Abnormal Endometrial Thickness and Irregular Menstrual Bleeding

Abnormal endometrial thickness?

In October, I experienced abnormal bleeding and discovered that my endometrium was thickened with polyps, which were removed.
My doctor prescribed Medroxyprogesterone for me to take, starting on November 5.
Before I finished the medication, I began to experience light bleeding on the 15th, which became very heavy on the 21st.
The doctor mentioned that menstrual flow would be lighter, but I had two days of heavy bleeding, and upon examination, the endometrium was still thick.
On November 26, the doctor switched my prescription to Diane, and I started taking it until the 16th, although I missed one dose.
On December 10, I began to have light bleeding, and by the 20th, my menstrual flow was more normal, although still on the lighter side.
The doctor said the endometrial thickness was normal.
I would like to ask the doctor if the endometrium needs to be examined under these circumstances.
My menstrual bleeding has been intermittent for a long time, and the doctor has prescribed Diane again.
If the endometrial thickness remains normal, is there a connection to the prolonged intermittent bleeding? Thank you, doctor.

Jia Jia, 40~49 year old female. Ask Date: 2020/12/28

Dr. Huang Yuande reply Obstetrics and Gynecology

Due to the need for hormone therapy to align with the physician's treatment plan, it is recommended that you take medication as prescribed by your doctor.
Generally, hormone therapy will improve the condition; however, if bleeding persists or is prolonged, other treatment options (such as endometrial curettage) must be considered, or it is necessary to diagnose whether there are other pathological causes.

Reply Date: 2020/12/28

More Info

Abnormal endometrial thickness and irregular menstrual bleeding can be concerning issues for many women, and your situation reflects a common scenario that many face. Based on your description, it appears you have experienced a series of irregular bleeding episodes, which have been linked to a thickened endometrial lining and the presence of polyps. After undergoing a hysteroscopic polypectomy, you were prescribed medications to manage your symptoms, but you continue to experience irregular bleeding.

Firstly, it is important to understand that the endometrium, or the lining of the uterus, can undergo various changes throughout a woman's menstrual cycle. The thickness of the endometrium can vary based on hormonal influences, particularly estrogen and progesterone. In your case, the presence of a thickened endometrium and polyps can lead to abnormal bleeding patterns. Polyps are benign growths that can develop in the endometrial lining and may contribute to irregular bleeding, especially if they are not completely removed during surgery.

The medications you have been prescribed, such as Medroxyprogesterone (often referred to as Provera) and Drosperinone (found in the birth control pill "Diane"), are intended to help regulate your menstrual cycle and manage the thickness of the endometrial lining. These medications work by providing hormonal balance, which can help reduce the incidence of abnormal bleeding. However, it is not uncommon for women to experience some irregularities in their menstrual cycles, especially after recent surgical interventions or changes in medication.

Regarding your question about whether further testing of the endometrium is necessary, it is essential to follow your doctor's recommendations. If your doctor has indicated that the endometrial thickness is now normal and you are on a consistent hormonal regimen, they may not see an immediate need for further invasive testing. However, if you continue to experience irregular bleeding or if the bleeding becomes more pronounced, it may warrant additional evaluation, such as a repeat ultrasound or even a biopsy to rule out any underlying issues.

The "drip-drip" bleeding you mentioned, where menstrual flow is inconsistent and not as heavy as expected, can sometimes be a side effect of hormonal medications. It is also possible that your body is still adjusting to the changes brought about by the surgery and the new medications. It is important to keep track of your symptoms, including the timing, duration, and volume of bleeding, and communicate these details with your healthcare provider.

In conclusion, while it is understandable to feel anxious about your symptoms, it is crucial to maintain open communication with your healthcare provider. They can provide the best guidance based on your individual circumstances and medical history. If you feel that your symptoms are not improving or if you have new concerns, do not hesitate to reach out for further evaluation. Regular follow-ups and monitoring are key to managing your reproductive health effectively, especially after experiencing abnormal bleeding and undergoing procedures like polypectomy.

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