postmenopausal bleeding

I am age 49 and 2 years postmenopause. (FSH=142.)  Never had any gyno problems/issues for over 23 years (only issue was D&C for miscarriage followed by two healthy/successful pregnancies). Never had monthly cramps.No problems with menopause. No hormones ever taken. In great physical shape, health,weight, etc. Recently started spotting with cramps and breast tenderness. Had biopsy. Diagnosis: Disordered proliferative endometrium with no evidence of malignancy identified. Pelvic ultrasound showed an endometrial stripe of 6.3mm with fluid in cavity and tiny subendometrial cysts suggesting possible adenomyosis. All bloodwork OK. Family history of uterine cancer (relative died from this). Spotting and cramping stopped after 2 weeks. Scheduled for D&C. Worried about developing cancer and want to know what is best course of action for my diagnosis. If D&C is best course of action, what should I be expecting in follow-up care? Is it possible for endometrium to grow and thicken w/o symptoms?

[Machelle Seibel, MD]

Your biopsy shows the lining to be totally benign and very far from any malignancy. So from the sounds of it, cancer is a very low likelihood. The D&C will make that even more clear for you and should help relieve your symptoms and fears. The uterus has an inner layer called the endometrium. It is the part that separates from the wall of the uterus and sheds with a period. Adenomyosis is a condition where the lining of the uterus, instead of shedding, begins to grow into the wall of the uterus. When that happens, the uterus has pools of blood in its wall and can't clamp down to stop the menstrual bleeding. The end result is cramping and prolonged bleeding. Most of the time a D&C won't treat adenomyosis (if that is in fact the problem). An ultrasound can often help make that diagnosis. But a D&C can help bleeding due to many other things so it does make sense to have it. If your doctor thinks you do have adenomysois, discuss with him or her your treatment options. They include both medications and surgery.
Machelle M. Seibel, MD