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Complex Hyperplasia without atypia Complex Hyperplasia without atypia

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Unread 06-17-2009, 08:28 PM
Complex Hyperplasia without atypia

Recently I was diagnosed with complex hyperplasia without atypia after an endometrial biopsy. My gyn recommended immediate TVH/BSO. I am 50 and haven't started menopause.

After reading all the posts here, I made an appointment with a Gyn/Onc for a second opinion. He said the hyst was unnecessary at this stage (although an option if I wanted one) and recommended six months of norethindrone, followed by another biopsy to see if things have cleared up. After doing some research myself, it looks like this can clear up, either with or without drugs.

Still, I'm sort of second-guessing whether this is the way to go. I have a feeling I am only delaying the hyst by six months. The norethindrone is going OK so far. I don't notice it making me feel any different.

If anyone has any advice or have gone this path, I would love to hear from you. I really don't want to have surgery if I need it. On the other hand, I don't want to fiddle around and have this turn into cancer because I didn't do anything. Thanks for any advice you have.

Also, regarding the endo biopsy, I notice many posters say that it was horribly painful. My gyn numbed my cervix, and it really wasn't painful - not pleasant, but not awful either. Please ask for that instead of suffering - there is no reason that I know of that we women have to do painful things with no anesthetic!
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Unread 06-18-2009, 06:14 AM
Re: Complex Hyperplasia without atypia

Hi Sunshine,
I'm sorry you're dealing with uncertainty but sounds like your gyn/onc believes things will clear up. If you have any doubts re the doctor you could always seek a second opinion. Also pls remember at this point you do not have atypia so this is not pre-cancer and with endometrial cancer it is very slow growing. Did your doctor say he believes if the hyperplasia goes away with the med your taking it very likely will stay away which would offer better peace of mind?
Of course the final decision whether to go for the surgery or not has to be yours and I am sure as you obtain enough information you will make the right decision for you.
Thanks for the info on the anesthetic used for the biopsy; I've always thought there had to be a way to avoid the severe pain some of the ladies have experienced having this test.
Pls keep us posted.
Unread 06-18-2009, 06:55 AM
Re: Complex Hyperplasia without atypia

I had the same diagnosis after my first endometrial biopsy. I went for a second opinion. With no risk factors the gyn did not think this was normal for me. He did a second biopsy and said if that came back the same (complex w/o atypia) , he would do a D&C. The second came back as cancer, it was missed in the first biopsy cause high up. I'm not sure why the first didnt show atypia. Just to be safe, I'd ask for a D&C.
I think all biopsies are done with numbing of the cervix but the numbing can be pretty painful & although numb, it was extremely an uncomfortable feeling of pressure for me.
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Unread 06-18-2009, 09:47 AM
Re: Complex Hyperplasia without atypia

I will add my experience..I too showed the same results my cancer came back in the D &C...I am not trying to scare you...but i will say if it was me I would not watch & wait ...I was lucky it was early but I should have a hysterectomy in my early 40s on reflection...heavy periods short cycle...then i could have avoided hearing that dreaded word,


Unread 06-18-2009, 03:25 PM
Re: Complex Hyperplasia without atypia

Do you have irregular or heavy bleeding? Often women with hyperplasia have problematic cycles. I have simple hyperplasia and I am taking Provera for 3 months and then will have another biopsy. The hyperplasia was diagnosed by a D & C so it should be accurate. My gyn said I could have a VH if I grew tired of the bleeding. I had an ongoing period from Feb till the middle of April. I just am not ready to have the surgery and am hoping that the Provera works. You may want to wait to see how well the medicine works. A gyn-oncologist is an expert in female cancers and should have more experience and knowledge than a regualr gyn. Ultimately it is your decision. Good Luck and take care.

Unread 06-19-2009, 05:38 AM
Re: Complex Hyperplasia without atypia

The biggest risk with biopsies is that they are only taking selected elements to test. You can biopsy one place and have it be normal, but still have cancer nearby that wasn't biopsied.

A D&C is a much more thorough procedure (they get more tissue from most of the lining) and therefore a better gauge. The only real true diagnostic is after a hysterectomy when the pathologist can look at the ENTIRE uterus and determine if there is or isn't cancer present. (There are several women on here who only found out about cancer after having their hysterectomy for other reasons).

Hyperplasia does often develop into cancer. If you are through having children then having the hysterectomy dramatically reduces your chance of getting it, but there are doctors who are wiling to do the hormonal treatment with close follow up. I'm looking into these options right now (I don't have kids yet and my cancer was found while preparing for IVF) but from what I've read the risk of cancer progressing despite hormone treatment is a real concern (about 25-35% from most of what I've read).

For myself, if i didn't have the baby dreams I know I'd have the hysterectomy immediately. Even now it's going to be the hardest decision of my life.
Unread 06-19-2009, 09:53 AM
Re: Complex Hyperplasia without atypia

Sunshine 105,

I had the exact same diagnosis as you after my edo biopsy. I am 44 and my family is complete. I was given the option of taking a drug for three months and having another biopsy. I had read that "sometimes" that is all that is needed for treatment...but I do have alot of cancers in my family..including colon..and discussed the hysterectomy with my doctor. I am very relieved I did it. I had the da Vinci and had very little discomfort, taking Aleeve for the first two days after leaving the hospital. The fatigue and constipation were my only issues, which are very normal. The pathology report came back no cancer but I have absolutely no regrets for doing it. I am not a wait and see personality. Everybody had their own personal reasons for having one or not. It was just my personal decision (after ALOT of prayer). Listen to your gut on this one.

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