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Q. Is MRI with contrast useful for endometrial issues?


 

Hi doctor,

I had not had periods for 8 years. There was some spotting for around a year. The endometrial thickness is 7.7. The complex echo suggesting menstruation, though not having periods. Please help me.


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Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hi,

Welcome to icliniq.com.

  • There is likelihood of serum progesterone deficiency.
  • Get a serum progesterone level test done. If low, then cyclical progesterone would have to be started.

For further information consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

 

Thank you doctor,

I am 48 years old. I think I have reached menopause. I have not tracked and I cannot remember the last period, maybe one year plus. I had heavy and prolonged irregular bleeding for about three years before and then periods became very spaced out and stopped. But, I have had spotting in the last one year. Now, I have three days of bleeding like periods. I have also been having symptoms such as cramps, loose stools, etc., for a few days at a time without regular periods. Two months back, before period ET was 5 mm and now 6.7, FSH 63 and estradiol 16.4. Small fibroid in the anterior wall, complex echo and menstruating endometrium reported in ultrasound though I was not having periods when this ultrasound was done. Am I in perimenopause? Is it postmenopausal issue? I do not wish to undergo invasive investigation. Last period was preceded by initiating exercise and a large cyst disappeared after the period (three days of bleeding). It is confusing me. Please help.

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

Welcome back to icliniq.com.

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. 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.

Revert back with the reports to an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

 

Thank you doctor,

The MRI showed no polyp or cyst. The plain MRI report also said endometrial cavity appears normal. I prefer a non-invasive procedure. Is MRI with contrast useful for endometrial issues? I had another MRI with contrast as the focus of this MRI was mainly to look for ovarian cyst reported earlier and endometrial thickness is not reported in this MRI. All the tumor markers are also negative. Thanks for your patience.

 

Dr. Sameer Kumar
MBBS., MS (OBS/GYNAE)., FMAS., DMAS., FELLOWSHIP IS ASSISTED REPRODUCTIVE TECHNIQUES
Infertility, Obstetrics And Gynaecology

Hello,

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.

For further doubts consult an obstetrician and gynaecologist online --> https://www.icliniq.com/ask-a-doctor-online/obstetrician-and-gynaecologist

 
 
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