Should I get a second opinion?

Posted by lgrec @lgrec, Mar 5 2:37pm

I’m a post menopausal 52 years old and just recently had a MRI done in Dec for my lower back. Besides my back issues…the radiologist found abnormal endometrial thickening, a potential right sided hydrosalpinx (never had a std), left partially septated adnexal cyst 2.5cm, suspected small nabothian cyst at the cervical level, partially imaged 1.1cm myometrial fibroid. I also had a ultrasound performed in August because I was taking HRT’s and I was still having frequent periods (I didn’t know that was a issue). My ultrasound said everything was fairly normal except for the heterogenous area in the endocervical canal had multiple echogenic foci. After these findings, my GYN now wants to perform a bilateral Salpingo-Oopherectomy because of my bad periods, PMDD, discomfort etc…she also needs to take a biopsy…said she couldn’t do a in-office one because she could not insert a IUD in me. She doesn’t seem concerned that I have cancer, but a lot of symptoms like the post menopause Hydrosalpinx, post menopausal periods and cramps, the right sided constant cramping and pain in my lower back and the fact that I never had children causes some concern to me. All my cancer blood tests came back normal, but I’ve heard that happens sometimes. Also, I don’t want to do a Bilateral Salpingo-Oohorectomy and then find out I need a full hysterectomy (because she can’t perform a hysterectomy)… which would mean I would have to get a second surgery. What do I do? I’m having a hard time connecting to a second opinion as well. I thought maybe someone on this board would have suggestions or similar experiences. Thank you…

Interested in more discussions like this? Go to the Gynecologic Cancers Support Group.

Helen, Volunteer Mentor | @naturegirl5 | Mar 5 6:12pm

@lgrec You've detailed a complicated history and I thank you for all the detail. This will help myself and others in our Support Group to provide support and suggestions.

I'd like to suggest that if you haven't already done so to please read through this discussion. @debra54 originally posted about her gynecologist's difficulty in doing an endometrial biopsy because her cervix would not open. I think you will find many suggestions and stories here that will help you figure out what to ask a physician.

Suspected endometrial cancer: Cervix won't open to do biopsy:

-- https://connect.mayoclinic.org/discussion/endometrial/

If I were in your shoes I would get another opinion. Since you are postmenopausal and the radiologist noted a thickened endometrial lining another physician may recommend pursuing an endometrial biopsy with other means. In addition, the recommendation could be, as you've written, a hysterectomy with bilateral salpingo-oopherectomy. Do you already have a clinic and/or gyn-oncologist in mind for the second opinion? Would your current gynecologist or your primary care physician refer you to Mayo Clinic for another opinion? Or you can self refer but in my experience it is better to have a physician referral along with imaging and any other testing available to send.

Here is the link to learn about a second opinion at Mayo Clinic:

-- http://mayocl.in/1mtmR63

What do you think you will do? And how are you feeling tonight about all of this?

brandysparks | @brandysparks | Mar 6 5:22am

In reply to @naturegirl5 "@lgrec You've detailed a complicated history and I thank you for all the detail. This will..." + (show)

@naturegirl5 @lgrec - I had a laparascopic hysterectomy around 2006 due to growing fibroid tumors. That involves 3 small (about 1/2") scars remain, which is minimal for me.

I recall (& you would verify/update this with a second opinion from an experienced surgeon) that the removed internal parts were removed via the vagina ("morcellation" = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140215/), but can be removed via the abdominal cuts used for the procedure.

If there is an issue with the opening of the vagina, you may want to read about this and definitely consult with a second opinion.

Best wishes...and let us know how that second opinion experience goes, if you'd care to.

lathomasmd | @lathomasmd | Mar 7 9:13am

Before getting a second opinion, you may try discussing your concerns with your current gynecologist. Ask “Why not take out the uterus, too?” (That would allow testing of the thickened endometrium.)
If you still are not comfortable with your gynecologist’s answers, definitely get a second opinion.
I have ovarian cancer. After 5 months of treatment with my local gynecologic oncologist, I went for a second opinion at Mayo. In their opinion, my treatment had been below standard of care. So I switched. My treatment at Mayo has been far more aggressive. For which I am eternally grateful.

lgrec | @lgrec | Mar 7 11:20am

I’m going to get a second opinion soon. The problem is that my GYN can’t do full hysterectomy and If I need one I don’t want to have to do 2 surgeries. She doesn’t think she can perform a biopsy on me because she could insert an IUD. I find it strange that my transvaginal ultrasound that I got in August only showed multiple heterogenous foci in the Endo cervical area…but my MRI I got for my lower back showed multiple issues that the ultrasound didn’t pick up. Glad I got the MRI or I guess this would of gone on for some time. So sorry about your situation. Good to know you are getting good care at Mayo.

gisellef | @gisellef | Mar 8 9:24am

In reply to @lgrec "I’m going to get a second opinion soon. The problem is that my GYN can’t do..." + (show)

Please don’t rely on an ultrasound for a proper diagnosis. Self refer if you can’t get your local doctor to refer you. Any issue should be followed up thoroughly and quickly. There are many excellent women’s health clinics including docs at Mayo.

amyb5 | @amyb5 | Mar 14 10:01am

I think a second opinion is a good idea. The thickness of the endometrium would be a top concern for me. Seeing more on an mri is to be expected, also if the ultrasound was done months before, gynologic anatomy is ever changing, often rapidly. An ultrasound & an mri are not comparing apples to apples. MRI’s are ordered to more thoroughly evaluate things.

Helen, Volunteer Mentor | @naturegirl5 | Mar 14 7:25pm

In reply to @lgrec "I’m going to get a second opinion soon. The problem is that my GYN can’t do..." + (show)

@lgrec I'm following up to ask if you've made an appointment for that second opinion. What did you decide to do?

lgrec | @lgrec | Mar 15 1:36am

In reply to @naturegirl5 "@lgrec I'm following up to ask if you've made an appointment for that second opinion. What..." + (show)

Thank you for asking! I did see another GYN, and she suggested that I get a follow up ultrasound and then she’ll do a biopsy. I still have surgery set for the end of April, bilateral Salpingo-Oophorectomy. The results will determine if I should get a full hysterectomy or if I can back off of the other surgery (if cancer free and the cysts have decreased). We’ll see and fingers crossed. I’ll let you know when I find out. Thank you

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