post-menopausal bleeding & thickened endometrium?

Hi ladies,

I had my LSH/BSO on 9/3 for pelvic pain, so this is the first time I've been to this board. I'm actually here for my MIL, to ask some questions and to hopefully get some slightly better news about her health problem.

She has not had any GYN surgery to my knowledge, with the exception of my DH via cesarean in 1971. She's 60 and has been in menopause for 10 years plus (at least no bleeding for the last 10 years, she says).

I can't remember how long she said that she'd been bleeding/spotting, but she's not an alarmist by any stretch, and she's usually the last to take care of herself. I'm guessing this has been going on for a little while -- I'm thinking weeks or a few months long, at least. Today, she finally saw her PCP who tried to get a uterine biopsy, I think (she couldn't tell me, just said he was painfully digging), with no results (couldn't get a sample?). They sent her to u/s, where the tech told her of a thickened wall (don't know the measurement). They are now sending her to a GYN to get the first test done again, and I'm assuming that they have asked her not to wait, as she's a little freaked out. I'm also guessing that since she's having to be referred to a GYN that she hasn't seen one in a while. She's on no HRT and I don't think she has any other health conditions (with the exception of being overweight). She also says that other than the bleeding, she's feeling ok.

I told her that I'd do some research, but my first concern is obviously endometrial cancer or hyperplasia. She's been married for 35 years, I believe, so I'm guessing that cervical is less of a possibility (although who knows when her last pap was). She has no family history of cancer that I am aware of, but nearly everyone I know from the area has at least some form of cancer in their family (environmental issues / rural area). I'm hoping that it's a polyp (she said that she thought the u/s tech mentioned something there that either should've been there or should not have been there - ??). What would be the treatment for polyps or hyperplasia at her age? Is a hysterectomy probably in her future, many other diagnoses being ruled out because of her age?

I know that you all have run the gamut of possible and eventual diagnoses, and I'm very thankful to be able to pose these questions. Many of you are quite young, needing the hysterectomy long before menopause, but the symptoms would still be the same, right? If any of you have had these symptoms during menopause, I'd appreciate any ideas/advice that you have to share. I realize that her docs will give her the diagnosis eventually, but I'd like to be able to either calm some of her fears or at least give her a heads up if I can.

Thank you *very* much, and s to you all.

Hi Melvis. It is very important that your MIL gets tested soonest to determined the cause of her spotting/bleeding which, as you note, can be a sign of endometrial cancer. There is, of course, the possibility that she has polyps or something else and so she should not assume it is cancer BUT if it is, it is very treatable, especially if caught early.
I am post menopausal and close to your MIL's age and last year experienced very slight spotting ; my gyn did a D&C which showed complex hyperplasia with atypia and added "cannot rule out cancer." She said I needed a TAH/BSO soonest since IF endometrial cancer was there, getting it out ASAP, before it grew, was critical. Given my dx, they would not know if there was cancer until they removed the uterus and did tissue path tests. A gyn/onc, who is a cancer specialist, assisted with my operation. They found a very early stage cancer and I have been told the surgery was the cure but, of course, I will be monitored for 5 years. It is important that you encourage your MIL to get this checked out ASAP and if there is any indication of cancer to be sure a gyn/onc assists with any surgery. Please let us know how she makes out.
s, peggiesue

Melvis: I second what Peggiesue said. You MIL must follow up on the US. It sounds much like what happened to me at age 58. I had not seen a GYN for about 5 years but my regular Dr did paps every year.

When I had the ultrasound I was sent to a GYN. Since I had not seen one since I moved to this area, he was new to me. He said I had a thickened endometrium and there was an area that looked like a polyp. He was convinced and so was I that it was a polyp. I went in for a hysteroscopy (an updated D&C procedure) to remove the polyp. It was then that the endometrial cancer was diagnosed.

Now, if it had just been a polyp, that would have been the recommended treatment and I would have been okay. As it was a cancer diagnosis, I had a TAH/BSO 10 days later. Luckily, it was an early catch and I have no more treatment other than 3 month checkups with the Gyn or the gyn/onco.

I tell you this story because bleeding can come from other sources than cancer. However, all such bleeding should be checked out.

As an aside, I asked my Dr. about how long this "thing" could have been growing inside me. I had had symptoms for about 4-5 months. The Dr. indicated that it was probably there for "years" before it caused symptoms. But once the symptoms show, it's good to get checked out asap.

And remember, waiting is the hardest part. Once there is a diagnosis, attention can be focused on the treatment plan (if needed).

Linda

I had post menopausal bleeding and a scan which they said showed a thickened endometrium. The talk was of atypia or early cancer but a hysteroscopy showed a huge polyp which was simply cut out. The endometrium wasn't thickened at all. Scans are not always interpreted correctly.

Hope all goes well for your MIL and they find something similar.

Ann

I have been post-menopausal for 3 years and had NO symptoms whatsoever when a pap revealed some stray endometrial cells on my cervix. My physician's asst tried to do an endometrial biopsy, but my stubborn cervix wouldn't cooperate (as usual), so I also had an ultrasound which revealed a thickness of 9.5 mm (almost double what it should have been). I am overweight also, and did not know that my fat was producing estrogen, combined with a prescription for estrogen (with no progesterone) must have fed those cells like crazy! I then had a D & C with hysteroscopy (under general anasthesia) and was diagnosed with complex hyperplasia w/atypia, a pre-emphasis on pre-cancerous condition. My doc wanted to do a TAH w/BSO, but I think he's consented to do a LAVH -- we're going to talk more about this and I'm getting a second opinion. Anyway, your MIL needs to stay on top of this and I hope the second biopsy goes well. If she needs a D&C, my experience was that the anticipation and sore throat from the endo tube was the worst part...hopefully, she will be okay. It's good that you are watching out for her...good luck!

I am younger but have the same story. I had regular, annual paps and pelvic exams and experienced an unexplained, abnormal bleeding. My doctor and I both felt it was just menapausal stuff but she ordered a US that showed a thickening and then off for a biopsy. From the biopsy, the dx. was adenocarcinoma, grade 1. Had the TAH/BSO and the final path confirmed stage 1a, grade 1. Thank god I followed up on the bleeding. I thought of just blowing it off. For me, the surgery was it. I was lucky. If this is what your MIL is experiencing, she may just have saved her life by doing something right away about it. I hope it turns out to not be cancer, but if it is then I hope it's early and surgery will take care of it. Keep us posted..the waiting is truly the worst.

My story is similar. Was 42 years old at diagnosis. Had been having regular (like set your clock to it regular) periods, never ever any problems. Normal paps every year. The bam, 2 yrs ago I had slight vaginal spotting mid-cycle. This was not associated with intercorse or infection or anything. I insisted my gyn evaluate it, we did an US - showed thicked endometrium with polyp. D and C showed endo CA. TABH/BSO, node sampling, omentectomy, etc showed very low stage/grade. All I needed was the surgery.

Your MIL is wise to have this checked out. If it is something, sounds like it possibly could be like mine, and a very low stage/grade. It is not a picnic, freaky to have cancer regardless of what it is - but there most certainly could be worse things! I am sure she appreciates your support, and know that the waiting is the hardest part! Soon you will know where the situation stands, and have mapped out a course of action, and things will be easier. Take care, try to relax, and let us know how things are going. Judy

Your MIL sounds like my mother 25 years ago. She too developed post menopausal bleeding which she did not have checked out right away. We had to use tough love with her, and eventually got her to the doctor's and tests proved she had a fairly invasive endometrial cancer. She went on to have radiation pre op which is what they did back then, a TAH/BSO, and by the Grace of God she has been cancer free all these years. I on the other hand who was peri menopausal and developed a pink tinged discharge over the course of a couple of month's, remembering what my mother went through prompted me to get to the doctor's ASAP. My doctor did not initially think my barely visible discharge was a major concern, and even said this type of cancer is not considered to be genetically linked, but I pushed to have an endometrial biopsy, and low and behold it came back positive for early stage endometrial cancer. This cancer presents in different ways with different people, but most women despite being pre or post menopausal had some type of intermenstrual bleeding or discharge. So please, be sure your MIL pursues the necessary testing to confirm or rule out this cancer.

s

Thanks, everyone. I'll be heading that way today, so I'll be talking to her about this. Thank you all for your wonderful advice and your personal stories. I hope that she's got an appointment very soon -- I'll report back when I have some info.

Please be safe in your travels this holiday!