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hysteroscopy good approach to dealing with post-menopause uterine polyp...
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hysteroscopy good approach to dealing with post-menopause uterine polyps?

I am 64 years old and have been in menopause for 10 years.  Now
after one episode of abnormal bleeding which never recurred and could also have been due to urinary tract infection, I have
been diagnosed with uterine fibroids(no problem) and polyps--possible problem.  Endometrial biopsy and diagnostic D&C were both negative for malignancy.  However, the polyp (diameter 2cm) is still there despite both these procedures and now they want to do a hysteroscopy to remove and biopsy it.
Given the clean results I've already had and the fact that most uterine polyps are benign, is hysteroscopy for further checking/rule-out a wise choice??  What are the chances I could still have some kind of uterine/endometrial cancer despite checks I've already had?  I don't want to have a procedure I don't need, but neither do I want to take risks by NOT doing it....Also, could you tell me how delicate and fine-tuned a procedure hysteroscopy with "resection"(?) of polyp is?  What I mean is does it require a lot of surgical finesse?  I am asking this because my gyn. surgeon is old, moves slowly, and seems somewhat shaky of hand....He is board certified and they tell me he does hysteroscopies regularly, but I am a little anxious about his fine motor skills for surgery....
I would so much appreciate any advice and comments.  With many thanks.
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A. It sounds like your problem is very straight forward.  If you have a negative D&C the chances of having cancer are very low. Polyps are benign but are believed to be able to turn into cancer over time so it is good to have them removed. A polyp usually is an oval plump bit of benign tissue attached to the uterine wall by a thin stalk (like a balloon on a string).  2cm is just a fraction larger than a nickel.  It should be possible to see the polyp with a hysteroscope and grab the stalk and pull it out.  

Hysteroscopy is a very common procedure.  It usually is done in the operating room and requires a light general anesthesia.  Operating time can be as short as a few minutes and for a polyp, should not take more than half hour. Complications can occur but are very uncommon. Most people go home the same day. Full recovery is usually no more than a day or so.  

It is impossible to determine if your doctor is able to do the procedure.  If he does them often and says he can do them, he probably can. Each hospital requires their doctors to have their surgical privileges reviewed every year or two. Hysteroscopy is classified as a minor procedure and the equipment makes it relatively easy to see.  However, if you are worried, choose another doctor who gives you more confidence. It is uncomfortable to have a person operate on you if you are not confident in them.
Machelle M. Seibel, MD
3 Comments
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I have had 2 hysteroscopy and D&C procedures, bracketing a 5 month course of Prometrium (micronized progesterone) for similar pathology to yours. I agree with your concern about finding a good surgeon , and I made sure I did even waiting 3 months to get to her, but as the dr. here says, hysteroscopy to my understanding too, is not a complex procedure. I would have no compunction asking the doctor if and how many he/she has done.

The Prometrium and 2 surgical procedures, which included removal of much of the endometrium for a complex atypical hyperplasia with indeterminate edges including  several polyps, and removal of fibroids, worked very well for me although I'm not done yet. I will have another transvaginal ultrasound soon, and may then either just monitor twice a year with ultrasound, or have another course of Prometrium, or consider another hysteroscopy.

The procedure will only put you out of commission for about a day, and may require no more than a bit of morphine post-surgery in hospital, and tylenol at home for a day or two.



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What I don't understand is WHY  on earth that polyp wasn't removed during the D & C??
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