Risk factors and hysterectomy

I am 56, postmenopausal and using unopposed estrogen b/c of progestin intolerance.  I had endometrial biopsy 3--4 months ago under Pentothal, and it was fine.  I am due for another biopsy in January, but gyno said that Medicare would probably not continue to pay for this.

My gynecologist has suggested a hysterectomy because of the following factors:  unopposed estrogen use, history of severe cervical dysplasia (had cone biopsy), elderly mother just passed away from ovarian cancer (her mother died from breast cancer).  

Right now I am bleeding off and on.

I am afraid to have hysterectomy but also afraid of having cancer.  I have read so many hysterectomy stories where women end of with other problems.

How do I make an informed decision?

Thank you.

Patty

[Elaine Brown, MD]

Hi!

A couple of thoughts:

Have you tried natural progesterone?  It is often much more tolerable than provera, and only 10 days per month avoids a hysterectomy.

Are you sure you want to continue with estrogen?  You mention a family history of breast cancer.  Weaning of the estrogen avoids a hysterectomy.

Have you double checked the insurance issue?  With appropriate documentation, they may very well prefer to pay for an office biopsy and refuse to cover a hysterectomy with your current indications.

If you can truly say that you want to continue with unopposed estrogen for the foreseeable future, then, with all else being equal, hysterectomy may very well make the most sense for you, as your biggest risk is for endometrial cancer.

Make sure you are knowledgeable about surgical risks, eg. risk of transfusion, infection, injury to surrounding tissues like bladder, etc and then you have made your informed decision.

Good luck!

Dr B