, she would not have offered if she was not comfortable with this common procedure. I believe, though, that her explanation of the thickened lining is not correct. It has been about one year since you went through menopause. You are basically not producing much estrogen or progesterone at all. Certainly the expectation is that you are not producing enough to cause uterine bleeding. So, the explanation for the bleeding is related to: 1. Atrophic changes (thinning of the lining) related to the LACK of hormones 2. The uterine fibroid near the lining 3. Possible a polyp within the uterine lining I would go ahead with the biopsy but I would also request the GYN consult anyway regarding counseling and long term management. Please turn here for clarification and education! Thank you.

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Brief Answer: Thanks for the followup... Detailed Answer: I am sorry about the delay. It is not unusual for women to turn to this site for clarification of a problem or with questions about current management. It is not uncommon to get a poor explanation of a problem from your doctor. It is unfortunate but true. Much of what we do here is "clarification and education". I am not trying to manage your health issues, but rather helping to provide clarity. I have no idea why she wants you to use vaginal estrogen pills. Maybe she thinks that you will tolerate the exam better?? It is really not indicated, and in fact, until your abnormal bleeding is sorted out, it is probably best not to give you any hormones. Vagifem is simply used for vaginal atrophy, or thinning of the vaginal lining that occurs after menopause. You sound like you were not complaining about symptoms related to vaginal atrophy, so I am not really understanding why they are recommending this medication. It would be very reasonable to finish out the workup of the abnormal bleeding and THEN have the discussion about vagifem. Do you have any questions?

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