charli et al - is this correct?

[BonBe]

Hi again.

I know I have been over this in my head many times, and I am prob for sure 'jumping the gun' but I keep going back over information and came across this little bit, in a CDN medical site just wanted to know if you knew if this was correct. The article is about the endometrial sampling vrs old fashioned D & C (I am from Canada)

everyone assures me it won't hurt that much, if at all... and I believe them.....but the little bit I read just now intrigued me as it was prob the first thing I have seen regarding my situation (menopause, and NOT on any HRT) cept for thyroid stuff.

"Postmenopausal bleeding. Any woman with postmenopausal bleeding who is not receiving hormone replacement therapy (HRT) requires endometrial sampling. About 7% of such bleeding is caused by malignancy,12 so postmenopausal bleeding should be considered to be from endometrial cancer until proven otherwise"

If this is a scare tactic? it shouldnt be, as I know that we all should be on top of any thing that is strange happening to our bodies? What (if you know) is the ultimate treatment for this thickness stuff, as per my age, 3 years menopause and stuff

Hope you and others can enlighten me

Bonnie

[Marimac]

The truth is always some where in between. The D&C is more invasive and there is always a risk of perforating the uterus resulting in an emergency hysterctomy. The sampling is not as simple as it sounds because if you are menopausal the cervix is likely to be shut tight as a drum and require painful process to enlarge the os so that a sample can be taken, this process has been known to be interrupted by a screaming female patient or two who could not withstand the procedure and told the doctor to knock em out or knock it off.

Theories abound about cancer and with so much litigation in the American medical field going on, the medical data on Cancer probabilities is suspicious as well. The only reliable thing is to go with your own opinion based on your knowledge of your doctor's competency. IF you don't trust it, don't do it. Cancer unfotunately can hide out until it is too late to do anything about it, or it can miraculously be engulfed by the body's high functioning immune system and be done away with. The statistics are not all in on that. Too many doctors taking credit for the body's ability to cure it self if left alone.
Back to the basic question, In well documented cases, post menopausal bleeding is suspicious for cancer, but not a definitive diagnosis.

[BonBe]

Thankyou for the honest opinion Marimac

Sorry but I am still in the 'pest mode' to your knowledge, considering my age, and length of menopause time (three years and counting) and this thickeness which was found via transvaginal ultrasound (1cm (or 10mm) if it is NOT cancerous (which I am positive thinking on that) what happens? how is it dealt with, or is it dealt with.

Boy I sound like a real idiot don't I, but since I have no one else in my family or friends who even KNOW what I am talking about without them getting all misty eyed, and ready to plan my memorial look (I do not let them know I see their sadness) they are really out in the field somewhere, and I really do appreciate these boards and the new friends I am making.

The last pap smear I have had (get them yearly by my family doctor and she has always been gentle and it has never hurt) UNTIL THE LAST TIME and I was one of those 'women' hollering out a very LOUD OUCH!!! she stopped immed. and the sampling was not conclusive according to the labs....I figured she was unable to get the cells she needed..... then all this happend (6 months after that exam). I was suppose to have a 'follow up pap smear' this month in fact (6 months later according to the lab) but this came up and I sure do not wish to have this or something like this done TWICE gee whiz.

Maybe the cervix has turned to the cement wall. It was always hard to get smears, and when I had my babies, the cervix did not even bother to dialate hence two emergency C-sections one 28 years ago, and the second one 24 years ago. My doctor used to kid me about me having the 'smallest cervix in town' I never knew what that meant, until now, when the fog is beginning to thin away.

HMMMMM

Bonnie

[csoar2004]

Hi Bonnie
Basically, there are two ways of sampling the endometrium: D&C (which not only samples but also treats) and endometrial sampling (which is inserting a small probe into the uterus and removing a piece of the endometrium).
Given that you have a stenotic os (fancy medical term meaning 'sealed cervix'), either of these may prove painful to you without some prep. I strongly recommend that you get your provider to use a topical anesthetic (like the stuff the dentist uses to numb up the gums prior to the shot of anesthesia). In addition, there are these tips that gyns share for getting through a stenotic oss:

Endometrial biopsy generally a simple task. But I've had my fair share of failed endometrial biopsies (EMBs), some resulting in trips to the operating room for dilatation and curettage (D&C). To keep you out of trouble, here aretips sent in by readers.

* The bent Pipelle trick.

Dr. Bo Li of Cleveland says the following trick has worked even on patients who had been scheduled for a D&C for failed office biopsy. If the Pipelle does not pass due to a very flexed cervix, use a sterile Kelly clamp to completely bend the Pipelle about an inch from the tip, making a dent. The dent may then allow the Pipelle to flex and pass an acute angle.

* A slick biopsy trick.

Dr. Stephen Rotholz of Raleigh, N.C., says that Dr. Alan Weingold, former chair of ob.gyn. at George Washington University in Washington, taught him to put a bit of K-Y jelly on the tip of the Pipelle. By doing this, he says he is able to perform the EMB without even placing a tenaculum about 80% of the time.

* The long Allis tip.

Dr. Richard Alvarez, an old friend of mine from Oxnard, Calif., told me to try using a long Allis clamp instead of a tenaculum to hold the cervix during office EMB's. I've tried this many times and it does seem to be much more comfortable for the patient.

* A better prognosis for stenosis.

Dr. Christopher Kaeppel of Houston points out that many times cervical stenosis is confined to the external os. He uses a disposable knife with a number 11 blade to stab the stenotic os and claims that this trick often immediately solves the problem. This sounds painful but perhaps no more so than the teeth of a tenaculum.

'Course, if your doc is using topical anesthetic such as Hurricaine gel, you won't feel any of it. In terms of what to do with the findings of the biopsy...

What is the Treatment for Endometrial Hyperplasia

The first step in the treatment of endometrial hyperplasia is a thorough evaluation of the endometrium by means of a D&C; this is essential in order to assess for the presence of atypia. Hyperplasia without atypia often regresses spontaneously, after D&C or progestin treatment. Progestin, such as provera, is given continuously, either by mouth or long acting injections. A D&C is repeated after 3-4 months of treatment to demonstrate resolution of the hyperplasia. Failure of hyperplasia without atypia to resolve (even if no atypia is found) in repeat D&C is cause for concern. A second course of medical therapy may then be tried consisting of high dose progestins. Following this course of treatment another D&C is performed.

Hyperplasia with atypia is considered precancerous. It is best treated surgically with hysterectomy. However, if a patient desires future pregnancy, a trial of hormonal treatment may be given. If a lower dose progestin regimen fails to clear hyperplasia with atypia, the patient may be given a choice between high dose progestin given continuously over a period of three months or hysterectomy. Failure of the high dose progestin treatment course to completely resolve the hyperplasia with atypia is a clear indication for hysterectomy. Resolution of the hyperplasia on the repeat D&C offers the patient the opportunity to try and conceive. However, she will require close medical supervision with repeat biopsies to monitor the endometrium.

In women before menopause, high dose progestin treatment with close monitoring is an accepted alternative to hysterectomy in cases of hyperplasia with atypia. In the postmenopausal woman with endometrial hyperplasia with atypia hysterectomy is recommended.

And this one:

Several studies have indicated that endometrial sampling is generally benign when the endometrial thickness is 5 mm or less. Although ultrasound cannot completely rule out malignancy, an informed patient may wish to stop the work-up if the endometrium is thin.

Get your doc some topical dental anesthetic so that he/she can get the next pap swab deep enough in the os to obtain those elusive endo cells.

Maybe the cervix has turned to the cement wall. It was always hard to get smears, and when I had my babies, the cervix did not even bother to dialate hence two emergency C-sections one 28 years ago, and the second one 24 years ago. My doctor used to kid me about me having the 'smallest cervix in town'

Sorry for the disjointed reply. Trying to answer a couple at once. Hope this helps!

best wishes,
charli
________________________
203/146/146 on the Fat Flush Plan for life and perky!

[BonBe]

thankyou charli, I have digested as much as I can understand. (I am really thick headed on things like this) and not ashamed to admit it.

I have printed up your reply


Thanks again
Bonnie