Atypical Endometrial Hyperplasia and Treatment Options

Use of atypical progesterone in endometrial conditions?

Hello, doctor.
Due to abnormal bleeding outside of my menstrual period and thickened endometrium, a dilation and curettage (D&C) was performed, which revealed atypical cells at 8%.
The doctor recommended removing my uterus and ovaries, and prescribed me 5 mg of progesterone (Dydrogesterone) to take for one month.
After my next menstrual period, I am to undergo another ultrasound and another D&C to check for any worsening conditions to determine if lymph nodes need to be removed as well.

Currently, I would like to ask:
1.
I had the D&C on October 20 and started taking progesterone on October 28.
During this time, I experienced light bleeding until two days ago when it completely stopped.
However, today, November 1, while on progesterone, I noticed a very light pink discharge.
Is this normal? Should I return for a follow-up immediately? If observation is recommended, under what circumstances should I return for a follow-up right away?
2.
If I have my uterus removed, is traditional surgery the best option? I have been feeling a bit anxious and stressed after researching atypical cells online.
If my questions seem overly simplistic or ignorant, I apologize.

Xiao C, 40~49 year old female. Ask Date: 2021/11/01

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Do not panic excessively; simply return for follow-up appointments as scheduled.
Whether there is a pathological change must be diagnosed through the results of a biopsy.
2.
Early lesions that are not cancerous can also be treated with a hysterectomy using hysteroscopic techniques.

Reply Date: 2021/11/01

More Info

Atypical endometrial hyperplasia (AEH) is a condition characterized by abnormal changes in the endometrial lining of the uterus. It is often a precursor to endometrial cancer and is classified into two categories: atypical hyperplasia and complex atypical hyperplasia. The presence of atypical cells indicates a higher risk of progression to cancer, which is why careful monitoring and treatment are crucial.

In your case, the recommendation for a hysterectomy (removal of the uterus) and possibly the ovaries is a common approach when dealing with atypical hyperplasia, especially if there is a significant risk of progression to cancer. The use of progestins, such as the medication you mentioned (婦安錠, which is likely a form of medroxyprogesterone), is intended to help regulate the endometrial lining and reduce the risk of cancer development.
Regarding your specific questions:
1. Bleeding While on Progestins: It is not uncommon to experience some light bleeding or spotting while taking progestins, especially in the initial stages of treatment. The fact that you had light pink spotting after starting the medication could be a normal response as your body adjusts to the hormonal changes. However, if the bleeding becomes heavy, is accompanied by severe pain, or lasts longer than a few days, it would be advisable to contact your healthcare provider for further evaluation. Monitoring your symptoms is essential, and any significant changes should prompt a visit to your doctor.

2. Surgical Options: If a hysterectomy is recommended, traditional surgical methods (abdominal or vaginal hysterectomy) are often considered the standard approach. However, the choice of surgical technique can depend on various factors, including the size of the uterus, the presence of any other conditions, and your overall health. Minimally invasive techniques, such as laparoscopic hysterectomy, may also be options depending on your specific situation. It is essential to discuss the risks and benefits of each surgical approach with your healthcare provider to determine the best option for you.

In terms of your anxiety regarding the diagnosis, it is completely understandable to feel overwhelmed. Atypical hyperplasia can be concerning, but it is important to remember that with appropriate treatment and monitoring, many women manage this condition successfully. Regular follow-ups, including ultrasounds and additional biopsies, are crucial in ensuring that any changes in your condition are detected early.

Finally, if you have any doubts or concerns about your treatment plan or symptoms, do not hesitate to reach out to your healthcare provider. They can provide you with the most accurate information tailored to your specific situation and help alleviate any worries you may have. Your health and peace of mind are paramount, and open communication with your medical team is key to navigating this condition effectively.

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