1. < Gynecologic Cancers

Endometrial Ultrasound findings and next step suggestions

Posted by beebe @beebe, Nov 9 3:57pm

Ten years post menopause I noticed mild vaginal bleeding and contacted my primary care physician. She ordered a pelvic and transvaginal ultrasound ( I drank 5 cups of water in 1/2 hour, waited 1/2 hour, and then had the ultrasound; no peeing allowed before the ultrasound). The results are listed below:

OVARIES: Right was normal could not see left ovary due to gas? Should I insist the left ovary be checked out with further testing.
ENDOMETRIUM: markedly thickened and measures 2.3 cm. Careful follow-up is recommended.
ENDOMETRIAL STRIPE: markedly thickened. This finding is consistent with endometrial hyperplasia or neoplasia. Careful follow-up is recommended.

What does the pathologist mean by "careful follow-up". Should I expect to be referred for a Hysteroscopic examination after I see the gynecologist in January (yes, that is the soonest I could get in and she is a Nurse Practitioner so may not do the Hysteroscope procedure).

What are the medical procedural steps I should request/expect to get a reliable diagnosis?
I have been using a vaginal estriol cream for atrophy/extreme dryness. Should I discontinue use of it while I wait for a diagnosis? My Doctor thinks it is fine to continue with it. I am thinking of cutting the dose in half just to be cautious or may find a substitute and discontinue it altogether. Research shows it does not contribute to endometrial cancer but I wonder.
Any thoughts on how I should proceed would be greatly appreciated.

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beebe | @beebe | Nov 11 3:06pm

Was able to get an appointment with a Gyno Nurse Practitioner for this Wednesday. Will cross my fingers and hope I can get a referral from her for an Gyno oncology Doctor to do the more involved hospital hysterscopy. Thanks to everyone for all of your input, I will try to not be meek and will aim to stand firm on demanding the treatment I feel is needed.

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1 reply
lilacs777 | @lilacs777 | Nov 11 4:34pm

So I did run into that some of them wanted a 'referral' before you could sched. What I did was explain to my Primary care that I needed a referral b/c I'm high risk, etc etc and once he sent over the referral request with my basic med history/records to the gyne onco's office, they let me get scheduled. Also if you've had any genetic testing that shows BRCA or any other high risk genes, add that to it b/c that may bump you up.

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aardvark2118 | @aardvark2118 | Nov 11 4:47pm
In reply to @beebe "Wow, this sounds so much like my current situation. Did you have the more involved hysterscopy..." + (show)
@beebe

Wow, this sounds so much like my current situation. Did you have the more involved hysterscopy that Lilacs777 describes (not the in office procedure)?
Thanks for sharing!

Jump to this post

Yes I had it as an outpatient procedure. Just don’t want you to have any regrets for not pushing to get answers. I received the answer I hoped for, no issues, but always had the why question that I should have pushed

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gisellef | @gisellef | Nov 12 7:37am
In reply to @lilacs777 "@beebe I would strongly recommend hysteroscopy with D&C by a gyne onco rather than just a..." + (show)
@lilacs777

@beebe I would strongly recommend hysteroscopy with D&C by a gyne onco rather than just a regular gyne or pcp. The gyne onco will be able to give you more accurate info and more likely to biopsy the areas correctly in the uterus. I had done some research on accuracy of endometrial biopsies, pelvic us, etc since I was deciding on BSO vs TAH/BSO and I found out that overall you will get the best care for potential gyn cancer by going to gyne onco even for the initial testing. Also - hysterscopy with D&C for the endometrial biopsy is more accurate than in office endometrial biopsy. While in office is 'easier' b/c you don't need to be sedated, the doctor has to do it 'blind' so they're just guessing and of course that limits accuracy. With the D&C approach they can visualize and take additional samples as needed if they see other areas of concern. They also take out polyps and anything else that shouldn't be there, whether its benign or not. Idk if the vag estrogen alone could thicken the lining but whether to continue that is another good question for a gyne onco. I'm on aromatase inhibitor for BC but was told by the gyne onco that since it blocks all estrogen that significantly lowers my risk for uterine cancer. If you don't "need" to take the vag estriol, you can just stop it for now in case there is any estrogen responsive (pre)cancer cells growing until you find out more info. Best of luck to you, hope you get your tests soon and that you get all good news.

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Excellent advice from @lilacs777 What you do now is extremely important. Going with a strategy that offers the greatest margins of safety at the beginning of your treatment pays off later. You should always be treated by a gyne oncologist if there is even a chance of cancer present as the protocols in place will serve you well in the long run.

Best wishes for an excellent outcome and recovery.

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Mentor
Helen, Volunteer Mentor | @naturegirl5 | Nov 12 7:58am
In reply to @beebe "Was able to get an appointment with a Gyno Nurse Practitioner for this Wednesday. Will cross..." + (show)
@beebe

Was able to get an appointment with a Gyno Nurse Practitioner for this Wednesday. Will cross my fingers and hope I can get a referral from her for an Gyno oncology Doctor to do the more involved hospital hysterscopy. Thanks to everyone for all of your input, I will try to not be meek and will aim to stand firm on demanding the treatment I feel is needed.

Jump to this post

@beebe That's wonderful news. I'm so relieved for you that got in earlier. Yes, I know how difficult it can be to be assertive for your own care. I'm often uncomfortable but I do it anyway. So I would say you can expect to not feel totally comfortable and even a little nervous but please remind yourself that this is your health you are standing up for.

Will you please let me know what happens tomorrow at your appointment?

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Denise | @denisestlouie | Nov 13 2:43pm

Did they take any biopsies while doing the ultrasound? The ultrasound is needed to see what is happening, but the biopsy is what will determine the course of action.

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beebe | @beebe | Nov 14 7:26am

Went to my follow-up pelvic scan appointment with the gynecologist nurse practitioner yesterday afternoon. We discussed my ultrasound and then she said "Lets take a sample!". I replied "what do you mean?" "She replied, We'll see if we can stretch you enough to get a good view and sample". Sounds like fun, right? "
I, then told asked her if a hysteroscopy wouldn't be more accurate, she agreed and referred me to there hysteroscopy clinic. I asked to be referred to the gyno oncologist for the procedure but that is not allowed without a dx.
So unless I want to try to find a gyno oncologist outside of my healthcare system I will have a hospital preformed hysteroscopy.
She did comment that there is a shortage of IV solution so she did not know if the appointments were backed up due to that issue. Can't they do the procedure with some type of local anthestics that don't require IV drugs?

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1 reply
gynosaur42 | @gynosaur42 | Nov 14 7:57am

Whew, @beebe

I'm glad you advocated for yourself so effectively!! (There is no "let's see if we can stretch..." in my pain tolerance repertoire.)

I should say that a GYN did my hysteroscopy and did a wonderful job. I think I had implied earlier that you would want a GYN ONC for that and that may not be realistic. I'd be interested to hear if others had a different experience.

Given that there was no IV shortage at the time, I was plenty glad to have IV-based anaesthesia for that...I was scared before, but the procedure went smoothly and I had zero to minimal discomfort (nothing I would call pain) afterward. I can't quite imagine that it would be completely safe to do a hysteroscopy without at least a line in in case a problem occurs, for example if your blood pressure were to drop. I had to be without food or drink for several hours prior, and with only clear liquids from 8PM until the procedure the next morning before that, so was not exactly well-hydrated going in, making IV solution useful on that score, as well. Just thoughts.

I hope you can schedule your procedure soon. The waiting gets really challenging. Stay connected here if it helps you. I'll be keeping you in my thoughts.

Gynosaur

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beebe | @beebe | Nov 14 3:44pm

Now that I am in the waiting game to schedule my hysteroscopy procedure I have a question for you all....... How long should I wait to be contacted by the Hospital before I call and ask when I will be contacted......days, weeks?
They have dropped the ball on contacting me for a Mammogram in the past so I hesitate to be too lenient.

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1 reply
Mentor
Helen, Volunteer Mentor | @naturegirl5 | Nov 14 4:32pm
In reply to @beebe "Now that I am in the waiting game to schedule my hysteroscopy procedure I have a..." + (show)
@beebe

Now that I am in the waiting game to schedule my hysteroscopy procedure I have a question for you all....... How long should I wait to be contacted by the Hospital before I call and ask when I will be contacted......days, weeks?
They have dropped the ball on contacting me for a Mammogram in the past so I hesitate to be too lenient.

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@beebe I'd wait about 5 office days. So, I would call the hospital on Wednesday, November 20. That should give them plenty of time to process your referral.

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