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Menopause (Expert Forum)
How accurate are D
Answered by
Machelle Seibel, MD - Women's Health, menopause, ReproductiveMedicine
University of Massachusetts Medical School
MA
Questions in the Menopause forum are answered by Dr. Machelle Seibel. Topics covered include menopause issues, depression, hormone replacement therapy, hot flashes, joint or muscle problems, memory problems, mood swings, osteoporosis, sexual problems, skin changes, sleeping problems, vaginal problems, and weight problems.
How accurate are D
by heart2heart, May 10, 2006 12:00AM
I went to my dr. yesterday and was told I need a D&C for prolonged bleeding. I am 54 yo and not yet in menopause. I've had this procedure before and I don't like the expense and inconvenience and risks with the anesthesia.My last one was 3 yrs ago and was normal. Should I have an ultrasound done instead of the D&C? How accurate are these D&C's anyway in diagnosing cancer or precancerous hyperplasia. Possibility of cancer is our biggest concern but this may all be just my hormones gone out of wack.
Doctor's Answer
by Machelle Seibel, MD, May 10, 2006 12:00AM
, May 10, 2006 12:00AM
A. You are asking the right question about concern: Is this just your hormones or is it cancer? That is why doctors do a D&C; to answer that question. The scraping off of the lining does two things; it generally corrects the bleeding for a while and it tells if there is cancer or a polyp or other cause of bleeding. The D&C is very accurate. A normal D&C 3 years ago is a very good thing but it doesn’t mean things haven’t changed. However, on the good side, it does take cells longer than 3 years to turn into cancer so in theory, the worst it should be is precancerous, but that is only in theory.
The ultrasound can tell sometimes if there is a polyp (a benign growth) and if the lining is thick (which is associated with cancer but not a diagnosis of cancer). If you have the ultrasound and the lining is thin (4mm or less), you might not need a D&C. If it is 5mm or more, you still need to have the lining checked. Your doctor might consider doing an office biopsy by placing a thin catheter inside the uterus and scraping off some cells to look at under a microscope. That will give an idea if there is a problem but can miss things. A biopsy doesn’t cure bleeding problems. If the biopsy if “normal” your doctor might be willing to treat the bleeding with hormones and not do a D&C, but that depends on your history and the doctor’s comfort with not knowing for sure if there is a more significant problem.
There is an office procedure which is between the biopsy and a D&C called a Vabra Aspiration. Sometimes they are known by other names but it is like a biopsy but a syringe is used at the end of the catheter to gather more tissue. The catheter for this is usually a little bigger than the ones used for a biopsy and so the procedure is a more uncomfortable but it gets out more tissue which does give a little more information without doing a D&C.
Machelle M. Seibel, MD
The ultrasound can tell sometimes if there is a polyp (a benign growth) and if the lining is thick (which is associated with cancer but not a diagnosis of cancer). If you have the ultrasound and the lining is thin (4mm or less), you might not need a D&C. If it is 5mm or more, you still need to have the lining checked. Your doctor might consider doing an office biopsy by placing a thin catheter inside the uterus and scraping off some cells to look at under a microscope. That will give an idea if there is a problem but can miss things. A biopsy doesn’t cure bleeding problems. If the biopsy if “normal” your doctor might be willing to treat the bleeding with hormones and not do a D&C, but that depends on your history and the doctor’s comfort with not knowing for sure if there is a more significant problem.
There is an office procedure which is between the biopsy and a D&C called a Vabra Aspiration. Sometimes they are known by other names but it is like a biopsy but a syringe is used at the end of the catheter to gather more tissue. The catheter for this is usually a little bigger than the ones used for a biopsy and so the procedure is a more uncomfortable but it gets out more tissue which does give a little more information without doing a D&C.
Machelle M. Seibel, MD
