Dr. Yadav Sunil Jagdish
Obstetrics and Gynecology
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Patient's Query
Hello doctor,
I am a 52 years 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 from last 15 years. After consulting many experts, we got three views, first is to carry out a biopsy and D and C, in the absence of malignant cancer, then 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 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 productions (even if it is 20 to 30%) after removal of ovaries? If ovaries are removed, do we have to get HRT? I have enclosed an ultrasound of the lower abdomen, transvaginal ultrasound, pap smear, MRI of the pelvis, and blood reports.
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 thickened endometrium of 9 mm, with 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 endometrium thickness. Or if symptoms continue then you can opt for a hysterectomy. Removal of ovaries after menopause can be done as hormone reduces significantly, the only problem with that may be postmenopausal symptoms like hot flushes, recurrent vaginitis, and osteoporosis, which we can deal symptomatically.
Patient's Query
Thank you doctor,
Will an ultrasound be able to monitor the endometrial lining thickness accurately, or do we have to go for an MRI? Will D and C remove the existing thick lining? Will there be a chance of fibroid hemorrhage during D and C?
Hello,
Welcome back to icliniq.com.
See D and C is not a therapeutic procedure, but it is a diagnostic procedure. In your case, D and C is 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 chances of hemorrhage is very less. Do not do a lot of web research, just consult your local gynecologist and proceed.
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Obstetrics and Gynecology
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