Endometrial Ultrasound findings and next step suggestions

Hello, @beebee

I do not know what you can expect, but imagine your thinking is in the right ball park. I base this on the experience of one patient, myself. I experienced post-menopausal spotting in December 2021. A gyn did a transvaginal ultrasound which showed a slightly thickened endometrial lining, and on exam found and removed a benign cervical polyp. After that I had no further spotting. Almost a year to the day later I had some more spotting. I joked it was my "time of the year." At that time, I expected the gyn to repeat the previous year's procedure. This time she recommended a hysteroscopy before I even saw her, getting me in a month later, during which cancerous tissue was extracted. I do not know what prompted her to raise my level of care (a second occurrence of spotting? the fact that I reported that a sibling had died 5 months previously of endometrial cancer? something else?), but I am grateful the cancer was found at a point at which it was removed completely by the hysteroscopy. Because of it, though, and them not knowing the extent of growth or whether there might be other tumors in parts of the uterus that were not reached by the curettage completed during the hysteroscopy, the only treatment plan recommended was total hysterectomy, oophorectomy, salpingotomy and bilateral sentinal node biopsies. No further malignancy was found for me during that procedure. As upset as I was at the time to learn that this was the best option medical science could offer, I feel profoundly blessed to have had this caught so early and to have this group as a resource, in part, to remind me of the value of living in the present.

I imagine other members of this group will have had similar or different experiences and can share their experiences and thoughts as well. Waiting, and enduring uncertainty, are two very challenging experiences for me. I will be thinking of you as you wait to meet with your GYN NP (underrated professionals, in my book) and hope that they are able to give you a clear sense of pathways forward for you and that you ultimately receive good care with excellent outcomes.

I wish you

Gynosaur,
Wow! You really dodged a bullet. I thank you so much for sharing your experience with me. It looks like I should insist on a hysterscopy to rule out things the ultrasound would miss. My Mom did have a D&C at about my age but did not write down the findings. I only found out about the procedure after her death (from other causes) when I was reviewing her paperwork.
Thank you so much for your encouraging words:)

The same happened to me 4 years ago; After total H, I was checked every 6 mo with a pelvic and Pap smear. All ok, Then, last year 2023, I had a strange discharge; saw same surgeon who upon doing a pelvic found a small mass; after biopsy I found I had endometrial cancer and needed a lot of radiation, some chemo. Seemed to be gone, then this September, upon a scan, we found it grew back. So now I'm on immunotherapy. One treatment so far and feeling fine. BUT, my suggestion is although you had a complete hysterectomy get CT screenings often. Recurrences do happen so you need to be proactive.

@beebe Welcome to our support group. @gynosaur42 explained in wonderful detail all the steps she had to diagnosis of endometrial cancer. My steps were very similar to hers although in a shorter time period. I was postmenopausal (age 67 at the time) and noticed spotting. I saw the gynecologist who first ordered ultrasound. The results showed thickened uterine lining (endometrium) and "suspected cancer" was indicated on the pathology report. That got my attention and of course the attention of my gynecologist as the pathologist cannot diagnose without actual tissue but using these words means to continue evaluation. I had a D&C with hysteroscopy and since the tissue from the D&C was sent to pathology now they had a biopsy to evaluate. The result was endometroid adenocarcinoma, FIGO Grade 1. All of this happened within a few months from initial evaluation in May, 2019 to D&C/hysteroscopy in late July 2024. Since the recommendation was hysterectomy which isn't performed in my rural community I was referred to Mayo Clinic in Rochester. My appointment was just days later and by the first week in August, 2019 I had the same surgery as @gynosaur42. My diagnosis after surgery was endometrioid adenocarcinoma, FIGO Grade 1, Stage 1a.

With all of this explanation my thoughts for you are to continue with the evaluations. If this were me I would call and pester the gynecology office to get me in sooner and/or ask to placed on a list for a phone call in the case of a cancellation.

I was also using vaginal estradiol which worked wonderfully for me. After diagnosis and the hysterectomy I was advised by the GYN-Oncologist and subsequent oncologists I have seen not to use that estrogen product any longer. But this was after diagnosis. In your case I would ask the gynecologist that question. If you cannot talk directly with the gynecologist then you might message or talk with their nurse and ask for that information.

How are you feeling? Any more spotting? Are you have pain anywhere?

Will please fill me in with any updates that you have?

Helen,
Thank you so much for your input. I will start calling the Doctor's office daily to check for cancellations. They do not keep a cancellation list anymore.
So far the spotting is intermittent and with it comes the heavy feeling in my lower abdomen that use to warn me that my menstrual period was about to begin.
I will reduce my estriol dose for now. My Aunt had a hysterectomy in her 30's which was hush, hush. Hopefully I can find out why from my cousin.

@beebe Good plan. I am hopeful that with your daily phone calls you will get an appointment soon.

@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.

Hello. My experience is similar to others. Had spotting which stopped before the ultrasound. Ultrasound came back ok. Continue to monitor and see you in a year. Never received a reason for the spotting and even though the questions were in the back of mind I let it go. Almost a year later spotting started and stopped. Had ultrasound which indicated thickening. Then biopsy showed stage 1 endometrial cancer. Total hysterectomy and final pathology stage 3. Chemo and both forms of rad and am now 1 1/2 years in remission. I’ve lived with and will continue to live with regret that I didn’t push fir more testing after first spotting to find out why. Had I had the biopsy the first time it might have been caught at stage 1. So my advice is to keep pushing until you get an answer Best wishes to you

I hope I can get into a gyne onco. I was told by the scheduler that they do not take patients until they have a diagnosis. If the medical system I am in holds the line on this policy it sounds like I should look outside of the system so that I get an accurate diagnosis.
Hopefully the Nurse Practitioner I am scheduled to see will have a way around the rule.

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!