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Q. I have postmenopausal vaginal discharge. Should I opt for a hysterectomy?

Answered by
Dr. Sanjay Kumar Bhattacharyya
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 13, 2017 and last reviewed on: Oct 09, 2018

Hi doctor,

I am a 52 year old female, who weighs 75 kg and I am 152 cm tall. I want to know whether we should opt for hysterectomy or not. I do not want to do a hysterectomy, as it may interfere with hormonal balance later. I have postmenopausal vaginal discharge, with a fair amount of red spots. What could be the cause?

I went through menopause 1.5 years back. I have type 2 diabetes, for which I take Glimepiride 1 mg, once daily. And I have hypothyroidism, for which I take Eltroxin, once daily. I was diagnosed with asymptomatic cholelithiasis, 15 years back. I have attached my ultrasound of the lower abdomen, transvaginal ultrasound, pap smear, and MRI pelvis reports.

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#

Hi,

Welcome to icliniq.com.

I have reviewed the reports (attachment removed to protect patient identity).

According to the reports, there is an increased thickening of the endometrium, which is the inner lining of the uterus. A thickness of more than 5 mm is considered abnormal and often considered as a predictor of cancer.

Those women who are diabetic, are more prone to spotting.

Your doctor had rightly directed for a hysterectomy. I assure you, at 52 years, there is no chance of hormonal imbalance following hysterectomy.

For more information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Hi doctor,

Thank you for your advice. One more thing, looking at the reports, there is no direct indication of any malignant growth. Would not biopsy detect any malignant growth? The sample would be taken from a particular place, if that place is free of malignant cells, the test will be negative. We have to attend a conference in a couple of months. Will it be fine to travel by flight for about 24 hours after the surgery? Or can the hysterectomy wait for two months? We are also planning to have the cholecystectomy simultaneously.

#

Hello,

Welcome back to icliniq.com.

You are right, looking at the reports (attachment removed to protect patient privacy) there is no conclusive evidence of malignancy. But, there are symptoms and reports which are early predictors of malignancy.

  • Modern medical science tries to pick the cases before they develop some irreversible damage. That is the reason we prefer a hysterectomy well in advance. As an example, 50 % women with postmenopausal bleeding develop a malignancy. So, you can be on either side of the 50 %.
  • Moreover, I do not ask for a biopsy here as you have thought, there might be skipped zones which often tell you a negative result, even if the biopsy is performed microscopically.
  • Lastly, you can fly for long hours after the surgery, depending on your general condition. It might take two weeks for recovery, after a laparoscopic or vaginal surgery.

For further queries consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Thank you doctor,

You have been very helpful. I think we will opt for LAVH. But, is hysterectomy advisable immediately, or we can do it after two months?

#

Hello,

Welcome back to icliniq.com.

The choice of the route of operation depends on various factors apart from your personal choice. There are some physical factors like obesity, the number of childbirth, route of childbirth, and associated diseases.

Secondly, a local examination is needed whether the uterus is low down or descended enough and suitable for a vaginal route. Often there is associated prolapse of bladder and bowel present, and that is better dealt by a vaginal hysterectomy.

Lastly, the surgeon's preference is the key. If after examining you, if he or she can feel vaginal route is acceptable, then will opt for it. Otherwise, just ask her whether LAVH (laparoscopically assisted vaginal hysterectomy) can be done. Postoperative recovery time and pain are usually same for both.

Finally, if you have an asymptomatic cholelithiasis, just ask your doctor whether it is feasible to evaluate the gall bladder by a general surgeon in the same sitting.

Is the spotting along with urination? Or it is a spotting from uterus? If it is from the uterus, she can start tablet Sevista (Ormeloxifene) 60 mg, twice a week, after consulting your doctor. Otherwise, repeat urine examination with culture sensitivity.

For further queries consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

Hi doctor,

After consulting many experts, we got three different views. First to carry out the hysteroscopy biopsy and D and C, in case of non-malignity we do not need to opt for hysterectomy even with the endometrial thickness of 9 mm. Second, remove the uterus and cervix, but keep the ovaries as ovaries produce 20%-30% of the required hormones even after menopause. Third, remove uterus and ovaries altogether and carry out the biopsy through the frozen section at the time of TLH. Please advise on the best option. What happens to hormone productions (even if it is 20%-30%) after removal of ovaries? If ovaries are removed, should I opt HRT?

#

Hi,

Welcome back to icliniq.com.

Already I have explained you all the options. The hysteroscopic biopsy cannot rule out either the possibility of missed areas or the development of cancer in future as she is a high-risk woman.

The 20% to 30% hormone production never occurs after menopause. Do you want to take the risk of development of ovarian cancer later from the left out ovaries? HRT is not a routine and only prescribed in rare instances if somebody develops symptoms.

There is no scope of frozen section biopsy in TLH (total laparoscopic hysterectomy).

Lastly, this is an advice from a gynecologist who is practically in the field. Keep it in mind, stop googling further and proceed accordingly. This operation has been advised not only for removing a diseased organ but also as this organ might turn malignant later, even if it is benign at present.

For further doubts consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist


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