Is MRI with contrast useful for endometrial issues?

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There is likelihood of serum progesterone deficiency. ET(endometrial thickness) 7.7 indicates a luteal phase defect and spotting indicates irregular shedding. Get a serum progesterone level test done. If low, then cyclical progesterone would have to be started.

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If you had your menses stopped for more than a year already since the age of 48, then you qualify for menopausal status. This is seconded by high FSH - follicle stimulating hormone levels. But, if this ultrasound report with endometrial thickness 5 mm was taken two months back when you had not started bleeding again, then still the thickness is high and more than 3 mm which should ideally be the thickness in menopausal case. Now, the estradiol levels are high potentiating the endometrial growth further and increasing the thickness to 6.7 mm now. But, in the absence of progesterone support there is an irregular shedding of whites, heavy and may contain clots as well. This is definitely postmenopausal bleeding and the possible cause here is not a perimenopausal stage. But, likely endometrial hyperplasia, which can preclude to endometrial cancer. It is very important to get an endometrial biopsy sample from the uterus in order to rule out any atypical cells which can be precancerous. There could be five reports of histopathology following endometrial biopsy:

1. Simple endometrial hyperplasia without atypia, need progesterone therapy.
2. Simple endometrial hyperplasia with atypia, need a hysterectomy.
3. Complex endometrial hyperplasia without atypia, cyclical progesterone if in reproductive age group, but hysterectomy in menopausal women.
4. Complex endometrial hyperplasia with atypia, precancer and definite hysterectomy.
5. Adenocarcinoma uterus, cancer requires staging and total abdominal hysterectomy with removal of both tubes and ovaries as in menopausal women. Then further treatment based on the histopathology report of the surgical sampling.

So, you should not take it lightly and get an endometrial biopsy done soon. It is a painless office procedure and at the same time you may get a pap smear done as well in the same sitting to rule out any cervical atypia as well.

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Welcome back to icliniq.com.

MRI does not actually comment on endometrial thickness and the tumor markers were done for the possibility of an ovarian cancer. But, our concern is endometrial or uterine cancer, which may not cause a change in the size and shape of uterus unless there is myometrial invasion. As there is a definite increase in endometrial thickness considering your postmenopausal status and unfortunately or fortunately endometrial biopsy would have to be done for histopathology. This is an invasive procedure, but nowadays can be done with pipelle, which gives it the advantage of an office procedure and that too without any need for anesthesia. You should not be wasting your time further and get investigated sooner.