Can MRI with contrast detect endometrial problems?

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

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If your periods have stopped for more than a year because of your age, this is considered menopause. This is further supported by high FSH (follicle-stimulating hormone) levels, which indicate ovarian failure.

Usually, in postmenopausal women, the endometrial thickness should ideally be less than or equal to 3mm. However, in your case, an ultrasound report with an endometrial thickness of 5 mm was taken two months before, when there was no bleeding. Now, since the estradiol levels are high, the endometrium is further thickened to 6.7 mm.

Since there is no progesterone support, the estrogen causes unopposed endometrial stimulation, leading to irregular shedding of the endometrium, which results in white discharge, heavy bleeding and passage of clots. This pattern is consistent with perimenopausal bleeding, not a perimenopausal transition.

The most likely underlying cause here is endometrial hyperplasia, a condition that can progress to endometrial cancer if left untreated. Therefore, it is essential to perform an endometrial biopsy to rule out atypical or precancerous changes. These could be a possible histopathology report after the endometrial biopsy:

1. Simple endometrial hyperplasia without atypia needs progesterone therapy.
2. Simple endometrial hyperplasia with atypia needs a hysterectomy.
3. Complex endometrial hyperplasia without atypia, cyclical progesterone if in the reproductive age group, but hysterectomy in menopausal women.
4. Complex endometrial hyperplasia with atypia, precancer and definite hysterectomy.
5. Adenocarcinoma of the uterus requires staging and total abdominal hysterectomy with removal of both tubes and ovaries, as in menopausal women. Then, further treatment is 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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MRI does not actually comment on endometrial thickness, and the tumor markers were done to check the possibility of ovarian cancer. But, our concern in this case is endometrial or uterine cancer, which may not cause a change in the size and shape of the uterus unless there is myometrial invasion. As there is a definite increase in endometrial thickness, considering your postmenopausal status and unfortunately or fortunately, an endometrial biopsy has to be done for histopathology. This is an invasive procedure, but nowadays it 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.