Question for DEE

[Guest guest]

Dee, saw my gyn today.... my ultrasound shows endometrial strip is 7ml, which is 2 ml above acceptable limit of 5. She says protocol dictates that I need to have a biopsy, but I am hesitant to have something invasive if it instead can be corrected with adjusting medications.

For the past 18 months, I have been using 5mg Norinthindrone (sp?) for 12 days every 60 days along with a .75ml Vivelle.dot patch. During this time I als tried compounded Prometrium 100 mg AM and 100 PM which I couldn't tolerate at all because of extreme fatigue and other side effects. I had two sonograms in that 18 months and the stripe was fine .

The 5 mg Norinthindrone caused such severe cramping the doc had me cut them in half for the last two cycles and the awful cramps went away, though the bleed was pretty much same volume and time. I strongly suspect however that the stripe increase is due to reduction in Norinthindrone.

I use topical testosterone, cream form and have a low normal level of testosterone even with this cream. My estrogen levels haven't been tested in about a year or so.

I tried to argue the doc out of the biopsy, but she just said it's protocol. Is it dangerous for me not to have the biopsy, or is she just covering her bases by insisting on it?

Dusty

[Guest guest]

HI Dusty,

Sorry to hear about the endometrial levels and your doctor is correct that standard protocol over 5ml in thickness (5mg or less is considered thin) is called for a biopsy at least and maybe a D & C..

I'm wondering though if she tried the progesterone challenge? I mean where a lot of progesterone is given to induce the blood flow and 'then' see where the lining level is? I don't really know if that would help or not but something I think 'I" would surely ask about.

I know how the Progesterone or progestins can give those side effects *sigh* and why I hate adding it to my own HRT (and don't) but I have always tried to keep up with the E levels so they don't go too high (not over 100) I'd ask to have those E levels checked too if you haven't recently.

One quote says this...

"If the echo (sonogram of the uterus) is not sufficiently thin, although this does not necessarily indicate anything more than proliferative endometrium, those patients may require either monthly progestogen or continuous-combined HT."

Some women do not lend themselves to a reliable assessment of the endometrial echo (at least not without saline infusion enhancement). Examples of such patients are those with an axial uterus, coexisting fibroids, marked obesity, and previous endometrial ablation.

2005The North American Menopause Society

I sure feel for you in your predicament and wish I did have some other answers. *sigh* and maybe it's a case of not being able to really see the sonogram clearly (as in the situations stated above) ?? For instance I have a fibroid so that might skew things up too. I am surprised since your other sonograms were fine and hoping it's nothing serious (which I doubt) but then you just never know. I think I might ask for a second opinion myself before I'd do anything invasive AND a 2nd sonogram. But....that's 'me'.

Good lucky Dusty, I can imagine what you might be thinking *sigh* but I don't think being a 7 when 5 is considered thin is dangerous just that the lining is thickening somewhat, so if a D & C is needed that's not too serious, (tho anytime we're put out for any kind of surgery has it's slight risks. I had one when I was in my 40's and have been fine ever since. Ironically mine was because I couldn't 'stop' bleeding and had these HUGE blood clots the size of my palm for almost a month. YOY... the things we women have to go thru. *sigh*

Dee~

[Guest guest]

HI Dusty,

Sorry to hear about the endometrial levels and your doctor is correct that standard protocol over 5ml in thickness (5mg or less is considered thin) is called for a biopsy at least and maybe a D & C..

I'm wondering though if she tried the progesterone challenge? I mean where a lot of progesterone is given to induce the blood flow and 'then' see where the lining level is? I don't really know if that would help or not but something I think 'I" would surely ask about.

I know how the Progesterone or progestins can give those side effects *sigh* and why I hate adding it to my own HRT (and don't) but I have always tried to keep up with the E levels so they don't go too high (not over 100) I'd ask to have those E levels checked too if you haven't recently.

One quote says this...

"If the echo (sonogram of the uterus) is not sufficiently thin, although this does not necessarily indicate anything more than proliferative endometrium, those patients may require either monthly progestogen or continuous-combined HT."

Some women do not lend themselves to a reliable assessment of the endometrial echo (at least not without saline infusion enhancement). Examples of such patients are those with an axial uterus, coexisting fibroids, marked obesity, and previous endometrial ablation.

2005The North American Menopause Society

I sure feel for you in your predicament and wish I did have some other answers. *sigh* and maybe it's a case of not being able to really see the sonogram clearly (as in the situations stated above) ?? For instance I have a fibroid so that might skew things up too. I am surprised since your other sonograms were fine and hoping it's nothing serious (which I doubt) but then you just never know. I think I might ask for a second opinion myself before I'd do anything invasive AND a 2nd sonogram. But....that's 'me'.

Good lucky Dusty, I can imagine what you might be thinking *sigh* but I don't think being a 7 when 5 is considered thin is dangerous just that the lining is thickening somewhat, so if a D & C is needed that's not too serious, (tho anytime we're put out for any kind of surgery has it's slight risks. I had one when I was in my 40's and have been fine ever since. Ironically mine was because I couldn't 'stop' bleeding and had these HUGE blood clots the size of my palm for almost a month. YOY... the things we women have to go thru. *sigh*

Dee~