Abnormal Menstruation and Hysteroscopy Procedures - Obstetrics and Gynecology

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Menstrual irregularities and hysteroscopic surgery?


On February 6, I experienced light bleeding on the first day of my menstrual period, which lasted for two weeks.
I had a consultation on February 20, and the doctor advised me to wait two weeks for an abdominal ultrasound, suggesting that it would be better to wait until things were clearer before proceeding with the scan (I had occasional light bleeding a couple of times in between).
Yesterday, on March 6, I completed the abdominal ultrasound, and the endometrium was still quite thick.
The doctor prescribed medication to induce menstruation for seven days and advised me to wait another three weeks for another scan.
If the endometrium remains thick, a hysteroscopy and endometrial curettage may be performed.
1.
Should I consider directly scheduling a hysteroscopy? (I asked the doctor directly, but the response was vague and unclear.)
2.
Is there a higher risk regarding the endometrial issue if I wait another month?
3.
What is the basis for the three-week waiting period? Note: My last three menstrual cycles lasted approximately 7-10 days, and my menstrual cycle is about 40 days long.
Thank you for your time, and I appreciate any guidance from the doctors.

Xin Ning, 30~39 year old female. Ask Date: 2023/03/07

Dr. Lin Manying reply Obstetrics and Gynecology


Hello, based on your description, it is not possible to determine whether your endometrial thickness requires immediate hysteroscopy.
Additionally, your age is a factor to consider, as thickened endometrium may also be a temporary issue caused by hormonal changes.
The Hualien Hospital of the Ministry of Health and Welfare is concerned about your health.

Reply Date: 2023/03/07

More Info


Understanding abnormal menstruation and the role of hysteroscopy in diagnosis and treatment is crucial for women experiencing irregularities. Based on your situation, let's break down your concerns and provide clarity on each point.

1. Considering Hysteroscopy: Hysteroscopy is a procedure that allows a doctor to look inside the uterus using a thin, lighted tube called a hysteroscope. It is often used to diagnose or treat conditions affecting the uterus, such as abnormal bleeding, polyps, fibroids, or endometrial hyperplasia. Given that your doctor has noted a thickened endometrium and has prescribed medication to induce a period, it may be prudent to consider a hysteroscopy if your symptoms persist or worsen. While your doctor may have suggested waiting, it’s essential to communicate your concerns about the thickness of the endometrial lining and any ongoing bleeding. If you feel that your symptoms warrant more immediate investigation, you should advocate for yourself and discuss the possibility of scheduling a hysteroscopy sooner rather than later.

2. Risks of Waiting: Delaying further evaluation of a thickened endometrium can carry risks, particularly if there is a concern for endometrial hyperplasia or even cancer. The endometrial lining can become thicker due to hormonal imbalances, and prolonged thickening without evaluation may increase the risk of developing more severe conditions. If you continue to experience abnormal bleeding or if the endometrium remains thick, it is advisable to follow up sooner rather than later. Your health and peace of mind are paramount, and timely intervention can prevent potential complications.

3. Understanding the Follow-Up Timeline: The recommendation to wait three weeks before re-evaluating the endometrial thickness likely aligns with your menstrual cycle. Given that your cycles are approximately 40 days long, your doctor may be timing the follow-up based on the expected changes in the endometrial lining that occur throughout the menstrual cycle. Typically, the endometrium thickens in response to estrogen in the first half of the cycle and sheds during menstruation. By waiting three weeks, your doctor may be anticipating that any induced bleeding from the medication will provide a clearer picture of the endometrial condition. However, if you have concerns about this timeline, it’s essential to express them to your healthcare provider.

In conclusion, while it is common for doctors to take a conservative approach in managing abnormal menstrual bleeding, it is equally important for you to feel comfortable and informed about your treatment options. If you are experiencing significant distress or if your symptoms are worsening, do not hesitate to seek a second opinion or request a more immediate evaluation. Hysteroscopy can be a valuable tool in diagnosing and treating uterine conditions, and your health should always be the priority. Remember, open communication with your healthcare provider is key to ensuring you receive the care you need.

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