Post Menopausal bleeding

I am 56, in good health, post menopausal LMP 06/07. I have been on HRT,  ClimaraPro patch for 3 years for wicked hot flashes & resulting lack of sleep. I initially began wearing 1/2 patch with good results.  18 months ago I began having bleeding.  My GYN did a biospy and ultrasound.  Ultrasound was normal and biopsy showed proliferative endometrium.  She suggested I begin wearing a whole patch as the resulting increase in progesterone could very well take care of the problem. When I start to spot I can trigger a "period" in  2-3 days by removing the patch. I put a patch back  on after things are cleared up, usually  7-10 days.  Since January 2010 the frequency of bleeding has increased to every 2-3 months.  I had a repeat biopsy today and my GYN is suggesting a hysterectomy.  She says oral progesterone  or D&C are not very effective in dealing with proliferative endometrium.  I could also go off HRT & see if things correct themselves but the thought of severe hot flashes & not sleeping are not very appealing either. Any guidance you can give me would be greatly appreciated.

[Elaine Brown, MD]

Hi!
Oral progesterone works well.  The best regimen is the low dose daily regimen.  Alternatively a Mirena IUD could be placed and would likely solve the problem.
Finally, an endometrial ablation could be done, most likely with excellent results.
I would certainly try a few other things before going straight to hysterectomy!

Good luck!
Dr B