Endometriosis, Uterine Polyps, and Hormonal Treatments

Endometriosis. Uterine polyps. Progesterone (Dydrogesterone)?

Hello Doctor: Here are my examination results from Hospital A: 2023/12/07 - uterus 8.02 x 6.35 x 5.72 cm, endometrium 2.08 cm, left ovary 3.60 x 4.34 cm, right ovary 3.48 x 2.98 cm; 2023/02/27 - uterus 6.05 x 5.83 x 5.67 cm, left ovary cyst 4.27 x 2.87 cm, right ovary cyst 3.86 x 3.42 cm, endometrial polyp 1.73 x 0.73 cm; 2023/07/17 - uterus 7.44 x 5.26 x 6.49 cm, endometrium 1.56 cm, rule out polyp 1.06 x 0.91 cm, left ovary cyst 4.56 x 3.30 cm, right ovary 3.63 x 2.98 cm.
I am 30 years old and have had a chocolate cyst that recurred.
I have been returning to Hospital A for follow-ups every six months to a year.
In the second half of 2022, I felt that my menstrual cycle was unusual, but no cause was found.
My CA-125 levels have consistently been above normal, but without significant fluctuations.
The reports from 2023 indicated these findings.
I have no sexual experience, and the doctor suggested a hysteroscopy, expressing concern about the polyps, although most polyps are benign.
Therefore, I opted for observation.
In December 2023, I visited another gynecology department, where the doctor prescribed Danazol, stating that I was not suitable for hysteroscopy.
I had taken progesterone for a year from 2018 to 2019, which led to more breast tumors developing.
Given my current situation, I am unsure what the best course of action is.
Thank you!

ANN, 40~49 year old female. Ask Date: 2024/01/09

Dr. Chen Zhiyu reply Obstetrics and Gynecology

It is advisable to discuss with the original treating physician.
Thank you.

Reply Date: 2024/01/09

More Info

Understanding endometriosis, uterine polyps, and hormonal treatments can be quite complex, especially when you have a history of conditions like chocolate cysts and abnormal menstrual cycles. Based on the information you've provided, let's break down your situation and discuss the potential implications and treatment options.

Endometriosis and Uterine Polyps
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside of it, often causing pain, irregular bleeding, and other symptoms. It can lead to the formation of cysts, known as chocolate cysts, which are filled with old blood. Your history of having undergone surgery for chocolate cysts suggests that you have been managing this condition for some time.
Uterine polyps, on the other hand, are growths on the inner lining of the uterus (the endometrium). They can be benign but may cause symptoms such as heavy menstrual bleeding, irregular periods, or even infertility. The presence of an endometrial polyp, as noted in your ultrasound reports, raises the possibility of it contributing to your abnormal menstrual cycles.

Hormonal Treatments
Hormonal treatments, such as Visanne (a form of progestin), are often prescribed to manage symptoms of endometriosis by suppressing the growth of endometrial tissue and reducing menstrual bleeding. However, these treatments can have side effects, including mood changes, weight gain, and breast tenderness, which you have experienced. The development of breast cysts while on hormonal therapy is not uncommon, as hormonal fluctuations can lead to changes in breast tissue.

Given your history of breast tumors and the side effects you've encountered, it is crucial to have a thorough discussion with your healthcare provider about the risks and benefits of continuing hormonal therapy. It may be worth considering alternative treatments or adjusting your current regimen to minimize side effects while still managing your symptoms effectively.

Recommendations
1. Consultation with a Specialist: Since you have a complex medical history, it would be beneficial to consult with a gynecologist who specializes in reproductive endocrinology or a fertility specialist. They can provide a more tailored approach to your treatment, considering your past surgeries and current symptoms.

2. Further Evaluation: The recommendation for a hysteroscopy to evaluate the endometrial polyp is a standard procedure. While most polyps are benign, it is essential to rule out any potential malignancy, especially given your elevated CA-125 levels. This test can also provide insight into the nature of the polyp and guide further treatment.

3. Monitoring and Adjusting Hormonal Therapy: If you decide to continue with hormonal treatments, regular monitoring is essential. Your doctor may suggest adjusting the dosage or switching to a different medication that may have a more favorable side effect profile for you.

4. Lifestyle Modifications: In addition to medical treatments, consider lifestyle changes that may help manage symptoms. This includes maintaining a healthy diet, regular exercise, and stress management techniques, which can all contribute to overall well-being.

5. Second Opinion: If you feel uncertain about the proposed treatment plan, seeking a second opinion can provide additional perspectives and options.

Conclusion
Your situation is multifaceted, involving endometriosis, potential uterine polyps, and the implications of hormonal treatments. It is crucial to work closely with your healthcare provider to develop a comprehensive management plan that addresses your symptoms while considering your medical history. Regular follow-ups and open communication with your doctor will be key in navigating your treatment options effectively.

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