Progestin instead of hysterectomy postmenopause

Hi there. I am very frustrated not know exactly what is happening with me and I am reaching out for support and guidance.

Have any postmenopausal women with complex hyperplasia without atypia chosen progestin instead of hysterectomy for treatment? Did everything turn out ok or did you end up having a hysterectomy because it turned into cancer?

I am 52 yrs old, and had postmenopausal bleeding at 17 months postmenopause. I'm diagnosed with complex hyperplasia without atypia. Between two general practitioners and a gynecologist I've had a pap (abnormal), cervical and endometrial biopsies, TVU (11mm lining and a cyst in myometrium going into the endometrium), and a D&C (clean).

At the first visit with the gynecologist to review my tests, he said I did not have pre-cancer but he wanted to do a hysterectomy and remove my ovaries, which looked good. I asked about a D&C and if it was possible to not have surgery because I don't want to have a major surgery if I don't need it. He said we can do the D&C and that it would give us more information, but he said the treatment for postmenopausal women is hysterectomy including ovaries, so that if it did turn into cancer I wouldn't get ovarian cancer. At the next visit to talk about the D&C results, which was clear, he said I do have pre-cancer. As far as I know, nothing changed between the two visits to make him say I don't have pre-cancer to yes, I do have pre-cancer.

I had a second opinion with a gynecologist oncologist who said I don't have pre-cancer because I am without atypica. He also recommended a hysterectomy but said I could keep my ovaries. I asked if I didn't have pre-cancer why would I need a hysterectomy and he said because that's what women my age do. Argh. During this meeting I realized he was reading off the pathology report from my gynecologist's office and he hadn't looked at my slides. Is this typical of a second opinion? I had requested all reports and images be sent to the gyn/ocon. I requested, again, the slides to be sent to him. He said he would have them reviewed in two weeks. It is now three weeks and nothing. I've called his office several times and I don't think its doing any good. Is this typical of a second opinion?

Do I need to be more patient? I'm worried I may have to have a 3rd opinion because these two doctors are not on the same page. My hysterectomy is scheduled for September 10 and the paperwork says abdominal hysterectomy. I have a physical on July 10 and I'll ask my primary why she authorized an abdominal instead of da Vinci, like my gyno said he thought I could have.

Sorry for the long post, but I can't stop thinking about this and my work requires me to plan events six months in advance and I don't know what is going to happen.

Thank you all so much.

HI. I'm sort of in the same boat as you but a little older at 61. At 56 I started spotting 3 years after menopause and went for ultrasound and D&C. Pathology was complex hyperplasia with no atypia. So gyn took conservative approach and started me on Prometrium. She said insurance wouldn't cover a hysterectomy at that point. I did ok for awhile but never refilled my script and about a year and a half ago I started spotting again. I put it off because I didn't want to go through the D&C rigamarol again. But by May I was bleeding so bad I couldn't put it off any longer. The ultrasound showed a 27 mm stripe and I had a repeat D&C. And I started the Prometrium again about 2 weeks ago. The pathology was the same, but since I'm not getting any younger she is sending me to a gyn/onc next week to be evaluated for surgery. The problem with the negative pathology for atypia is that the only definitive way to R/O cancer is to remove the uterus and do pathology. Unfortunately some women with negative D&C's do in fact have cancer upon hysterectomy. Also at this point if cancer is a possibility, my Dr wants an oncologist to do the surgery,because it may be more involved than just a simple hysterectomy. (pelvic wash and nodes, etc...)
Years ago they just did a hysterectomy right away, but now the insurance companies want you to try the conservative approach first. For me, now I am ready to be done with it all!

Thank you, Mollybear, for sharing your story. The gyno/oncol nurse called yesterday with his results from looking at the slides. I have complex hyperplasia without atypia and he is still suggesting hysterectomy, but keeping my ovaries. He does not think I have pre-cancer. I'm probably going to have the surgery, but I am so anxious about it. I fear things going wrong more than the diagnosis of cancer. This is because I had a simple procedure five years ago and wound up with a paralyzed vocal cord. I'm just so scared of making the wrong choice: having surgery, which doctor, etc.

I appreciate you replying. I'm in the states, so Happy 4th of July!

Hi -- I had my apt with the gyn/onc on tues and I'm scheduled for a DaVinci hysterectomy on 8/12/15. I'm happy and nervous at the same time. The scary part is that he may have to convert to an open abdominal if I can't tolerate the deep trendelenberg position and they won't know that until I'm under anesthesia.

Good luck with your surgery. I understand your fear about the surgery and I had to look up that position you mentioned because I had never heard of it before. My authorization is for an abdominal procedure, but my gyno said he thought I would be a da Vinci candidate so I need to ask for clarification. I will be thinking of you. My surgery isn't until September 10.

Hi! If your surgeon is comfortable with the davinci, that is the best option. Healing goes better without all the muscle damage from an open abdominal. I did'nt think I was a candidate for the davinci because I am very overweight but the doc said he wants to at least try it. If the anesthesiologist doesn't think it's going well, they will convert to a vertical abdominal incision. I'm hoping for the best and preparing for the worst ! I really hope he can complete the davinci because then I can drive after a week, vs 4weeks. I live alone and driving is a big deal for me. Keeping you in my thoughts and prayers!