Need answers!

Doctor,
I am so frustrated with not getting answers from my gynocologist. I need an expert opinion on what to do next.  I am 50, almost 51 and for the last year have had the following symptoms:  bloating, constipation, fatigue, feeling of fullness, urinary urgency (but no UTI) and I have had a TVUS.  The ultrasound showed cysts on both ovaries, a mass on my uterus and "things" floating around that they think might be ademyosis.  I have friends and family all telling me that I am just in menopause and that's all. My gyn put my on progesterone for 2 months (a 10 day regimen each month) but I did not bleed nor did I start a period naturally.  For the last year, I have had sporadic periods. The last one in November.  His latest recommendation is 1. Double the progesterone 2. Have another ultrasound or 3.  Do nothing!

I feel that with all my symptoms, doing nothing is irresponsible. I don't see the purpose of the progesterone as it hasn't induced any bleeding yet.  

What would you advise me to do? and thank you so much!

[Machelle Seibel, MD]

It can certainly feel frustrating with the symptoms you are having. It is always difficult to answer with certainty without an exam and more information, but here are some general considerations that might be helpful. The most worrisome thing you could have with the symptoms you are having is ovarian cancer. But your ultrasound suggests that is not the case. Small cysts are usual. If the cysts are large, bigger than a quarter, then repeat the ultrsound in 2-3 months. That size or smaller won't cause the symptoms your having.

An enlarged uterus can make a person feel full and have urinary urgency. Adenomysis isn't things floating around. It's lining of the uterus that has invaded the inner muscle of the uterus making the uterus bigger because it is full of extra tissue, and often causing bleeding that drags on because the uterus can't clamp down on the blood vessels to make them stop with all that tissue in it. There is no cure for that. It gets better with menopause or it can be treated with medications or removing the uterus.

If progesterone doesn't cause a bleed, more progesterone might not either. Sometimes going on the birth control pill for a few months can help the adenomyosis and it will cause bleeding to occur which should help with some of the bloating.

The most common cause, with the information I have, is that you are in perimenopause. You can also see a urogynecologist to look at your urine and maybe inspect the inside of the bladder with a telescope to see if the wall of the bladder is inflamed. In any event, checking back in 3-4 months seems like a good idea to see if there is new information or if symptoms are getting worse.
Machelle M. Seibel, MD

[lvfrogs]

Thank you for answering my post. Your answer was very helpful.  I have just one question for you - can they tell from ultrasound that it is adenomyosis?  I think that is why it says recommend an MRI, because they aren't sure?
Thank you!