Endometrial Thickening: Is Surgery the Only Option?

Inquiring why endometrial thickening can only be treated surgically?

Since I started menstruating at the age of 9, I have experienced irregular periods starting from 13-14 years old.
For nearly twenty years, I believed it was just polycystic ovary syndrome (PCOS) and have not sought gynecological care.
The last ten years have been the most noticeable, with periods occurring only once every 1-3 years, while in my childhood, I had two to three periods every six months.
My weight once peaked at 97 kg, but over the past five years, I have gradually lost weight to 74 kg.
Consequently, I now experience dark brown discharge three to four times a year.
The last normal period I had was in March of last year, lasting only five days.
However, since February of this year, I have been continuously discharging dark brown material, which disappears after two to three days and then reappears, persisting for a whole month.
In the middle of the month, I also had two days of clear mucus mixed with bright red blood, but afterward, it returned to dark brown discharge.
I visited a large hospital for a check-up, and the doctor performed a pelvic examination, stating that everything appeared normal without any masses.
An ultrasound was then conducted, revealing that I have a uterine lining thickness of 2.4 cm.
The doctor recommended that I undergo a dilation and curettage (D&C) procedure to clean it out and send samples for testing.
However, I opted for a seven-day course of progesterone to see if it would induce a period and thin the lining.
Based on my weight, the doctor prescribed only two pills daily for a total of 10 grams of progesterone for seven days, stating that if I do not menstruate after that, I should return for surgery.

Upon reviewing the medical history, I noticed that the doctor mentioned menstruation would only occur after stopping the medication.
Given that I am only taking it for seven days, what are the chances of having a period? How long should I wait after stopping the medication without menstruating before returning for a follow-up? Additionally, I would like to ask, since the ultrasound only showed thickening and I am aware of the likelihood of having PCOS due to the dark acanthosis on the back of my neck, is surgery the only option? Would it be advisable to seek a second opinion from another doctor? Although I do not plan to become pregnant now or in the future, I am still concerned about the potential effects of a D&C on my body.
Thank you for your response; I appreciate it.
I have always thought that having fewer periods was convenient, which is why I have delayed seeking treatment until now, but I still hold a glimmer of hope for avoiding surgery.

muimui, 30~39 year old female. Ask Date: 2020/03/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it is normal to expect menstruation within a week after taking progesterone.
If it exceeds one week, or if it is the fifth or sixth day of your period, it is advisable to return for a follow-up appointment.
If the endometrium is still thick, it is recommended to undergo surgical evaluation.
Wishing you good health.

Reply Date: 2020/03/24

More Info

Understanding endometrial thickening and the potential need for surgical intervention can be quite complex, especially considering your long history of irregular menstrual cycles and the recent findings of a significantly thickened endometrium.
Firstly, it’s important to clarify what endometrial thickening means. The endometrium is the inner lining of the uterus, and its thickness can vary throughout the menstrual cycle. A thickness of 2.4 cm (24 mm) is considered abnormal, especially in the context of postmenopausal women or those with irregular cycles, as it may indicate the presence of conditions such as hyperplasia or even endometrial cancer. However, in premenopausal women, variations can occur due to hormonal imbalances, such as those seen in polycystic ovary syndrome (PCOS), which you mentioned.

Your history of irregular menstruation, weight fluctuations, and the presence of dark brown discharge could suggest an underlying hormonal imbalance, which is often seen in conditions like PCOS. The fact that you have experienced infrequent menstruation for many years and are now seeing unusual discharge patterns further complicates the picture.
Regarding the treatment options, your doctor has suggested a surgical approach, specifically a dilation and curettage (D&C) procedure, which involves scraping the endometrial lining. This is often recommended to obtain tissue samples for histological examination to rule out any serious conditions, especially given the thickness of your endometrium. While surgery can provide definitive answers and treatment, it is understandable to have concerns about the implications of such a procedure on your body, especially since you are not planning to conceive.

You mentioned that your doctor prescribed progesterone (yellow body hormone) for a short duration to see if it would induce a menstrual cycle and potentially thin the endometrial lining. It’s true that progesterone can help regulate the menstrual cycle and may lead to a withdrawal bleed after stopping the medication. However, the duration of treatment and the dosage can significantly affect the outcome. Seven days of progesterone may not be sufficient for some individuals to induce a menstrual cycle, especially if there are underlying hormonal issues. If you do not have a period after stopping the medication, it would be reasonable to follow up with your doctor as advised.

As for whether surgery is the only option, it is not uncommon for patients to seek a second opinion, especially when faced with significant medical decisions. If you feel uncertain about the necessity of surgery, consulting another gynecologist could provide additional insights or alternative management strategies. Some practitioners may suggest a more conservative approach, such as hormonal therapy or close monitoring, particularly if the endometrial thickening is not accompanied by alarming symptoms or findings.

In conclusion, while surgery is a common recommendation for significant endometrial thickening, it is not the only option. It is crucial to weigh the benefits and risks of the procedure against your current health status and future reproductive plans. Engaging in a thorough discussion with your healthcare provider about your concerns and exploring all available options, including the possibility of a second opinion, can help you make an informed decision that aligns with your health goals and preferences. Remember, your health and comfort are paramount, and it’s essential to advocate for what feels right for you.

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