Dear Dr.

I am so glad I found you website. I am struggling with adecision whether or not I should go for a hysterectomy and really happy that Ican ask your advise from this website. Thank you so much for offer such greatservices. It is so thoughtful.

Here is my history. I was always bleeding since my first period. In2002, I was diagnosed as endometrial hyperplasia with atypia. Becauseof my strong desire to have a baby, my Dr. put me on progesterone treatment and wasfollowed up by D & Cs and biopsies. After many months on 200mg progestrone , the hyperplasia was controlled but as long as I was not on progestrone, I would bleeding irregular again. Iwas monitored very closely in the past years with biopsy and D & Cs. The sample of endometrium of those biopsies showed complex hyperplasia a few times, simple hyperplasia a few times and the best time was Proliferative endometrium. None of them with atypia. Meanwhile, I was struggled with fertility treatment. I was pregnant from my 3rd IVF cycle in 2007but sadly lost my twin babies at 20 month due to prelabour. I kept bleeding after delivery and a biopsy 4 months later showed complex hyperplasia without atypia. In 2009, I did mylast IVF cycle and that results my daughter. Again, I kept bleeding after delivery.A biopsy at 2 month check up after delivery showed complex hyperplasia again no atypia. I was then put on prometrium but a oncologist suggest a D & C . I stopped prometrium right away and did the D & C a week after. Since i only stopped prometrium for about a week, the results should be distorted. The results showed no hyperplasia at all. My Dr. was not sure how much the prometrium might have distort the results. Anyway, as no hyperplasia was found in D & C, I was put on Marina IUD to prevent it. I kept spotting for 5 months after that. I asked for a biopsy so they took off the IUD and did a biopsy in the same day. Results shows no hyperplasia and my lining responsed to the drug from IUD well. But again, I am worried that doing a biopsy at the same day that IUD is off may covered the real situation of my uturs. I am not sure if i should make a decision based on that biopsy result. It was a year ago.
Anyway, I was then put in another IUD. This time I kept spotting for 9 month. even now, the continue spotting stopped 3 months ago, but I still have spotting for a day or two sometimes.
My Dr. said it may because I am a little person and the progestrone supplied by IUD is too large dose for me. Since I am done with having more baby, My Dr. gave me two options:

1: continue prevent hyperplasia with IUD. They said theoretically it should work but no 100%guarantee. Bad side is they can't do a regular biopsy check up with a IUD in.

2: hysterectomy.

I am 41 this year. My last biopsy was a year ago ( when they took off the first IUD), the result showed no hyperplasia. In your opinion, shall I do a hysterectomy? Is IUD proved work well for control hyperplasia? Is it normal to spotting that long with IUD ?

Sorry for the longmail. Thank you so much for your time and again I really appreciate yourthoughtful service. I am looking forwardto hear from you.