Enlarged uterus! Very concerned about results

History of menorraghia . 46yrs,s periods every 23 days usually lasts for 2 heavy days & 5 days light spotting. I had an ablation done in 08 but right back to heavy menses in 09. uterus always been retroverted.OB/GYN  tried to do an endomentrial biopsy today but was unsuccessfull  & now wants to schedule a D&C . I am very concerned about a recent ultrasound report that reads as follows:
Findings(Transabdonimal) study has a prior study for comparison dated 12/7/09. At that time, the endom. measured 7 mm. There is a small posterior leiomyoma that measured 1.2 cm. Currently, the uterus  in a normal anteverted anteflexed,orientation, but has enlarged since the prior study, currently measuring 13.9. x 7.8 x 5.6 cm compared to a prior measurement of 8.8x 6.9x5.9 cm. The endometrium measures 12 mm, which is mildly thickened and is considerably thicker than the previous measurement of 7 mm. The right ovary 2.1 x 2.2.x1.9 cm There is a cyst in the left adnexa measuring 1.7 x 1.2x1.3 cm. There is no free fluid within the cul-de-sac.
Conclusion: The uterus has gotten considerably larger than on the prior study & endometrium is thicker than on the prior study.Findings TRANSVAGINAL: high resolution transvaginal techniques, pelvis was evaluated. uterus measures 13.9.x7.8x5.6 cm The endom. is well seen & measures 12 mm. There is a small simple cyst in left adnexa measuring 17 mm. The right ovary is grossly normal measuring 2.1x2.2x1.9cm.  no evidence for a leiomyoma.CONCLUSION:1. diffuse & heterogeneous enlargement of uterus with mild thickening of the endom., but  don't see a discrete leiomyoma. Also had abnormal Pap test with endometrial cells (!?) however the pap test was done on the last day of my period where i still had slight spotting so could that have effected the Pap Test?
Could this be of concern for cancer? Can a D&C be done under twilight anesthesia? And last not least is D&C the next necessary step or can an MRI give a good conclusion before doing the invasive D&C.

[Elaine Brown, MD]

Hi!
I'll try to anwer in order!
This is how I would counsel a patient of my own:
The enlargement of the uterus is most likely caused by adenomyosis which is a form of endometriosis, and is benign. Yes, doing the pap on the last day of your period could have affected the results. I would not be too concerned especially since you are not menopausal.  There is a very small possibility of cancer. A d&c can be done under many different types of anesthesia, depending upon patient wishes and the anesthesiologist's recommendations.  I believe that d&c is what is needed next.  An MRI can't give a sample to the pathologist, and that is what is needed to rule out cancer.
Hope this helps!
Dr B

[mandy64tampa]

Thanks so much have a few more question. So if a D&C is done and cells are none cancerous what is next? Is a hysterectomy needed for adenomyosis? And how is adenomyosis detected witha  D& C also?
He also said something about a scope. Maybe he is taking some device to look in there.? What is the best way to know if it is Adenomyoisis? Would an MRI do any good?
THanks in advance