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Gynecology

Thick uterine wall

04/03/2008

Question:

Last month I experienced very unusual heavy "flooding"/menstration. The bleeding was very heavy and contained many large clots (although now based on some things I have read; a bit smaller than golf ball sized are sometimes on the "small end" for some!) Because the bleeding was unusual and it scared me; I went in to the emergency room. They looked at me like I was nuts; and then later decided to do a vaginal ultrasound. The ultrasound showed that I had a thick endometrial wall. I was discrhaged and told to take 600mg of Motrin and that probably would slow the bleeding down, which it did. The following week I went to my gynecologist and she did a CBC, pap and internal and all came back normal. She did say that she wanted to do a sonohysterogram which I went in for this past Friday. Upon going in to the room, I was given another vaginal ultrasound which did not show any fibroids (but that is why my doc told me that she wanted to do the sono; because sometimes it shows what vaginal ultrasounds don`t so I`m not even clear why this was re-done) After the vaginal ultrasound, the doctor came in and ATTEMPTED to do the Sonohysterogram; but said I had a high cervix and she was unable to be sure of positioning of the cathedar for the Sono. It hurt when she was trying to insert it and I think she realized it was not positioned correctly. The tech then reinserted the vaginal wand and it only showed saline in the cervix, not in the uterus, and the procedure was almost abruptly ended. The doctor then told me that because my wall was thick (13 mm), she thought I better have a D and C and one thing they would do was check for uterine cancer. A side note to this....my period this month was normal (although I was taking 10mg of Provera as prescribed by my gyne that I started on day two of my period, for 10 days..only because I felt I was not doing as the doc ordered) I had no spotting between last months period and this month and the period lasted the normal amount of time as it always has. My question to you is....is it normal for a doc to "rush" to go the D and C route after one month of heavier than usual bleeding? I have been dealing with a lot of stress caring for a terminally ill family member, was VERY sick myself the months of Dec and Jan, and KINDA thought perhaps that was why the change in my cycle during the "flooding" month. Also; I am 42 years of age and I`m in the "Peri" period of menopause. I expressed my concern about rushing in to the D and C and was told "I wouldn`t tell you to do this if I didn`t think we needed to find out why the wall was thick". Don`t some women just have thicker walls? While I realize a Pap is done for Cervical issues, wouldn`t something show in that along with my bloodwork, that would indicate if there was something more to be alarmed with? I haven`t slept in days fearing the worst. Oh; and because I`m heavy I was told that I am at a far greater risk for Endo/Uterine cancer. Wouldn`t my hormone levels be off if the extra estrogen found in heavier women was present? Is "wait and see" for a couple/three months completely out of the question, just to see how my periods go?

Answer:

If you really only had one heavy period and otherwise normal periods with normal frequency, then you could be watched. The thickened lining of the uterus is only significant for looking for endometrial cancer in postmenopausal women, not premenopausal women. The most important thing a sonogram would be looking for is a fibroid. If your CBC didn't show anemia, then your bleeding wasn't even significantly heavy. If, on the other hand, you have been having very irregularly spaced cycles wit varying lengths and frequencies, and are at increased risk, then you should undergo a D&C. Along with your D&C, you should undergo a hysteroscopy too in order to be complete.

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Response by:

Thomas  A deHoop, MD Thomas A deHoop, MD
Formerly Associate Professor of Clinical Obstetrics and Gynecology
Director, Medical Student Education
No longer associated