Post-menopausal uterine stuff - smart or not?

DianaCox

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So in 2019, I had an MRI of my pelvis to look at my tailbone. But the radiologist noted an “incidentaloma” the endometrial lining of my post menopausal uterus was thickened. I had two biopsies that didn’t yield any information, so I contacted a gynecological oncologist to do a D&C to see what was what, in case I needed her services at that time.

It turned out to be a 3 cm long benign polyp, which was removed.

In October, I had my yearly exam with my PCP, who asked if I had followed up with my GYN. I said no, and I really don’t have a GYN (no need to go back to the oncologist), so he referred me to one.

Saw the GYN at the end of December, and he wanted me to get an ultrasound. Got the U/S on January 14th, but didn’t hear anything, so when I went in for my mammogram on Monday, I picked up a copy of the U/S report. Everything looked fine, no major change in my fibroids, except the endometrium “was obscured.”

Called the GYN Tuesday to ask what was the next step. The doctor’s PA or NP called back at about 7 pm last night (they’d had a bunch of deliveries), and told me that the doctor wanted to do a hysteroscopy and fibroid removal - apparently the fibroids were obscuring the endometrium.

I was rather surprised to have such an invasive procedure recommended. I asked whether perhaps another MRI might be better to see if the endometrium was thickened, and she said that wouldn’t really indicate enough to make it worthwhile, and that a direct look up there would be better. And to get rid of the fibroids while in there.

I pushed back and said I still thought it was overkill since I had no symptoms, and she said that postmenopausal bleeding was concerning. And I said I understood that, but I didn’t have any bleeding - I was just following up on the procedure in 2019.

So we went bsck and forth for a bit, and concluded that it could probably wait since I have no symptoms, and since Covid-wise this is not a great time to have a non-urgent procedure.

But I’m perplexed. I don’t mind having a look-see, another D&C, plus the fibroid removal, if I need it, but I don’t know if I need it. TBH, my dusty 67 year old ute would probably better off out of me than tidied up and still having to be looked into every year, along with removing my remaining ovary, on the theory that anything not being used is just a cancer waiting to happen.

No close family history of ovarian or breast cancer, 23andMe showed none of the common BRCA mutations.

Benign neglect for now? She said it could wait a year.

As an aside, I’m not impressed that they didn’t call me back almost 3 weeks after I had the U/S, and then made their recommendation based on a mistake that I was bleeding. Did the doctor actually review my file before suggesting a surgical procedure?

Trying to decide what to do.
 
Waiting for a while is most likely a good decision. And me personally, rather than having something that is going to continue to cause problems, I would want it to just be removed. Why keep something unnecessary that is going to require a lot of followup, possibly for decades. I do wonder if ablation would destroy enough of the endometrium to keep more fibroids from forming? That would be even easier than a hysterectomy. Faster recovery too. Ablation is outpatient too. No hospital stay.

Unless something is really necessary, I am avoiding all medical places and doctors in general. Hence the hernia is still there. Wish I could get rid of it. If I ever get the shots I will proceed and get it done. I have already been waiting a damn decade. I want to start looking like I am the thinnest I have ever been!
 
Another option would be getting a second opinion, especially since you have concerns about the incorrect assessment of your situation. It shouldn't be necessary for you to correct something as important as whether or not you have post-menopausal bleeding.
 

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