Lots of good questions. My response may be a bit slanted by the fact that I have personally had a pre-malignant polyp removed from my uterus. As you are probably aware, these polyps may be caused by chronic high estrogen levels in the body. The problem with polyps is that because the circulation to them is poor, they are not subject to the same careful cancer surveillance by the body's immune system as normal tissues, and are therefore more apt to develop malignancy. They are an abnormal growth in the first place which also makes them high risk.
I would personally want the polyp removed and biopsied. Could another doctor try a hysteroscopy? I realize that is another surgery. You may want to also consider the future. The extra weight you are carrying is the source of the estrogen that is causing these polyps to develop, and so, unless that changes, you are going to have this problem indefinitely. Even after menopause--and it may actually get worse then because there will be no progesterone at all to counter act the estrogen.
I guess what I am saying is that even though your potential risk with major surgery is nothing to sneeze at, unless you want your uterus for child-bearing, you may want to strongly consider the hysterectomy. Your surgical risk doesn;t get any better with age!
As you know, the best option would be to lose the weight. Have you researched the laparoscopic band procedure? I don't know if they could combine a lap band/ lap assisted hysterectomy for you, and minimize your anesthetic risk!
The Mirena MIGHT work. An endometrial biopsy is PRETTY GOOD (but it is done blindly and can miss the polyp altogether). If the polyp prolapses, you might be able to extract part of it, but they are very fragile, and it would be very likely to break into lots of pieces leaving the concern for re-growth if part is left behind,
Gynecologic Oncologists have 2- 3 extra years of surgical training and are much more comfortable with the extra surgical risk associated with obesity. If you were my patient, unless you wanted babies, I would get my favorite gyn/onc expert to assist me with your laparoscopic vaginal hysterectomy.
I hope this is helpful!
Thank you so much for the prompt reply. It was very helpful. You touched on all the points of my concern. I didn't like the idea of just leaving the polyp in there and always having to worry about it. I guess it is time for me to get a second opinion from another gyn to see if they think they can possibly try another hysteroscopy and if not, have a discussion about a hysterectomy. Unfortunately, I don't live in a very big town (Topeka, KS) so I'm not even sure we have an gyn/onc around here. Something I will definitely ask about. Weight reduction surgery is something I have been thinking about, but I'm not sure I am quite ready to do it yet. I have been slowly losing weight for the last year and am down 45 lbs, so I have been holding off on the surgery but perhaps I should rethink that also.
Anyway, thanks again for your help!!
oh man, get a different doctor sweetie... this one is bad.... couldn't get a biopsy during the hysteroscope and D&C? Bad doc.. bad bad BAD doctor...
and don't do the weight loss band surgery! Lost a friend at 44 from gangrene in her intestines after that surgery!