Ultrasound results, should this concern me?

37 year old female (me).  3 children.  No family history of cancer except pre-cancer polyps (both my mom, and me) in the colon.  She had hysterectomy in her mid-20s due to cervical cancer...so who knows about her uterus, and my grandma also had hysterectomy in her 20s due to fibroids and ovarian cysts.  She died at 63 of brain tumor.  No other significant history.

I have had 18 months of chronic GI issues, that have been thouroughly worked up, and all tests are normal.  (only the pre-cancer polyps showed up, but don't explain the chronic diarrhea, pain, and bloating and weight loss.)  

Had horrible periods from 1/2008-2/2009-bled three weeks a month, had uterine polyp and ended up anemic.  Had endometrial ablation (Novasure.) 3/2009-worked for about 10 months.  Bleeding is back but more like black old blood mixed with a mucous discharge..every other week for days at a time.  Sometimes clotty..always black/brown...assumed it was "left over" from ablation..?  Also have achy pelvic area, bloated down there, painful sex and sharp twingy pains at times.  

Went to gyn for first time since ablation 12 days ago.  He ordered ultrasound. Here are results:

(i'll just put what sounds abnormal to me)

Uterus "tiny nabothian cysts", endometrial stripe: 1.2 cm EV, fluid within the endometrial canal outlining a polypoid lesion 7x7mm.  Minimal fluid also in endocervix.  Contour: Lobular, Echotexture: Heterongenous. (radiologist puts recommendation to have a hysterosonogram to further characterize.)  right ovary ok, but left ovary has a "slightly complex ovarian cyst" (2.6cm)-and arterial flow couldn't be assessed on that side.  (radiologist recommends a re-check in a couple of cycles) Small amount of free fluid.

My gyn hasn't called with results yet (i just picked this up for my records...)  But I am worried about what the above might mean...?  Any knowledge you could impart would be so appreciated.
Thank you.

[Annekathryn Goodman, M.D.]

HI there,

thank you for your complete information.
First of all, in a busy practice, sometimes it can take awhile to get a call. You could call them or make an appointment to go over your results.

The ultrasound is not very abnormal however the biggest challenge is how to interpret the US and also your symptoms after an endometrial ablation.

It could be as simple as the ablation did not completely destroy all the lining tissue in your uterus and you now have a partially blocked passageway so it hurts when you bleed and it gives that appearance by ultrasound

or it could be that you have a problem with a cancerous or precancerous polyp or growth (much less likely)

The difficulty is that after an ablation, it is very hard to get complete information about the lining of the uterus because it is now scarred together.

The standard evaluation would be a D&C (dilation and curettage) and hysteroscopy (looking inside the uterus)

You should talk to your doctor about these issues.  Also find out what the pathology was of the lining of your uterus before you had th ablation.Your doctor should have done a biopsy or a D&C prior to the ablation to make sure that there were no abnormal endometrial cells before doing the ablation.

There are some situations where because of persistent abnormal bleeding and/or pain, women who have had ablations go on to have a hysterectomy
best wishes

ps I found this interesting site:

http://www.endometrialablationdiscussion.com/
.

[beka777]

Me again...do you think it's ok to assume that the above results are ok, and not something that needs following up since I had the test 10 days ago, and still no call from my gyn to give me the results?

[beka777]

Thank you so much for the information.  I wondered if the ablation could cause the abnormal appearance on the ultrasound.  I did have a D&C before the ablation and was told it was normal.

My doctors office did call, and said they want to order this hysterosonogram....they said "asap".  Is this going to provide anymore info than the ultrasound already did?  Im totally agreeable to going and just getting a hysterectomy (Im sick of the problems/pain, and done with having kids)  Is it important to know exactly what is going on in there before having a hysterectomy?  I wouldn't mind skipping all these uncomfortable tests and just getting it done.  I asked why the additional test...isn't a polyp a polyp??  (i had one before my ablation too...and there wasn't this concern to get a better look.)  The nurse just said they need to get more information.

Again, thank you for your reply, and your kindness, and the information.