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Should Hysterectomy Be Done For Fibroids And Irregular Periods?

Posted on Wed, 5 Mar 2014

Question: Hello Doctor, Im 52 yrs old. I have very large fibroids. In May 2013 I had FSH value 28.1. In Feb 2014 the FSH was 53 (two days ago). In between Ive been having normal periods, with 30 days gap average, with 2 times 40 days and the last on 9th Feb almost no flow of blood. One doctor says I have to have immediate hysteroscopy since the echogenic endometrial lining has changed from 1mm to 9.7 mm from May 2013 to Feb 2014. They said hysterectomy can be delayed since no symptoms except negligible bladder misfunction from thin to normal flow of urine on and off. Another doctor said everything is normal for the menopausal age and I need not do hysteroscopy. What do I make of this ? is it an emergency or not ? Please help. Thanks a lot I forgot to add that I had spotting in between periods for 5 months from end 2012 to mid 2013. The spotting was very little after 10 or 12 days of periods start. Thanks

Answered by Dr. Rhea Chanda (30 minutes later)

Brief Answer: not immediate emergency Detailed Answer: Hello XXXXXXX the fsh value has increased because you are indeed peri menopausal. Thats is why you are having irregular periods. The main concern here is your endometrial thickness. Since you have been bleeding on and off, your ET cannot be less than 5mm. The time the ultrasound was done is important. If it was done before a bleeding episode, it would indeed be more. Repeat the scan just after your period. On day 6/7 of the cycle. Only if its more than 4mm, a d/c is advised. I dont think a hysteroscopy is needed, immediately, at least while you are still having periods regularly. You are peri menopasual so irregularity will occur until complete menopause is achieved. Hystrectomy will depend on symptoms and size of fibroids.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rhea Chanda (1 hour later)

Thank you very doctor for your quick response. The other doctor's argument was as follows: she told me: 'you had fsh value 0n XXXXXXX 1 2013 at 51.5 yrs as 28.1 and ET measuring 1mm. (this value was taken between the following period dates: period start date 13/5/13, spotting after 12 days very little though on 25/5/13 and next period start on 13/6/13.) you entered postmenopausal state with this value. Then your periods should have stopped. But instead you had periods for another 8 months with the fsh value shooting to 53 on 9 th feb, when almost no bleeding was there at last and your ET shot up to 9.7 mm. This is an emergency. You have to do hysteroscopy' After this I got alarmed and went to another hospital this morning and that doctor said: no alarm. 9.7 mm is not excessive, no need of hysteroscopy. Please give me your reactions in the light of these facts. I can do another scan, but the last period after a 45 day gap was almost nil on 9 feb and today it is already 6th day after that. Thank you very very much doctor for your objective help. Kind regards XXXX

Answered by Dr. Rhea Chanda (5 hours later)

Brief Answer: wait and watch Detailed Answer: Well firstly , menopause is a transition phase . It doesn't occur in 1 day . It takes time to achieve complete menopause even upto 2 years . In your case rising fish values indicate that you are not yet in complete menopause. Cycles also don't stop suddenly . It becomes irregular and eventually without a period for at least 6 months we can assume menopause is achieved . In your case i would agree with your second doctor and would like to repeat a scan before hysteroscopy . The ET doesn't diminish in your1 day either . Once your hormone levels are steady then there will happen be no more endometrial thickening . I think you may still bleed hence your lining is thicker . 9mm is normal for a mentruating women . I suggest your wait and watch . Repeat the ultrasound after 2 months if there is no bleeding , or immediately after menstruation occurs . Then if the ET is above normal a hysteroscopy can be done .

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rhea Chanda (17 hours later)

Dear Dr. XXXXXXX thank you for your comprehensive approach. Since I found your answer very good, I permit myself to upload my typed out reports for your perusal since I was not able to upload the jpg files. This morning I took the ET measurements and it is 14 MM ! (after very spotty period on Feb 9th after a gap of 6 weeks) My question now is: since you said in the 1st message after ET of 4mm generally one has to do D and C and in the second message you said it is normal to have 9 mm for pre-menopausal stage, and then you had asked me to do ET measurement two months after bleeding stops. Should I do the D and C now with value 14 mm or is it normal in the light of my reports and pre-menopusal condition ? Should hysteroscopy be avoided given the nature of multiple fibroids. Please advise, I really value your judgment ! Thanks a lot once again. XXXX

Answered by Dr. Rhea Chanda (46 minutes later)

Brief Answer: clarification Detailed Answer: Madam let me clarify few points . First , according to the initial scan done XXXXXXX 2013 the ET is 1. 0cm in the text but says 0. 1cm (1mm) in the final summary . I believe it's could be be be an error in typing and the actual ET is indeed 1. 0cm . In then next scan done DEC 2013 ET is measuring 9.7mm . Both are ok while you are still menstruating . As you have said you haven't had a proper period in the last months except some spotting . Hence the endometrial lining will be thickened . I believeyou will bleed again . Your rising fish levelindicate that you are peri menopausal and levels may increase until you gain complete menopause and then remain steady . 6 months ago your fsh indicated the start of menopause . I still think you can wait and watch until you achieve menopause completely and then check ET . Post menopause ET should be less than 4mm . Another point to note here is that you have significant sized fibroids which may need surgery . Some may cause pressure effects . Hysteroscopy can be done but in some large fibroids may cause difficulties . It will depend on surgical skill . As your the hysteroscopy , you can do it if you wish . There is no contraindication .

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rhea Chanda (31 minutes later)

Yes doctor, the ET in the first report is indeed 1 cm. Sorry for the typing error. I'm really alarmed at the doctor who made it seem like an emergency. For her high ET is bas without taking into consideration all the variations, permutations and combinations of all the factors that govern my present condition. I plan to put off hysterectomy for 6 months for fibroids. In the meantime it was a question of avoiding any emergency regarding the ET thickening. So I can safely put off hysterctomy for 6 months, no? In the meantime I want to try a homeopathy medicine called Sepia given to me by an experienced French doctor. She said it is very effective. Pl answer this last question, I'll be rest assured. Again very good comprenhensuve analysis, thank you very much doctor. Best regards. XXXX

Answered by Dr. Rhea Chanda (20 minutes later)

Brief Answer: homeopathy Detailed Answer: You can indeed try homeopathy if you want . I'm not qualified to comment on it's efficacy . In the meantime maintain a menstrual calendar to note your bleeding pattern . If you have no bleeding in 6 mths then repeat the scan . No problem delaying the hysterectomy if asymptomatic . Start calcium supplements .

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar