Medical test options for post menopause spotting, cramps

My situation was somewhat different, but the two main options that I know of are an office biopsy and a "hysteroscopic D&C," which is done in the hospital under anesthesia. I had both of these, or rather, I had a failed attempt at an office biopsy, and then a month later had a D&C. From reading this forum, it sounds like failed office biopsies are quite common. It should be somewhat comparable to a pap smear, except that they have to push the little plastic stick through the cervix. Not being able to get through the cervix seems to be the cause of failures. I learned on this forum that some doctors have women put misoprostol pills in their vagina prior to the office biopsy to soften the cervix, which apparently reduces the failure rate.

My 2 cents worth is that you should definitely at least have a biopsy: you don't just have slight endometrial thickening, you have symptoms too. If a D&C is possible with your vaginal narrowing, it might also make sense to go straight to that, in the hope that they might scrape out whatever is causing your problems, even if it is "benign."

@leeosteo I had similar symptoms as you when I was 67-years-old. My symptoms began with spotting (post-menopausal) and after that occurred twice I called my gynecologist. Over the period of about a month I had an ultrasound that showed a thickened endometrial lining and then a D & C with hysteroscopy. I didn’t have an in-office biopsy which is just as well because during that one month period I developed cramps that got worse. The cramps went away after the D & C and I had two fibroids that were removed however my results showed endometrial adenocarcinoma, FIGO Grade 1.

Like @val64 I learned here that some gynecologists prescribe misoprostol which dilates the cervix so that a uterine biopsy can be performed. I also agree with @val64 that since you have both the thickened endometrial lining and vaginal bleeding with cramps that it makes sense to go ahead with the D & C. The results of the D & C may show that the curetage of the uterine lining with the fibroids take away your symptoms and the pathology report will show no evidence of disease. I do hope that is the case for you however I think you should go ahead with the procedure soon.

How are you feeling tonight and what you thinking you will do?

Only difference is ,in the hospital you'll be put to sleep. That's how I had to do it but with me they couldn't get a biopsy still due to my cervix not opening...

I had similar experience. Tried the office procedure which didn’t work. Had hysteroscopy and d&c in the hospital which was easy. Prescribed misoprostol night before. Don’t wait until uterine lining is 10 or greater.

val64, thank you for responding. I agree a biopsy should be done at minimum. I don't want to wait and risk a bigger issue down the road.

Helen, thanks for your reply. Fortunately, I was able to get my August 25 GYN doctor consult appointment moved up to this Monday, July 31. I appreciate you and val64 sharing your experiences. This gives me a good idea of questions I should be asking the dr. How thick was your endometrial lining when you had the D&C?

aardvark2118, thanks for sharing your story. May I ask how thick your uterine lining was when you had the hysteroscopy and d&c?

Helen, did you have any issue with a narrowing of your vagina?

aardvark2118, another question... sorry for another message... this is all new to me. Did this procedure fix everything for you? Meaning, was your doctor able to determine what the issue was after the d&c?

Hello. Mine was measured at 17 and unfortunately endometrial cancer was identified. Don’t wait until the lining gets thicker to do the biopsy. I don’t like to share negative experiences but I had spotting first in 2021, had ultrasound and was told everything was ok. See you in a year (spotting had stopped). Wish I had thought to ask for a biopsy or at least repeat ultrasound in 3-6 months to determine cause vs waiting a year (when coincidentally the spotting started again) . When spotting started again went back and had the hysteroscopy and d@c And unfortunately endometrial cancer was identified. had a radical hysterectomy Dec 23 2022 and final pathology identified stage 3 endometrial cancer. Had I had the biopsy in 2021 could chance it would have been caught at stage 1. Good news finished chemo in may Just finished external beam radiation Tuesday and will finish up with brachytherapy in a couple of weeks. Have been lucky chemo and radiation have been pretty easy My advice. Don’t wait fir the lining to get thicker if you can get the biopsy now. Will be thinking of you on Monday