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Post Menopause, Endometrial Thickening, Cervix opening closed
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Post Menopause, Endometrial Thickening, Cervix opening closed

I am 60, in menopause @10 years, a year ago my doctor prescribed Vagifem because my vagina was dry and thin and she couldn't do a papsmear.  A year later all went relatively easy.  The problem is I had some pressure that she thought would be worth checking so I had a vaginal ultrasound, which wasn't comfortable for obvious reason.  They found thickening of the endometrial lining and when she tried to do a biopsy in the office, found that my cervix opening was closed so now I am scheduled for a hysteroscopy & D & C.   She said sometimes a thick endometrial lining can be normal for an individual, sometimes it came mean something else and the fact that my cervix is not open, she is concerned there could be trapped blood (I have no bleeding) and it would be worth getting in there to see what's going on.  
My question is if it turns out this thickening is just normal for me, is a D & C problematic or is it a good idea to go ahead and get whatever is causing the thickening out of there?  Will I always need a hospital procedure to get into my cervix in the future to make sure everything is OK if my opening is closed, or at the same time is there a procedure that can surgically open it for future access?  
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1761023_tn?1313710814
Dear Healthy4now ,

You are having asymptomatic endometrial thickening.

To rule out abnormality, your doctor is planning endometrial tissue assessment by hysteroscopy and D&C (dilatation and curettage).
When she will insert the hysteroscope, your cervix will be open before that, so you do not need separate surgery to open cervix. Cervix can be opened with the help of dilators just before any procedure and does not require a surgery. There is no need to keep the cervix open always for future access.

D&C is not problematic if done by an expert and at good centre.

Most common cause of endometrial thickening in postmenopausal women is proliferative endometrium, polyp and hyperplasia. All these are treatable, so do not worry and go ahead.

Hope that this information helps and hope that you will get better soon.

Thank you for using MedHelp's "Ask an Expert" Service, where we feature some of world's renowned medical experts in their fields. Millions have benefitted from our service to get personalized advice for them and for their loved ones.

Best Regards,
Dr. Meenakshi Titoria Sahu
4 Comments
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I'm still not clear about your response regarding my closed cervix opening.  How in the future will my doctor be able to do a pap exam in the office if my cervix opening is closed?   Also, is there any issue to keep taking the Vagi Fem given the possibilities you mentioned:  proliferative endometrium, polyp and hyperplasia?
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1761023_tn?1313710814
Dear Healthy4now,

I apologize for not being clear in my previous response. Let me try to explain again.

Cervix is the lower end of uterus which is 2.5 cm long and has an internal and an external opening. Cervical stenosis is the medical term used to refer to a closed cervix. Most of the time it is the internal opening which is closed. In women with cervical stenosis (closed cervix), an instrument cannot go inside the uterus but microscopic cells in the cervix itself can be collected. Pap smear is taken from cervical cells shed off in upper part of vagina (fornices). So I do not think cervical stenosis will pose any problem while performing Pap smear in the future.

As far as cervical stenosis is concerned, it doesn’t cause much problem in future. As per my understanding, your doctor is planning to perform a hysteroscopy and D&C to rule out pathologies such as polyps and  hyperplasia that might be the cause of your thickened endometrium. A closed cervix can be opened using an instrument called a dilator. It is a simple procedure. It does not involve surgery, i.e making an incision as such. You do not require any surgery to keep your cervix open at all times. Your doctor can open it with dilators if needed. But it won’t be needed for performing investigations such as a PAP smear.

As for Vagifem, it should be taken under supervision of a Gynecologist. Your gynecologist would be able to suggest if further use of vagifem is right for you after the hysteroscopy and D&C that is planned now.

Best Regards,
Dr. Meenakshi Titoria Sahu
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Avatar_n_tn
Well I had the procedure last Friday, and my follow-up with the Doctor yesterday and she told me she was not able to dilate my cervix opening, that there was scaring from lichen schlerosus and she had to make an incision to get in and do the biopsy of the cervix, up close to the uterus, which came back negative.  She also was not able to get into the uterus, so she could not do the D & C because it is so small without concern she might puncture it.  She had to use a pediatric speculum to get in that far and she said the surgery center did not have an ultrasound so she could go further.  I'm not sure I understand what that means, maybe you can explain.    She said the fact I am a lesbian and haven't had intercourse for over 40 years could also have an impact to why I'm so small.  I'm also 5'2" and 140 lbs, so I'm not a really big person to begin with.        
My concern is that she wants to wait 3 months, have me do another one of those painful vaginal ultrasounds and see if there has been any more thickening.  
So basically, I went under General Anesthesia, spent all this money to essentially not get the procedure done that I went in for (D&C and possible removal of polyps), and have nothing conclusive.    
She said if I have bleeding, then that would be a problem and now that she made this incision in the cervix, the blood should come through, but I'm wondering if that is true since she couldn't get into my uterus, how is the blood suppose to come out?  If I wait until I have bleeding symptoms, does that mean if it is cancer, it could progress to a stage that would be more difficult to treat?    What would you recommend I do?

Confused & Concerned
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