Which is the best treatment option for postmenopausal vaginal discharge?

Question

Hello doctor,

I am a 52-year-old female who weighs 165 lbs, and I am 5 feet tall. I have postmenopausal vaginal discharge with a fair amount of red spots. What could be the cause? I had my menopause 1.5 years back, and I have type 2 diabetes, hypothyroidism, and asymptomatic cholelithiasis for the last 15 years.

After consulting many experts, we got three views. The first is to carry out a biopsy and D&C; in the absence of malignant cancer, we do not need to opt for hysterectomy (even with the endometrial thickness of 9 mm). Second, is to remove the uterus and the cervix, but keep the ovaries, as the ovaries still produce 20 to 30% of the required hormones even after menopause. Third, is to remove the uterus and ovaries altogether and carry out the biopsy through frozen section at the time of TLH. Which is the best option, and why? What happens to hormone production (even if it is 20 to 30%) after the removal of the ovaries? If ovaries are removed, do we have to get HRT?

I have enclosed an ultrasound of the lower abdomen, a transvaginal ultrasound, a pap smear, an MRI of the pelvis, and blood reports.

Kindly guide.

Answer 1

Hi,

Welcome to icliniq.com.

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

First, D and C (dilation and curettage) with cervical biopsy with acetic acid or Lugol's iodine should be done, as you have postmenopausal spotting with a thickened endometrium of 9 mm, with an associated risk factor that is diabetes. This is required to rule out malignancy. Also, an antibiotic course should be given. Once this test is normal, then serial ultrasound every three months can be done to check for the endometrial thickness.

Or if symptoms continue, then you can opt for a hysterectomy (depending on blood type). Removal of ovaries after menopause can be done as the hormone levels reduce significantly; the only problem with that may be postmenopausal symptoms like hot flushes, recurrent vaginitis, and osteoporosis, which we can deal with symptomatically.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

See, D and C are not therapeutic procedures, but they are diagnostic procedures. In your case, D and C are to rule out the cause of postmenopausal spotting. The endometrial thickening is not the disease, but may be a sign of the disease, which we rule out by D and C. It is a minor procedure, and the chances of hemorrhage are very low. Do not do a lot of web research, just consult your local gynecologist and proceed.

I hope this helps.

Thank you.