Confused...please help

[michelle27440]

I went the my doc recently because my periods would last for weeks at a time with a few days break and then start back up again, sometimes very heavy with a lot of clotting but mostly regular to light…but very dark and thick…to almost black.  I have not been experiencing any pain other than the occasional cramping.  This has been going on off and on for almost a year now.  The only symptoms I am having other than the irregular bleeding is extreme mood swings, fatigue, my hair is thinning very badly, and acne, which I have never had problems with.  During my visit, the doctor did an vaginal ultrasound which showed that the lining in my uterus is thicker than it should be, 1.8cm.  He ordered blood test and did a pap test.  Everything came back normal except it showed that I am a little anemic.  When I went back, he prescribed me birth control pills to take and something for the anemia. I had my tubes tied after my third child, so that is why I have not been taking them before now.  He then said I had two options….Novasure or a D&C.  I asked why he thought the lining was thicker than normal  and his answer was which ever procedure I chose to have would give him that answer….and then he showed me a diagram of a uterus that showed a thickened lining and two different kinds of tumors or masses, im not sure, and said that it would tell him which one I had.  I am very confused and I plan on getting a second opinion. What are the normal procedures for something of this nature, so when I do go for a second opinion I know what questions to ask.  Thanks for any advise you can give.

[Keith Downing, MD]

Hello,

First you want to make sure you have had an appropriate evaluation for irregular menstruation.  This would include ruling out pregnancy, endocrine abnormalities (e.g., thyroid hormone changes), structural lesions within the uterus (like endometrial polyps/fibroids) by office hysteroscopy (i.e., looking inside the uterus with a small camera) or sonohysterogram (instilling saline into the uterus while simultaneously having a ultrasound, considering anovulation (not ovulating monthly) and depending upon your age and risk factors performing an endometrial biopsy to look for abnormal tissue inside the uterus (e.g., endometrial hyperplasia or cancer).  With those results proper treatment can be instituted.  

Irregular bleeding, depending upon the cause can be managed in different ways ranging from medical hormonal management (e.g., the pill, or the Mirena IUD), minor procedures (e.g., endometrial ablation), or major surgery (e.g., hysterectomy).  I agree you should seek out a second opinion to make sure your evaluation has been complete and to hear all of the possible management options.

Best regards,

Dr. Downing

[michelle27440]

Thank you very much for you time, this helps tremedously.