Luteal Hormone Treatment for Endometrial Precancerous Lesions

Treatment of Luteal Phase Support in Endometrial Carcinoma Precursors

Hello Doctor, I visited due to several months of pain and abnormal bleeding and discharge in mid-February.
A hysteroscopy revealed numerous irregular growths in the endometrium, leading to a quick clean-up surgery on February 20.
After resting for two days post-surgery, I returned to work, but I continued to experience light pink bleeding, which even increased slightly.
During my follow-up on February 27, the doctor informed me that the test results indicated precancerous changes (atypical hyperplasia), and I began treatment with progesterone.
Additionally, my surgical wound was healing poorly, and I still experienced uterine cramps and bleeding, for which I was prescribed medication.

However, after a week of taking progesterone and antispasmodic medication, my abdominal pain has gradually diminished, but the bleeding has increased instead.
Sometimes, I notice dark brown, thick discharge (or bleeding?), and today I experienced a larger amount of bright red bleeding.
Is this a normal phenomenon? Is it menstruation, or should I be concerned about abnormal bleeding and return for a follow-up? It has been two weeks post-surgery, and the ongoing bleeding is quite distressing, but I also worry about making a big deal out of what might be a minor issue.
I would greatly appreciate your response.
Thank you very much!

Wendy, 30~39 year old female. Ask Date: 2020/03/06

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, after a normal surgery, bleeding should decrease.
It is recommended that you consult a gynecologist.
Wishing you good health.

Reply Date: 2020/03/06

More Info

Luteal hormone treatment, particularly with progestins like norethindrone acetate, is commonly used in managing endometrial conditions, including precancerous lesions such as atypical hyperplasia. In your case, it seems that after undergoing a hysteroscopic procedure to address irregular endometrial growths, you were diagnosed with atypical hyperplasia, which necessitated the initiation of hormone therapy to help regulate the endometrial lining and reduce the risk of progression to endometrial cancer.

The primary function of progestins in this context is to counteract the effects of estrogen, which can stimulate the growth of the endometrial lining. By providing progestin, you are essentially promoting the shedding of the endometrial tissue, which can help in normalizing the menstrual cycle and reducing the risk of further abnormal growths. However, it is not uncommon for patients undergoing this type of treatment to experience irregular bleeding patterns, especially in the initial stages of therapy.

Regarding your concerns about the bleeding you are experiencing post-surgery and during treatment, it is essential to understand that some degree of bleeding can be expected as your body adjusts to the hormonal changes. The presence of dark brown or coffee-colored discharge can indicate older blood that is being expelled from the uterus, while fresh red blood may suggest new bleeding. This can be particularly common in the weeks following a surgical procedure, as the uterus is healing and the hormonal environment is being altered.

However, the increase in bleeding you mentioned, especially if it is heavier than what you would consider normal or if it is accompanied by significant pain or other concerning symptoms, warrants further evaluation. It is crucial to maintain open communication with your healthcare provider. If the bleeding persists or worsens, or if you experience severe pain, it is advisable to return for a follow-up appointment. Your doctor may want to perform an examination or imaging studies to ensure that there are no complications, such as retained tissue or an infection, which could be contributing to your symptoms.

In terms of the potential side effects of progestin therapy, they can include breast tenderness, mood changes, and alterations in menstrual bleeding patterns. While these side effects can be bothersome, they are generally manageable. The goal of your treatment is to stabilize your endometrial lining and reduce the risk of cancer, which is a significant consideration given your diagnosis.

As for the question of whether this bleeding is normal or indicative of a more serious issue, it is essential to trust your instincts. If you feel that the bleeding is excessive or if you have any other symptoms that concern you, do not hesitate to reach out to your healthcare provider. It is always better to err on the side of caution, especially following a diagnosis of atypical hyperplasia.

In summary, while some irregular bleeding can be expected during luteal hormone treatment, particularly after recent surgery, any significant changes in your bleeding pattern should be discussed with your doctor. They can provide guidance tailored to your specific situation and ensure that your treatment plan is effectively addressing your health needs. Your health and peace of mind are paramount, so do not hesitate to seek further evaluation if needed.

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