Bulky Uterus

Age 48 yrs old..Last period was during Jan 2009 lasting for 5 days and the flow was moderate. The next period was in the 2nd week of May 2009 and it was heavy for 4 days. Meanwhile the USG of abdomen revealed uterus size 107 x 67 mm with endometrium thickness 9mm and it is echogenic.Due to medication Norethisterone 5mg three times a day for 3 days(from 20th to 22nd May 2009), the flow stopped. However, the flow/bleeding though not heavy started on 27/05/2009. Please advise course of action. athere is no pain or other abnormality in USG.

[Elaine Brown, MD]

Hi!
If you were to read a medical text on the subject, it would probably advise an endometrial biopsy.  This would certainly be the safest approach.  If you had no risk factors for endometrial cancer ( esp. obesity/diabetes/family history, etc), and if you prefered, I might consider treating with Provera or Prometrium for 14 days and then repeating the ultrasound scan.  I am also assuming here that you have not ever had 12 months in a row with no menstrual period ( that is the definition of menopause, and post-menopausal bleeding always warrants a biopsy!).

There are a couple of methods to control peri-menopausal irregular bleeding.  If you are a non-smoker, oral contraceptives can be used.  Hormone replacement therapy can be used also.  Some women prefer to take progesterone every 1-3 months as needed. The Mirena IUD is very nice in some cases like this.  OR an endometrial ablation can be a dream come true!

I would also recommend (if you were my patient) a follow up ultrasound in 6 months to re-evaluate the uterine size.  It is a bit above normal, but nothing to get alarmed about if it is stable.

Hope this helps!
Dr B

[rachna80]

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