Brief Answer:
Surgery done for persistent, unscheduled bleeding.

Detailed Answer:
Hi XXXX,
Thanks for writing in to us.

I have read through your query in detail.
Abnormal uterine bleeding in the perimenopausal age group as in the case of your mother is a concern.

Studies show that in perimenopausal patients, endometrial biopsy and other methods of detecting endometrial hyperplasia or carcinoma must be considered early in the investigation. This has already been done and the biopsy results are not conclusive for malignancy.

As per current medical practices, perimenopausal women may also be treated with low-dose oral contraceptives or medroxyprogesterone at first, if that can control the bleeding.

Suggested removal of uterus by abdominal or avginal hysterectomy may be necessary in patients who have failed or declined hormonal therapy, who have symptomatic anemia, and who are experiencing persistent, unscheduled bleeding.

While taking hormones can be discussed with her gynecologist, if there is severe bleeding and anemia then surgery is the best option.

Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Please attach old and new ultrasound scan reports.

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

As discussed earlier and with the current treatment practices, your doctor has rightly given MEPRATE (medroxyprogesterone) and this is routinely prescribed in patients like your mother.

It is good to know that her periods have stopped. She can continue taking it for a month and review with the doctor.

For surgery opinion, I would like to see the ultrasound reports (old and new) if you can attach it with your query.

This will let me study the findings in detail and then give you the best answer whether surgery is required urgently.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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Brief Answer:
Suggest ultrasound scan pelvis to know any increase in fibroid size.

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

I have taken look at the reports attached. There is a small fibroid and at that size it is unlikely to cause any problem. But since the scan in done in April 2014, if your mother were my patient, I would request another ultrasound scan at the moment to assess if the fibroid is growing fat. As six months are over and she is having bleeding, doing another ultrasound pelvis (trans abdominal or transvaginal) is justified. This will help to know if the fibroid has indeed grown in the last few months and causing bleeding as reported. Pending this ultrasound scan findings, a surgical treatment can be decided up on.

The endometrial thickness is at upper limits in last scan and it can again be measured for persistent increased values when doing ultrasound scan.

Hope your query is answered.
Do write back if you have any doubts.

Regards,
Dr.Vivek

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