
Dr. XXXXXXX I AM IN NEED OF YOUR HELP AGAIN.

I AM IN NEED OF YOUR HELP AGAIN. I'M SO CONFUSED RIGHT NOW. JUST A LITTLE RECAP.
I HAD A VAGINAL ULTRASOUND ON 10/20/20 AND IT REVEALED THAT MY ENDOMETRIUM LINING WAS 12.0 MM. ENDOMETRIUM IS UNREMARKABLE. SMALL SOLITARY SUBMUCOSAL FIBROID IN THE FUNDUS WHICH MEASURES 1.7 X 1.6 X 1.5 CM.
I had the biopsy on 11/3/20 IN THE DR OFFICE and the finding FROM THE LAB were: SCANT PROLIFERATIVE ENDOMETRIUM. MINUTE FRAGMENTS OF BENIGN ENDOCERVICAL AND SUPERFICIAL SQUAMOS EPITHELIUM, BLOOD, AND MUCUS.
I GUESS SCANT MEANS LITTLE MEANING THE DOCTOR DID NOT GET ENOUGH TISSUE. I DON'T KNOW.....
TODAY I HAD ANOTHER VAGINAL ULTRASOUND ON 11/24/20 AND IT REVEALED: MY ENDOMETRIM MEASURES 17 MM. SUBMUCOSAL FIBROID IS PRESENT WITHIN THE ENDOMETRIAL CAVITY, MEASURING 1.7 X 1.5 X 1.5 CM.
HOW CAN THIS BE? WHAT DOES ALL THIS MEAN? THE DOCTOR IS STATING THAT I NEED TO HAVE A D AND C AND DO A TOTAL CLEAN OUT AND RULE OUT ANY DOUBTS OF WHY MY ENDOMETRIUM LINING IS STILL GETTING THICKER AND RULE OUT CANCER. WHAT DO YOU THINK COULD BE GOING ON? I REALLY DO NOT WANT TO BE PUT TO SLEEP OR HOSPTALIZED NOW DURING COVID OR GO THROUGH SURGERY. HOW LONG IS THE RECOVERY IF NEEDED? IS THERE ANYTHING ELSE THAT I CAN DO TO RULE OUT CANCER?

I AM IN NEED OF YOUR HELP AGAIN. I'M SO CONFUSED RIGHT NOW. JUST A LITTLE RECAP.
I HAD A VAGINAL ULTRASOUND ON 10/20/20 AND IT REVEALED THAT MY ENDOMETRIUM LINING WAS 12.0 MM. ENDOMETRIUM IS UNREMARKABLE. SMALL SOLITARY SUBMUCOSAL FIBROID IN THE FUNDUS WHICH MEASURES 1.7 X 1.6 X 1.5 CM.
I had the biopsy on 11/3/20 IN THE DR OFFICE and the finding FROM THE LAB were: SCANT PROLIFERATIVE ENDOMETRIUM. MINUTE FRAGMENTS OF BENIGN ENDOCERVICAL AND SUPERFICIAL SQUAMOS EPITHELIUM, BLOOD, AND MUCUS.
I GUESS SCANT MEANS LITTLE MEANING THE DOCTOR DID NOT GET ENOUGH TISSUE. I DON'T KNOW.....
TODAY I HAD ANOTHER VAGINAL ULTRASOUND ON 11/24/20 AND IT REVEALED: MY ENDOMETRIM MEASURES 17 MM. SUBMUCOSAL FIBROID IS PRESENT WITHIN THE ENDOMETRIAL CAVITY, MEASURING 1.7 X 1.5 X 1.5 CM.
HOW CAN THIS BE? WHAT DOES ALL THIS MEAN? THE DOCTOR IS STATING THAT I NEED TO HAVE A D AND C AND DO A TOTAL CLEAN OUT AND RULE OUT ANY DOUBTS OF WHY MY ENDOMETRIUM LINING IS STILL GETTING THICKER AND RULE OUT CANCER. WHAT DO YOU THINK COULD BE GOING ON? I REALLY DO NOT WANT TO BE PUT TO SLEEP OR HOSPTALIZED NOW DURING COVID OR GO THROUGH SURGERY. HOW LONG IS THE RECOVERY IF NEEDED? IS THERE ANYTHING ELSE THAT I CAN DO TO RULE OUT CANCER?
endometrial thickness
Detailed Answer:
Hello,
I don't think there is any need for a repeat endometrial biopsy as 17 mm is still an accepted endometrial thickness considering that your previous office biopsy didn't show any hyperplasia or atypia ruling out cancer completely. Also , the submucosal fibroid size is the same and hence i would not be concerned about it at present. If you are not bleeding in excess per vaginum apart from your menses ( which is normal ), then there is no apparent need for any intervention.
However in near future, hysteroscopic myomectomy can be planned if excessive bleeding or menorrhagia is an issue in future.
Regards

endometrial thickness
Detailed Answer:
Hello,
I don't think there is any need for a repeat endometrial biopsy as 17 mm is still an accepted endometrial thickness considering that your previous office biopsy didn't show any hyperplasia or atypia ruling out cancer completely. Also , the submucosal fibroid size is the same and hence i would not be concerned about it at present. If you are not bleeding in excess per vaginum apart from your menses ( which is normal ), then there is no apparent need for any intervention.
However in near future, hysteroscopic myomectomy can be planned if excessive bleeding or menorrhagia is an issue in future.
Regards


Are you understanding what I'm saying exactly? They are trying to say that there was not enough tissue sent to the lab to evaluate because the finding is saying SCANT which means too little to give a definitive answer. I am very confused and why would my lining be 17mm now when on 10/20/20 it was only 12 and why do you say 17 is within normal range???? So, if 17 is normal than what the heck is abnormal???? These doctors here claim that this is alarming for a woman that is 53 years old to have had bleeding for 3 days like a period not real heavy but still blood and a lining of 12 at the time but now a lining of 17? All of my previous ultrasound showed less than 4mm so now once again how can 17 be acceptable???? What should I be asking these doctors because it seems like they just want me to go into the ER of surgical site to have hysterscopy and a D and C to rule out endometrium CANCER! I REALLY DON'T KNOW WHAT TO DO AND WHAT'S THE RIGHT ANSWER TO MY QUESTION??? I NEED IT TOTALLY EXPLAINED TO ME BECAUSE I HAVE A MEETING WITH THE DOCTOR TOMORROW AND I NEED TO KNOW WHAT TO ASK AND SAY TO SEE WHAT THEY SAY ABOUT SURGERY.... PLEASE THOROUGH EXPLAIN WHAT I NEED TO SAY OR DO WITH LOGIC.
THANKS!

Are you understanding what I'm saying exactly? They are trying to say that there was not enough tissue sent to the lab to evaluate because the finding is saying SCANT which means too little to give a definitive answer. I am very confused and why would my lining be 17mm now when on 10/20/20 it was only 12 and why do you say 17 is within normal range???? So, if 17 is normal than what the heck is abnormal???? These doctors here claim that this is alarming for a woman that is 53 years old to have had bleeding for 3 days like a period not real heavy but still blood and a lining of 12 at the time but now a lining of 17? All of my previous ultrasound showed less than 4mm so now once again how can 17 be acceptable???? What should I be asking these doctors because it seems like they just want me to go into the ER of surgical site to have hysterscopy and a D and C to rule out endometrium CANCER! I REALLY DON'T KNOW WHAT TO DO AND WHAT'S THE RIGHT ANSWER TO MY QUESTION??? I NEED IT TOTALLY EXPLAINED TO ME BECAUSE I HAVE A MEETING WITH THE DOCTOR TOMORROW AND I NEED TO KNOW WHAT TO ASK AND SAY TO SEE WHAT THEY SAY ABOUT SURGERY.... PLEASE THOROUGH EXPLAIN WHAT I NEED TO SAY OR DO WITH LOGIC.
THANKS!
endometrial hyperplasia
Detailed Answer:
Hello,
The facts are as follows:-
1. You are 53 years old and in your perimenopausal age group when in most women menses stop by now or they reach menopause. If you have been still menstruating which you have not mentioned, then 17 mm would label as you being in secretory phase of your cycle. But if you have been labelled as perimenopausal with side symptoms of hot flushes, joint pains and vaginal dryness then 17 mm thickness of endometrium is alarming.
2. 17 mm would then call for a repeat endometrial biopsy , which can be done in office itself with the help of a pipelle and you need not get admitted for the same during COVID these days. But yes a repeat biopsy would be required now for histopathology examination to rule out hyperplasia with or without atypia.
3. It is very difficult to comment on as to why now you have suddenly increased endometrium of 17mm this time but now that the usg finds so, it cannot be denied. This calls for a repeat endometrial biopsy for sure. And yes, the aim is to rule out the worst which could be endometrial cancer. Hence please get it repeated.
Regards

endometrial hyperplasia
Detailed Answer:
Hello,
The facts are as follows:-
1. You are 53 years old and in your perimenopausal age group when in most women menses stop by now or they reach menopause. If you have been still menstruating which you have not mentioned, then 17 mm would label as you being in secretory phase of your cycle. But if you have been labelled as perimenopausal with side symptoms of hot flushes, joint pains and vaginal dryness then 17 mm thickness of endometrium is alarming.
2. 17 mm would then call for a repeat endometrial biopsy , which can be done in office itself with the help of a pipelle and you need not get admitted for the same during COVID these days. But yes a repeat biopsy would be required now for histopathology examination to rule out hyperplasia with or without atypia.
3. It is very difficult to comment on as to why now you have suddenly increased endometrium of 17mm this time but now that the usg finds so, it cannot be denied. This calls for a repeat endometrial biopsy for sure. And yes, the aim is to rule out the worst which could be endometrial cancer. Hence please get it repeated.
Regards


I am in a very confused situation right now. I went to my new doctor today and showed her All of the paperwork from the other dr and the 2 other ultrasounds that showed 12 and 17 mm for the endometrium lining. Well, she looked them over but she wanted to do her own ultrasound in her office being that she is a FACOG . She conducted it and said that my lining is measuring at less than 4mm today. I told her I'm totally confused! She even had the tech look at it and she stated about the same thing as 4mm. Now, I'm totally confused because the other ultrasounds were done at the radiology imaging office. Can this really be?? How would you handle this situation????
The new doctor course of action moving forward is to: to see me back on December 28 at 10:15am which would be in 1 month. At that time the ultrasound will be repeated and monitor endometrium and fibroid. If I should start bleeding at any time she wants to know to prepare me for a hysteroscopy. What do you think is going on with me? I'm devastated now because I'm so confused. I don't want to wait to late and find out that I could be dying from endometrium cancer and could have done something to be proactive. I was believing that those number were accurate and thinking I started off with 12mm and then after her doing the biopsy the number went to 17mm and I felt the numbers increased because the biopsy aggravated something inside of me. Does that make sense?
What are actually the signs of endometrium cancer? Everyone wants to believe this could be hormone related. I just don't know enough medically to know what I should or should not be doing now? I'm scheduled to have a pap smear done next week. Would that possible show anything?
What do you feel should be my next move at this point??? Thanks for being a listening ear.

I am in a very confused situation right now. I went to my new doctor today and showed her All of the paperwork from the other dr and the 2 other ultrasounds that showed 12 and 17 mm for the endometrium lining. Well, she looked them over but she wanted to do her own ultrasound in her office being that she is a FACOG . She conducted it and said that my lining is measuring at less than 4mm today. I told her I'm totally confused! She even had the tech look at it and she stated about the same thing as 4mm. Now, I'm totally confused because the other ultrasounds were done at the radiology imaging office. Can this really be?? How would you handle this situation????
The new doctor course of action moving forward is to: to see me back on December 28 at 10:15am which would be in 1 month. At that time the ultrasound will be repeated and monitor endometrium and fibroid. If I should start bleeding at any time she wants to know to prepare me for a hysteroscopy. What do you think is going on with me? I'm devastated now because I'm so confused. I don't want to wait to late and find out that I could be dying from endometrium cancer and could have done something to be proactive. I was believing that those number were accurate and thinking I started off with 12mm and then after her doing the biopsy the number went to 17mm and I felt the numbers increased because the biopsy aggravated something inside of me. Does that make sense?
What are actually the signs of endometrium cancer? Everyone wants to believe this could be hormone related. I just don't know enough medically to know what I should or should not be doing now? I'm scheduled to have a pap smear done next week. Would that possible show anything?
What do you feel should be my next move at this point??? Thanks for being a listening ear.


follow up...
Detailed Answer:
Hello,
I am really surprised at the varied usg reports for endometrial thickness . I would like to see the reports in person.
Also i am of the opinion that as you have been on hormonal contraception till october, there are chances that endometrial thickness may have been increased under progesterone effect but it usually reduces after a withdrawal bleed or menses. If the present usg is after the withdrawal bleed and is 4mm endometrial thickness , then you have entered the menopausal range.
Anyhow, please send the usg reports for review .
Regards

follow up...
Detailed Answer:
Hello,
I am really surprised at the varied usg reports for endometrial thickness . I would like to see the reports in person.
Also i am of the opinion that as you have been on hormonal contraception till october, there are chances that endometrial thickness may have been increased under progesterone effect but it usually reduces after a withdrawal bleed or menses. If the present usg is after the withdrawal bleed and is 4mm endometrial thickness , then you have entered the menopausal range.
Anyhow, please send the usg reports for review .
Regards


I had been on "Activella" hormone contraception since 8/2018 and had a normal pap and mammogram in 2019. I started the bleeding on 10/18/20 until 10/22/20. I had the 1st ultrasound done on 10/20/20 that said 12.0 mm. I had the biopsy did in the office on 11/3/20 and report back on 11/11/20 . Keep in mind the doctor that performed my biopsy never took an ultrasound for verification. She just went with what the imaging report stated. She did say after the biopsy that I don't think we have enough tissue for a great comparison to send to the lab but we will send what we have. Then I said, what do you mean? She then replied for your endometrium lining to be 12mm, i should have been able to get more tissue. Now, that I'm thinking back over what exactly happened. Anyway, I stopped "Activella" on November 3rd same day as biopsy. I had another ultrasound done at the same previous imaging office on 11/24/20 that said my lining was now at 17 mm. I went in to see my new gynecologist "FACOG" she reviewed all my results but said she wanted to complete her own ultrasound there in the office and she said my endometrium lining is coming in little less than 4 mm. I repeated back to her are you sure and she said look and showed me the monitor and an area that look white like a line to me but said there is no way this could be 12 or 17 mm and then the assistant said maybe they were measuring your fibroid in the measurement or something. Everyone was baffled and of course, I was left with even more confusion. For some reason my computer will not allow me to upload the reports. Do you have another email that I can load them to you under? This happened to me before as well. I want you to see them desperately but it won't allow me to send. I'll keep trying if you don't send me another email. Thanks again, for everything!

I had been on "Activella" hormone contraception since 8/2018 and had a normal pap and mammogram in 2019. I started the bleeding on 10/18/20 until 10/22/20. I had the 1st ultrasound done on 10/20/20 that said 12.0 mm. I had the biopsy did in the office on 11/3/20 and report back on 11/11/20 . Keep in mind the doctor that performed my biopsy never took an ultrasound for verification. She just went with what the imaging report stated. She did say after the biopsy that I don't think we have enough tissue for a great comparison to send to the lab but we will send what we have. Then I said, what do you mean? She then replied for your endometrium lining to be 12mm, i should have been able to get more tissue. Now, that I'm thinking back over what exactly happened. Anyway, I stopped "Activella" on November 3rd same day as biopsy. I had another ultrasound done at the same previous imaging office on 11/24/20 that said my lining was now at 17 mm. I went in to see my new gynecologist "FACOG" she reviewed all my results but said she wanted to complete her own ultrasound there in the office and she said my endometrium lining is coming in little less than 4 mm. I repeated back to her are you sure and she said look and showed me the monitor and an area that look white like a line to me but said there is no way this could be 12 or 17 mm and then the assistant said maybe they were measuring your fibroid in the measurement or something. Everyone was baffled and of course, I was left with even more confusion. For some reason my computer will not allow me to upload the reports. Do you have another email that I can load them to you under? This happened to me before as well. I want you to see them desperately but it won't allow me to send. I'll keep trying if you don't send me another email. Thanks again, for everything!

Thanks again

Thanks again
follow up
Detailed Answer:
Helo,
I am sorry but i don't see your reports having been uploaded. kindly upload them for review please. I cannot see it on my query dashboard. Can you send the reports at YYYY@YYYY and address it to my name: Dr Sameer Kumar
Regards

follow up
Detailed Answer:
Helo,
I am sorry but i don't see your reports having been uploaded. kindly upload them for review please. I cannot see it on my query dashboard. Can you send the reports at YYYY@YYYY and address it to my name: Dr Sameer Kumar
Regards





follow up
Detailed Answer:
Hello,
I have gone through the reports.
The latest usg of 4mm ENDOMETRIAL THICKNESS IS SEEN AS YOU said that you have been told verbally.
1. the biopsy report completely rules out any chances or evidence of endometrial cancer in your case at present as the endometrium received for biopsy was proliferative and its normal to receive proliferative endometrium in cases which care not ovulating like peri or post menopausal age group.
2. the apparent rise in endometrial thickness remains unexplained. I too am of the opinion that the presence of submucousal fibroid can be possibly read as part of endometrium thickness by a radiologist ( again the angle of the probe matters).
If the last scan was transvaginal and shows 4mm then there are all chances that 4mm is the correct endometrial thickness.
Regards

follow up
Detailed Answer:
Hello,
I have gone through the reports.
The latest usg of 4mm ENDOMETRIAL THICKNESS IS SEEN AS YOU said that you have been told verbally.
1. the biopsy report completely rules out any chances or evidence of endometrial cancer in your case at present as the endometrium received for biopsy was proliferative and its normal to receive proliferative endometrium in cases which care not ovulating like peri or post menopausal age group.
2. the apparent rise in endometrial thickness remains unexplained. I too am of the opinion that the presence of submucousal fibroid can be possibly read as part of endometrium thickness by a radiologist ( again the angle of the probe matters).
If the last scan was transvaginal and shows 4mm then there are all chances that 4mm is the correct endometrial thickness.
Regards



follow up
Detailed Answer:
Hello,
i don't think that you need to be worried at all regarding cancer or even endometrial hyperplasia, as i see that you are undergoing a natural transition towards your menopause. Please don't start on any hormonal pills hence and to keep the perimenopausal symptoms at bay, try incorporating natural estrogenic foods in your diet like alpha sprouts, tofu, flax seeds or soybeans.
I don't have an experience with saw palmetto, so really cannot make a comment over it.
And yes , a repeat transvaginal is a good idea with a patient radiologist :)
Regards

follow up
Detailed Answer:
Hello,
i don't think that you need to be worried at all regarding cancer or even endometrial hyperplasia, as i see that you are undergoing a natural transition towards your menopause. Please don't start on any hormonal pills hence and to keep the perimenopausal symptoms at bay, try incorporating natural estrogenic foods in your diet like alpha sprouts, tofu, flax seeds or soybeans.
I don't have an experience with saw palmetto, so really cannot make a comment over it.
And yes , a repeat transvaginal is a good idea with a patient radiologist :)
Regards


Thanks!

Thanks!
follow up
Detailed Answer:
Hello,
In my opinion, there is no apparent nee to be on any medication as such for menopause. Wait for next 3 months without any medications and as such when the endometrial thickness is 5mm , it is evident that you are into perimenopausal status.
In case you bleed, you can opt for antifibrinolytics to control bleeding.
Regards

follow up
Detailed Answer:
Hello,
In my opinion, there is no apparent nee to be on any medication as such for menopause. Wait for next 3 months without any medications and as such when the endometrial thickness is 5mm , it is evident that you are into perimenopausal status.
In case you bleed, you can opt for antifibrinolytics to control bleeding.
Regards

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