New, Dr. recommending D&C then Hysterectomy

I don't even know where to begin. Anyway, I have had large fibroids for many years, had an embolization in 2004 that didn't help at all. Profuse bleeding for many years. Two years ago (age 55) started having irregular periods and hot flashes.....also dianosed hypothyroid and glucose intolerant around same time. Lots of incontinence, but tolerable. After 8 months of no period, suddenly had lots more incontinence, followed by one heavy period last June (whicy Gyn called abnormal bleeding). After the period, incontinence was somewhat relieved. Ultrasound showed the large fibroids and one ovarian cyst, and a biopsy showing nothing significant except some polyp material. Decided to do nothing and see how it goes. FSH consistently shows I am still producing estrogen, but did not have period for a whole year this time, now this June, suddenly had stronger incontinence again, mucous discharge, some breast tenderness, and started spotting tinged with blood for several days. Did not have heaving bleeding, just pink spotting. Dr. wants to do D&C now, says fibroids are not shrinking, though they have not gotten larger since last ultrasound, she thinks biopsy is not good enough this time. I do not understand why a biopsy was sufficient a year ago with the same size fibroids and same difficulty seeing endometrial lining on ultrasound, but this time she is saying I *need* a D&C in order for her to get a good tissue sample to send to the lab. I have asked her but she says only because I am continuing to have symptoms. This does not make any sense to me....that the second round of abnormal bleeding requires a different tissue sample. Does anyone have any speculation? I would think that even the first time, she should have also been interested in getting a decent tissue sample. She also says that she thinks my fibroids will not shrink any more than they have (don't understand how she can know this), and is recommending a hysterectomy based on my recurring symptoms.

Could I still be in perimenopause even with the above history, no period for a year, then bleed a little? She does not seem interested in taking my FSH. Can anyone shed some light or experience? Thank you.

TerryAnn

I wish your Dr. was more responsive to your questions, that can be so frustrating. My suspicion is that since you haven't had a period, your estrogen levels are upand now you have started bleeding again that your Dr is trying to rule out some form of endometrial cancer.

The reason for the D&C is that due to the clean-out of the uterus there is more to sample and they are better able to determine if there is cancer present.

Bleeding after menopause is a classic sign that something is wrong and frequently is an indicator of cancer.

Please call your Dr. ask her if this is the concern so you are fully informed. If cancer is found my recommendation is that you get a referral to a gyn-oncologist.

I am sure this is not what you were expecting to hear but in my experience this is what your Dr. is trying to determine.



G

Yes, it is what I was expecting to hear.I already understand she is wanting to rule out cancer, not sure why you would think that this isn't what I was expecting to hear. She did tell me this, however, she said she doubted if it was cancer because I have had some breast tenderness and mucous discharge a week before the bleeding started, and sudden incontinence. What interests me, tho is that that when I started bleeding back in 2010 after 8 months of no period, she insisted on a biopsy because she wanted to rule out cancer, now after a year without a period, she is insisting on a D&C. I would think that if there is suspicion about it, she would *always* do whatever procedure is the best to rule out cancer....the D&C, and would not even have ever considered the biopsy last time. This is what I don't understand.....

Anyway, you said that your suspicion is that my estrogen levels are up now. Is this possible after a year of no bleeding?

I think that she should have done a D&C last time if this is the best way to rule out cancer. I had the same size uterus last time, same size fibroids that would make a biopsy difficult to get a good sample. I am upset that she did not insist on a D&C last time, if in my case a biopsy isn't good enough to rule out cancer, given the difficulty of my fibroids getting in the way of obtaining a good sample.

G, what symptoms were you having before you had the D&C? Were you in menopause? How are you now? Can you tell me your story?

Terry

I saw that you said you were still producing estrogen so thought maybe the levels were higher than our gyn had anticipated that they should be. As for why she didn't do the D&C the last time, don't know maybe with where you were in peri-menopause that she wasn't thinking cancer.

My sister was waiting for full menopause hoping it would cause her fibroids to shrink as it sometimes does. They didn't and after menopause she began bleeding so Dr. told her she had to have a hysterectomy. They weren't expecting cancer but during the surgery it ws found.

As for me I wasn't menopausal, had regular periods but they were very heavy. Dr. scheduled me for a D&C and hysteroscopy. After the procedure told me that everything looked good visually but was sending things away for pathology tests and that was how I got my unexpected cancer diagnosis.

Some Drs don't like to say the "C" word until they know for sure so they way you were asking why she was doing the test I was thinking maybe she hadn't said cancer to you.

The only treatment that I required was a total hysterectomy with BSO (removal of both tubes and ovaries). Actually for me they D&C got all the actual cancer and all the gyn-onc found after the pathology was complex hyperplasia with atypia.



G

G....thank you so much. I have myself pretty worked up, and all these tests and stuff are not even yet on the radar...she wants to do the D&C but I dont' know when that is going to be. When I called and asked her, she was "on call" and didn't have time to talk. When I called the nurse, she sounded perturbed with me and of course deferred to the doctor for my questions. When I called to make appointment for a second opinion, I was told that there are not openings until late August!!! I am dismayed when I read through all the posts how many women had normal biopsies and D&Cs, and yet when the hysterectomies are done, they find cancer anyway. I had ovarian cyst and also polyp material was found at last biopsy, but my gyn said there were "no problem". I don't know whether to trust her or not? Do you think I should get with an onc/gyn already? I wonder if they would even let me see one when we don't even know what is wrong yet?

I have huge fibroids for at least 10 years, and now abnormal bleeding after one year of no periods. However, my gyn was encouraged because of recent symptoms that "look" like surges in estrogen....hot flashes increased, mucous discharge like ovulation, increased incontinence. One week after the mucous, the bleeding started...but it has only been like pink tinged discharge that lasted a week. The ultrasound showed my endo lining was on 4mm, but they could not see all of it because of the fibroids. My uterus is a pain in the you know what and I think just getting rid of it would be best, but I have great fear about the hyst. Gyn thinks she can do a robotic, if the D&C comes back normal. But she wants me to take Lupron for a few months to shrink the fibroids to make the uterus smaller first. I am frightened to death of this drug after researching it.

Thank you for listening G.

Terry -

Can you get a 2nd opinion at a different practice instead of at the same practice but a different Dr.?

There are many women who have used Lupron to shrink fibroids but since we're all different you never know how your body may react to it.

The best you can try to do is not "borrow trouble from tomorrow" but keep trying to move the tests forward and get the information that you need.



G

	Quote:
Originally Posted by terryannj G....thank you so much. I have myself pretty worked up, and all these tests and stuff are not even yet on the radar...she wants to do the D&C but I dont' know when that is going to be. When I called and asked her, she was "on call" and didn't have time to talk. When I called the nurse, she sounded perturbed with me and of course deferred to the doctor for my questions. When I called to make appointment for a second opinion, I was told that there are not openings until late August!!! I am dismayed when I read through all the posts how many women had normal biopsies and D&Cs, and yet when the hysterectomies are done, they find cancer anyway. I had ovarian cyst and also polyp material was found at last biopsy, but my gyn said there were "no problem". I don't know whether to trust her or not? Do you think I should get with an onc/gyn already? I wonder if they would even let me see one when we don't even know what is wrong yet? I have huge fibroids for at least 10 years, and now abnormal bleeding after one year of no periods. However, my gyn was encouraged because of recent symptoms that "look" like surges in estrogen....hot flashes increased, mucous discharge like ovulation, increased incontinence. One week after the mucous, the bleeding started...but it has only been like pink tinged discharge that lasted a week. The ultrasound showed my endo lining was on 4mm, but they could not see all of it because of the fibroids. My uterus is a pain in the you know what and I think just getting rid of it would be best, but I have great fear about the hyst. Gyn thinks she can do a robotic, if the D&C comes back normal. But she wants me to take Lupron for a few months to shrink the fibroids to make the uterus smaller first. I am frightened to death of this drug after researching it. Thank you for listening G.

I am reading your posts and it all sounds familiar to me.
My bleeding had carried on for about a year. I ignored it, even though it was heavy and had chunks. I mistakenly thought it was peri-menopause. It wasn't. I finally went to the doctor, and it was Complex Atypical Hyperplasia.
The sample was described by the pathologist as very "scant," in other words, too small. Since the OB/GYN could see a tumor, we decided that he would remove it at the hospital as an outpatient.
The second pathology report came back the same..CAH.

He recommended a hysterectomy. I agreed, but he said that I could wait until summer (It was January 2011). I decided that this may be O.K., or not O.K., depending if it could turn to cancer or not. Cancer is unpredictable. Will it grow fast or slow? Who knows.

I decided to get another opinion, and I went to the best GYN/oncologist/surgeon at the best cancer hospital in our state. He felt that I shouldn't wait. That I was just "rolling the dice." I agree and still do, but that is my opinion.

I did what he suggested only because I knew that I had had the bleeding for at least a year, like an idiot. I just thought my body was going through "the change" menopause, and was deciding whether or not to continue to have periods, and they were heavy. Thank goodness a friend that was about 5 years older than me told me that I should go see the GYN.

I am doing fine after my hysterectomy on February 18. I am really glad that I had both ovaries taken out because one of them had a small cancerous growth on it that was microscopic. It helped that I am older (55). I may have gone through menopause anyway.

The reason I think it is good for a GYN/oncologist to do your surgery at this point is that they are more knowledgeable about the various gyn cancers and what to look for. Also, they have skilled pathologists working with them that can advise them during your surgery and after the surgery.

Since your doctor suspects cancer, why not have the gyn/oncologist specialist involved doing the surgery?
JMHO.
This is only my personal opinion. You have to do what is best for you. Good Luck.

My surgery was robotic. It was 4-5 little incisions.
I feel fine, but I hate not having my ovaries.
Sexually, I have not been able to have an orgasm yet, and it has been 4 months. No HRT, because I am prone to cancers.
I am relived that I have no cancer for now, but who knows. I at least did what I thought was best to stop the cancer from spreading.