Fibroids and vaginal bleeding

@leeosteo I’m presuming that you posted your question here because you are concerned you might have a gynecological cancer?

I was 67 when I noticed spotting/bleeding over a few days. I also had fibroids that were removed during a D & C about 10 years prior to that. I went to the gynecologist when I saw the spotting. About one month later I develop cramps that were unlike any I’d had since the age of 13 or 14. By then I was already scheduled for another D & C and hysteroscopy. After the D & C all the symptoms went away. However, the biopsy showed endometrioid adenocarcinoma.

My advice to you is to get that checked out as soon as you can. It could be fibroids but it could be something else. If I were you I’d insist on a follow up that could include the following which is what I had: ultrasound (that showed a thickened endometrial lining and two small fibroids), and then the D & C/hysteroscopy. My gynecologist thought I did not have the risk factors for endometrial cancer but actually I did. I had a late menopause (after the age 55) and never had children. Two risk factors.

Will you call or make an appointment with your gynecologist on Monday?

Helen, thanks for the reply. Yes, I'm concerned as to what this might be. I just know bleeding at this age is not good.

What did you do when they found endometrioid adenocarcinoma? Did the D&C/hysteroscopy resolve this? or did you have a hysterectomy? I also found out I have osteoporosis and want to save as much estrogen as my body can produce at this age. My understanding that after a hysterectomy you produce little, if any, estrogen. Although I'd have to research this.

@leeosteo Yes, bleeding in our age group is not good.

When the endometrial cancer was diagnosed by pathology my gynecologist called me as soon as he got the report and invited me to come in that day without a prior appointment to review. We live in the Upper Peninsula of Michigan and there wasn’t (and still isn’t) a surgeon who treats cases like mine. I asked for a referral to Mayo Clinic and got in to the Surgical Dept. Of Gyn-Oncology within a few days. The recommendation by the Mayo Clinic surgeon was a hysterectomy with fallopian tubes, ovaries, and cervix also resected. This all happened within 10 days of the diagnosis. After surgery, the cancer was diagnosed as endometrioid adenocarcinoma (like the original pathology) staged at 1a, FIGO Grade 1.

Like you, I have osteoporosis. I was taking Fosomax already at the time of the hysterectomy, doing weight bearing exercise and everything I could think of to preserve bone density.

Are you already seeing an endocrinologist? If so, then this is a discussion to have with that specialty in the event that you do have a hysterectomy - which I do hope will not be the case for you.

I’m very unclear on the role of the ovaries after menopause and how much estrogen is produced. Like you I have to do more research on this.

Have you found any articles you can recommend on the topic of estrogen after hysterectomy post menopause?

I began with intermittent vaginal spotting / light bleeding and a negative endometrial biopsy at age 69. Vaginal ultrasound showed thickening. Symptoms persisted and a 2nd biopsy at age 70 revealed adenocarcinoma / endometrial cancer FIGO 1. Cat scan revealed tumor had not escaped the uterus. Had a complete hysterectomy performed robotically within a month. No more treatment necessary. Feeling great 6 months out. No more stained panties ! Recent mammogram showed no cancer there. God is good and I feel blessed!

Helen, did you go to the Rochester Minnesota Mayo location? That was great got in so quickly. Did your doctor recommend any type of hormone replacement after the hysterectomy.. even though your age was post menopause?

My endocrinologist appointment (for osteoporosis) is in August. I've had to wait 8 months to get this appointment. I've never seen an endocrinologist so this is new for me. My PCP referred me. I'm doing everything within my power to improve my osteoporosis prior to the appointment. Changed my diet, weight bearing exercise and a few tests that my PCP felt comfortable prescribing, e.g., 24 hr urine calcium, CBC, CMP, NTx.

I have not done any research re estrogen levels after a hysterectomy other than a few brief articles on line. The Mayo Clinic must have some information on this online? My parents went to the Mayo Clinic in AZ for over 20 years. As a result the Mayo is my primary source for all medical issues.

Wrightvillebeach, I'm glad you ok now. When you first began your symptoms did your GYN go immediately to an endometrial biopsy? How is that different from a PAP smear? My PAP smears have been negative since the beginning. Did you have fibroids?

@leeosteo Yes, I was referred to Mayo Clinic in Rochester. No hormone replacement was discussed after surgery. I did continue to use, on the OK of the GYN-Oncology surgeon, the estradiol vaginal cream for vaginal dryness. I had to discontinue using it after my recurrence when the oncologist told me I need to move to a non-estrogen vaginal moisturizer.

I’m still waiting to make an appointment with an endocrinologist. I’m hoping it will be in September when I return to Mayo for other appointments including my next cancer surveillance follow-up. I’m expecting lots of labs and tests with endocrinology. I’ve already made major alterations in nutrition and diet on the advice of the integrative medicine physician that I see at Mayo Clinic. I’ve been weight-lifting for 30 years and changed it up to be more effective and less likely to injure myself.

I go to Mayo Clinic in Rochester for all my specialty care. I have a primary care physician in my local community that I like and we work well together.

Pap smear may have been done same day as first biopsy. All were negative. My cancer was a slow growing type and perhaps it had to get larger to be detected. I was first told it might just be a “ sloughing off of old cells” and yet was also told that the thickening detected by the vaginal ultrasound was “ not normal” . Just decided to monitor it. It took a year and a positive biopsy to move into action. The hysterectomy was the right thing to do in my case. Wish it had been done a year earlier. Seventeen years post menopausal with any kind of spotting is not normal… uterus and ovaries were no longer needed so take them out ! The DaVinci Robot makes recovery period very short. There were only 5 one inch incisions and I did not stay in the hospital overnight. My surgery was Dec. 7 and I was able to enjoy Christmas. (I had great home care from my husband - a retired family physician who knew exactly what I needed each step of the way. ) I slept in a recliner chair for better part of first week but was able to climb stairs after a few days.

Your very fortunate to have access to the Mayo Clinic and a PCP who will work with you.

Wrightvillebeach, thanks for sharing your experience. Did you have fibroids?