Provera?

I am perimenopausal and because of irregular cycles (I skip a month then have two or three week period) I was given transvaginal and pelvic ultrasound.  Endometrium and one ovary were on the "high" side of normal.  My doctor sent me to a gynecologist who said everything was actually pretty normal for my age, but wants meto starton provera.  Now, I had a spontaneous blood clot five years ago and my brother died of a pulmonary embolism.  We ate all factor V Leiden.   I am on coumadin.  Do I risk taking a hormone??  I really feel fine, but I don't want to develop endometrial cancer.  Suggestions?

[Elaine Brown, MD]

Hi!
You pose a rather difficult question! I guess I would consider the options:

1) no treatment and surveillance with ultrasound every 3 months or so
    
2) biopsy now and treatment based on results (biopsy is not my favorite choice with a patient on coumadin, although usually there are no problems)

3) treat now with a 10-14 day course of Provera or natural progesterone (presumably your body is making progesterone anyway at least during some cycles) Because you are on Coumadin any increased risk might be offset.

4) consider hysterectomy for a permanent solution to the problem, OR endometrial ablation after a biopsy has ruled out pathology (you would have to normalize your INR before surgery)

I believe there are risks associated with any of the above, and I also believe that any of the above might be the correct solution for you.  It is going to boil down to which risks you feel most comfortable taking.  I think the only wrong answer would be to ignore the problem and do nothing at all.

Hope this is helpful!
Dr B

[rejemaky]

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