Dr. Dattaprasad Balasaheb Inamdar
Obstetrics and Gynecology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had induced abortion three months ago and had a transvaginal US. It showed everything was normal and the endo lining was 8 mm and the uterus looked closed. I cannot find that report, but I know the uterus looked normal, just like on all my previous reports. I had my periods regularly for the next two months. I think I ovulated both times because I had all the signs and the temperature rise. Both periods were quite heavy and last one was a bit more on the hemorrhagic side, but not something to worry. I just noticed, it was more abundant and red than my normal and also less crampy and painful. No spotting or any other irregularities. Yesterday, cycle day 11, I went for an ultrasound to monitor my follicles and incidentally the doctor saw something in my endometrial lining, which she assumed was a polyp. The endo lining was 12 mm. I have attached images for your reference. The doctor was not worried about it, since it was so soon after the late abortion and she said maybe it will go away on its own and wait for two to three months. Although she said if it is a polyp then it will not go away. So, I am confused. Anyway, I have become very stressed over this, worrying that it is endometrial cancer and why else would a polyp grow so much and so quickly in just seven to eight weeks. On all my ultrasounds in the last years, no polyp was ever found or suspected and the image never looked like this.
I am wondering how serious and worrisome for cancer this looks. Should I push for a hysteroscopy? I know that if it is cancer, I am going to lose my uterus and ovaries and never going to have a baby and I am terrified this will be the case. And I have read that up to 4 % of endometrial polyps are cancer. My bad luck seems to never end. Also, could it be something other than an endometrial polyp, such as a placental polyp or a blood clot or a placental site nodule? I read about those online. I have taken a home pregnancy test and it was negative. So, I do not have much HCG in me anymore and I also ovulated normally and have a dominant follicle right now waiting to ovulate. I am just surprised that it is so soon after the miscarriage. Can you let me know your opinion? What does it look like to you on the ultrasound pictures? What should I do next?
Hi,
Welcome to icliniq.com.
From the ultrasound picture (attachment removed to protect patient identity) you have provided, it does not look like polyp in endometrium. In fact it looks like some collection such as fluid or blood in endometrial cavity, although the appearance of single static film can be deceiving. Polyp normally looks more hyperechoic (whitish). Even if it is polyp, there is no need to worry as many polyps come and go with menstrual bleeding and as you said there is 96 % chance of it not being cancer. I always like to look on positive side. So, there is no need to hurry for hysteroscopy.
Chance of polyp being endometrial cancer is very low especially if it occurs after abortion or childbirth as your endometrium had more than sufficient exposure to progesterone to prevent cancer. If you are feeling physically fit to carry pregnancy and of course if hemoglobin has come back to normal, there is no contraindication for conception. But, my recommendation would be to wait for at least one more month. If polyp is seen again in next midcycle scan, we can plan hysteroscopy in future and there is no need to think about it right now.
Patient's Query
Hi doctor,
Thank you for the quick reply. I have one more question. If this is a fluid collection, is not that an indicative of malignancy? Can a regular polyp or other benign process cause such fluid collection? Please check the image I have attached which I got in internet and look similar to my condition. It turns out as endometrial cancer. This made me very apprehensive. I just want to know whether I can have a fluid collection and/or a polyp without it being related to cancer. Thank you again.
Hi,
Welcome back to icliniq.com.
I had seen the pictures (attachment removed to protect patient identity). There are few points which should be of your interest.
In case of endometrial cancer, endometrial thickness would almost always be more than normal. The polyps shown in images are hyperechoic, which is not in your case. Endometrial cancer does not arise out of blue normally. There are predisposing risk factors like chronic anovulation, diabetes, obesity, family history and sometimes associated colon cancer. I do not think most of them are present in your case.
In addition, you had five months of exposure to progesterone during pregnancy (both endogenous and exogenously supplemented) which is sufficient to take care of early stage cancer. All these factors go against possibility of endometrial cancer in your case. Still, we are going to follow polyp or fluid collection by doing ultrasound in next cycle. Ultrasound recommended on day two to three of menses and once more in mid-cycle). If both ultrasounds come normal, endometrial polyp and cancer is almost ruled out. Even when it comes abnormal and shows polyp, we can take it out hysteroscopically and there is very low chance of it being malignant (cancerous). So you can stop worrying as of now and relax.
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