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Adenomyosis versus hyperplastic changes of the endometrium
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Adenomyosis versus hyperplastic changes of the endometrium

I'm a 59 year old post menopausal woman who recently had my 4th follow-up transvaginal ultrasound because of a small ovarian cyst.  The cyst is still there (but quite small), however, my latest ultrasound has caused my doctor to schedule an endometrial biopsy for me.  Here are the findings:  "The endometrium measures 5mm in thickness.  Tiny cystic changes are noted involving the endometrium.  This finding was not seen on previous examinations.  There is trace amount of fluid in the cul-de-sac."  Impression:  "Leiomyomatous uterus.  Adenomyosis versus hperplastic changes of the endometrium."  My doctor said that these changes could be due to Vagifem 25mcg which I've been taking twice a week for approximately 2 years.  She said I could stop the Vagifem for 3 months and have another ultrasound, however, she recommends that I have the biopsy now.  Can you please explain what "Adenomyosis versus hyperplastic changes" means?  And would you suggest a biopsy based on these results?  My doctor told me that I don't have to stop taking the Vagifem, however, I don't feel comfortable taking it now.  Do you feel I should discontinue?  Thank you for your assistance.
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603463_tn?1220630455
Hi!
If you were my patient, I would also give you the option of taking progesterone for 14 days and having a "period"  followed by another ultrasound afterwards.  The changes that they are noting in your uterus are VERY mild and the thickness of the lining almost entirely rules out cancer of the endometrium.
However, if the progesterone did not help, or if you didn't want to take it, I would suggest a biopsy.  They are fairly quick and can be done in the office. I won't say painless though.  Adenomatous and hyperplastic means that there is possibly a build up of glandular tissue within the uterus due to stimulation of the endometrium by estrogen (Vagifem).  The tissue needs to be sloughed (drained) somehow, or it might continue to build up and eventually become cancerous.
Hope this helps!
Dr B
6 Comments
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Avatar_m_tn
Adenomyosis versus hyperplastic changes means that it can be either of them. Adenomyosis is the presence of endometrial tissues within the myometrium. Hyperplastic changes means that the endometrium is growing in an exaggerated proliferative way.

It will be better to do the biopsy as soon as possible. Vagifem can be the cause of the hyperplastic changes, if the biopsy proves that these are hyperplastic changes.
I feel you must stick to what she said and follow-up regularly.

Regards
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Avatar_f_tn
Thank you for the explanation.  The biopsy is in a week....I must say I'm not looking forward to it.  Thanks again.
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Avatar_m_tn
Don't worry. The biopsy will be of great value so that hyperplastic changes can be excluded or confirmed. Wish you all the best.

Regards
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Avatar_f_tn
Thanks again.  At this point, I'm more apprehensive of the procedure itself.  
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Avatar_f_tn
Thank you, Dr. Brown, for putting my mind at ease.  I will talk to my doctor about a course of progesterone.
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