A new meta-analysis suggests that the commonly used 5 mm cut-off for endometrial thickness on transvaginal ultrasound may be a bit too optimistic at predicting the absence of endometrial cancer in women with post menopausal bleeding. European Researchers now suggest that 3 mm is a better cut off point, below which there is a 98% reduction in the chance of having cancer of the endometrium. A thickness of 4 mm gives a 95%, and 5mm a 90% reduction in odds of cancer.
That means if you have post menopausal bleeding (which has a 10% chance of being a cancer among all comers), an endometrial thickness below 3mm on transvaginal sonogram reduces your chance of cancer from 10% to 0.6%, while the old 5 mm cutoff would have reduced you odds to 1%.
From what I understand, the researchers created receiver operator curves (ROCs) for each study, and them combined then, as opposed to a single ROC from the combined data, which was what had been done in the past to generate the 5 mm cutoff. Having a pretty rudimentary knowledge of statistics, I have no idea which methodology is better, and will await commentary and guidance from those who know these things better than I.
I do know, however, that in the past few months I diagnosed two patients with endometrial cancer whose endometrial thickness was below 5 mm. Given that no cut off value is 100% predictive, this of course was bound to happen sooner or later given how long I have been practicing, but it was nonetheless disconcerting. Interestingly, both women had endometrial thickness which would have put them above the 3mm cut off recommended in this new study.
Ultrasound as a Tool for Evaluating Post-menopausal Bleeding
I, for one, have long appreciated transvaginal sonogram as a non-invasive tool for evaluating post menopausal bleeding.
In years past, a single drop of blood more than a year after menopause meant an automatic trip to the OR for a D&C – that’s a “dilation and curettage”, also known as a “dust and clean” to my mom’s generation. This would include women who bled from vaginal dryness, infection, blood thinners or even the occasional errant menstrual cycle, most of whom do not have endometrial cancer. That’s a lot of D&C’s.
With the advent of office endometrial biopsy, or EMB as we call it, most women were saved the trip to the OR, trading it for a quick, but rather painful office procedure. (If you’ve ever had an EMB, you might not consider it such a good trade off..)
Then along came vaginal ultrasound, and we were able to stop even those endometrial biopsies in all but the few whose sonograms did not make the 5 mm cutoff. The OR is now reserved for those women unable to have an office biopsy or who have obvious endometrial polyps on sonogram (which require removal to rule out malignancy, just as colon polyps require removal.)
There’s nothing more satisfying than being able to reassure an anxious woman that her bleeding is a benign process and she does not need to have an invasive test. (Of course, one must interpret the sonogram results in light of the clinical scenario., and sometimes your clinical sense tells you to biopsy regardless of the sonogram results. If it does, trust it. You just may be right, as I was with those two patients I mentioned.)
Now what?
It’s too soon to say, but I’ll be watching this one closely. If we do move from a 5 mm to a 3mm cut off, I predict I’ll be doing more endometrial biopsies in my menopausal patients, something that will make neither my patients nor me very happy. The question of course, is how many more biopsies, and at what cost (both financial and in terms of complications such as perforation or infection)? I could not glean that answer from the paper.
But if more biopsies is what we have to do, then we will do it. Because the downside is missing a diagnosis of cancer.
And that’s something none of us wants.
___________________________________________________________
Timmermans, A et al. Endometrial Thickness Measurement for Detecting Endometrial Cancer in Women With Postmenopausal Bleeding: A Systematic Review and Meta-Analysis. Obstetrics & Gynecology: July 2010 – Volume 116 – Issue 1 – pp 160-167.
My brain keeps going back to one thing when I think about this: your idea of "non-invasive" is very different from mine (re the transvaginal sonogram).
Is that so? I think of an invasive approach on that.
Bardiac and CieAura-
It seems to me that the transvaginal sonogram is no more invasive than a pelvic exam…..If you've had postemenopausal bleeding, you're already in my stirrups and getting a pelvic exam, so when I add in a transvaginal sonogram (especially when i can do it right there in the office), I do see it as a very good thing. And yes, I call it noninvasive.
Now if you're f the "every pelvic exam is an invasive procedure" point of view, then I guess there's not much I can say to convince you otherwise.
I do offer topical anesthesia for sonograms and pelvic exams in little old ladies and others who can't tolerate anything being inserted, (see my old post on pelvic exams), as does the sonographer to whom I refer my patients.
I've never, thank goodness, needed an EMB, but my sister did. Her male gyn assured her it was a big nothing. She nearly passed out from the pain.
My daughter also had to have one. She was also assured it would be no big deal. She is an adult, so I am respectful of her autonomy. I tried to prepare her and encouraged her to discuss pain issues with her doctor (a woman), but left it at that. She chose to not push it. And subsequently vomited on the way home from the pain.
It is clear you are totally aware that this is not a 'big nothing'. But, for future reference for my daughter, I wondered what is your protocol for dealing with the pain?
Also, the previous comments and your response were ironic to me (although not in a bad way, I have nothing but admiration for you as a doctor). I think because it is so routine and you are so professional, you don't think anything of pelvic exams. But so many of us who have had any kind of sexual abuse or trauma view a pelvic exam as incredibly invasive and emotionally painful.
After reading your blog for a long time, I know you are a sensitive and kind practitioner. But also a pragmatic one. You are right, it should be a very matter of fact exam. But for many of us it is a tough one. Our heads may know it is routine, but our hearts don't and the physical memories it evokes are traumatic. And, if other women are like me, we keep it to ourselves, leaving you in the dark and mystified as to why it would be a big deal.
You probably already knew all that, but I just needed to say. 🙂
just wondering what if you were diagnosed with a endometrium thickness of 12mm…??? sounds scarey, seeing that under 5mm is the norm.
Stacy-
Endometrial thickness alone is meaningless – it must be interpreted in light of what is going on with the patient, if she is pre or post menopausal, does it look like a polyp, etc, etc. If the endometrium is above 5mm, it does not mean a person has cancer – it just means we cannot use ultrasound alone as the final test to decide what is going on in the case of post menopausal bleeding. Most endometrium above 5mm are in fact benign. But you should talk to your doc about this, not me!
P.
Yes I agree! I am 45 and had my endometrium biopsy and came back benign. I decided to do it because my uterine lining showed 27 mm on my vaginal ultra sound. Now I am not decided yet if I will do the ablation.
I just found this site and it is great. My question is: If a pelvic ultrasound was done to evaluate fibroids that have been present for years (with “minimal change noted”), there has been no bleeding since menopause, but the endometrium was 6 mm, is there cause for concern?
Ale –
I’m sure you understand that I cannot interpret sonogram results or give out medical advice on this blog. I’m assuming this was your circumstance and your sono, and that you and your doc are evaluating these results. Do ask your doctor these questions, and if you are not confident in the answers, seek a second opinion in person from another doc.
Sorry.
Thanks for reading.
Peggy
I am 64 (15 yrs post meno) and had PMB in 2004(D&C normal), then again in 2006 with same reslut and now have it again with trans vag u/s measuring thickness of 6mm. It was recommended that I return in 2 months for follow up U/S. I wonder if I should get a hysterectomy?
I think transvaginal u/s is non invasive and in fact hardly even pleasurable. I didn’t feel it but then when I get into a bath the water level goes down instead of up. 🙂
I’m sure you understand that I cannot give medical advice on the blog.
I will say that in my practice, I tend to use endometrial biopsy in the office to evaluate post menopausal bleeding in women with a thickened endometrium, reserving D&C for obvious polyps or difficult diagnostic cases. Sonohysterography is often useful in cases where no pathology is found but thickening persists – sometimes there are small polyps. The decision to do a hysterectomy is generally based on a diagnosis of some sort of uterine pathology or in cases where high risk due to personal, genetic or family history exists.
As always, if you have questions, ask your own doctor. if you are not satisfied, get a second opinion.
After all the research I have been doing and trying to keep myself sane, I found your blog.
Can you tell me if you know of any connections with reversing cell damage via high antioxidants, diet and menstrual cycles in post menopausal women.
Several years ago a friend of mine had gone through menopause, changed her diet significantly to vegetarian, low fat and high antioxidants. She lost so much weight, improved her health but then began having a menstrual cycle again. Tests showed she didn’t have cancer but that her body had been ‘tricked’ into thinking it was young again, therefore, menstruation began AND she went through menopause again. She wasn’t happy.
Fast forward, I am on a high antioxidant diet, never experienced any menopause symptoms and was told via blood work last year that I am post meno. I didn’t even know I was or had been in menopause until that blood test. I am still getting a period and now there is great concern: 6mm lining, EMB test was abnormal (I think he said that cells showed hormone activity and that more tissue is needed… a D&C is coming up.)
I cannot find any data in medical journals that supports high antioxidants reversing cell damage (turning back the clock) and post menopause. I am hoping you know or might be able to direct me to this information. Thank you.
*Note I did read information from Dr. Neal Barnard who advocates a plant based diet for women. As it relates to menopause he stated that Japanese women don’t even know what that word means, they do not have these problmes; Western Diet consumers do.
Jean –
The reason you cannot find the data is that it does not exist.
The menopausal ovary is not as quiescent as you think, can still make estrogen and even occasional menses can occur in the first year or so after menopause. Neither does a single elevated FSH does not necessarily coincide with the cessation of menses. The perimenopause and early menopause are a dynamic time of change and unpredictability of ovarian and menstrual function, irrespective of vitamin usage.
That said, a balanced diet that includes fruits and vegetables (preferably without pesticides) is a good thing for your health, But don’t expect it to delay menopause.
I cannot comment on any aspects of your medical care – please see the disclaimer on the “About me” page of this blog.
Dr. P I do understand why you cannot comment about any individuals medical care and I would be alarmed if you did; I am glad you don’t or I’d probably not have stayed here to comment.
I am in total agreement about whole clean foods and eating organic. I am also pretty sure that eating hormone injected meats is not such a good idea; select grass fed or seek organic meats.
I do hope that science extends its reach to study and report on the anti-aging affects of antioxidants. My gut tells me there is a lot of information that can really help a lot of people just waiting to be found and reported.
One statement that I think needs to be super clarified is ‘when you have not had a period for one year’ you are in menopause. If menopausal women are still having their period, like me, it seems to raise a lot of red flags *pardon the pun. Maybe the message should be ‘you are now post menopause and if you get a period call the office.’ My OB was in shock and stunned when I gave him my ‘keep track card’ to see how many periods I have had since being declared ‘post menopausal’.
In addition, every woman I have ever talked to is quick to blurt out ‘Oh it’s got to be one year of not having a period to be considered post menopause.’ I wonder how many women know to contact their physician? I didn’t based on the original message.
In regards to the numbers reported from blood work that shows a doctor if a patient is in menopause, what are the numbers and what do they mean? Thank you for your explanation. It is very much appreciated.
Jean – see this post – it may clear up any confusion you have.
Take care.
http://www.tbtam.com/2008/05/menopause-defined-2.html
What I want to know and understand is,why is there no anesthesia or pain medication for the endometrial biopsy? No,I don’t spell very well. But seriously,something that painful should require anesthesia. I have to have one in a week and I had to find my own way to make it less painful! I think if we did this procedure to a man there would be pain relief. I’m a little angry about it all!
Tracy –
We can and do use anesthesia for an EMB – a paracervical block is often used. But that involves injecting two needles into the cervix, something that for some women is as uncomfortable as the biopsy itself. It also does not block the uterine cramping that is the major source of discomfort from the procedure.
Folks have tried injecting anesthetic directly into the uterine cavity as a wash, using anesthetic gels and various combos of this and others. Nothing in clinical trials tends to take away all the pain,which I find to be very individual – some women hardly feel it, others are in pain even with the speculum.
The good news is that it’s literally a 10 second procedure one it’s set up. Taking motrin or aleve ahead of time may help.
If you’re to have an emb, talk to your doctor about the various options for making things go a bit easier.
Thanks for reading.
Peggy
If I’m correct you are talking about biopsy in cervix?
My dr gave me the morning after pill. Her theory was it relaxes the cervix for easier access. Still not pleasant but a previous one had me seeing stars !
Sorry. In uterous …
Endometriosis etc
I can think of only one way to avoid aging.
I think it is sad to see women desperate to avoid nature particularly the cult of surgical intervention that leaves women all looking like they had Joan Rivers face transplanted on them. Why they think this looks better than ‘age’ is beyond me.
Dr. P I have an update.
I had the D & C procedure and the results showed all normal. What totally baffles my doctor is that the images he has and (shared with me of me vs the typical 53 yo female uterus) is like night an day. What he actually saw and shared with me is my body looks and is behaving as if it were about 8 years younger. There is no cancer or any other problem that ‘should’ be there based on what he described.
He expected to see areas of inflammation and/or cancer but saw very little inflammation saying that it was ‘hard to find any’. We spoke about what I have been doing and consuming high antioxidants. He admitted he was not trained in nutritional therapy but the only explanation is that what ever I have been doing has reversed the aging process and ‘tricked’ my body. I really do wish that Western medicine would take a closer look at high antioxidants and anti-aging because it appears that I am living proof. The next thing they should do is report on that to help other doctors or patients who may be seeking information on nutritional therapy. Whole clean foods are God’s medicine. I’ve stumped my OB and I have already stumped my Primary by healing my body naturally from other chronic illness.
I lived in complete ‘hell’ for 60+ days waiting for the test and the results. I had far too long to go research and was sure I had Uterine Cancer. Everything I found pointed to ‘probable’. I am thankful to God for NOT having Uterine Cancer and being able to consume His medicine. Of all the research I did while I waited your blog housed the best information and I am glad I found you. Keep doing what you are doing here because you have a fantastic platform to educate other women like me. God bless.
Jean, can you tell us what your high antioxidant diet is?? thanks
I was diagnosed with endo 10 years ago. Huge endometriomas, but little or no pain and zero impact on a happy, healthy, active, life. I got a post-menopausal period (15 months since the last one). Now I’m scheduled for a transvaginal ultrasound with endometrial biopsy. Is there any data about postmenopausal women with endometriosis? Where do you suggest I look for more info? Thanks!
[…] Menopause SymptomsEndometrial Thickness in Post Menopausal Bleeding – Is 3 mm a Better CutoffEndometrial Thickness in Post Menopausal Bleeding – Is 3 mm a Better […]
My endometrial thickness is 18mm
Does that automatically say I have cancer?
Carol –
While I cannot comment directly on your case, I can say that the thickness of the endometrium depends on many things, including age, menstrual status, phase of the cycle, pregnancy (or not), as well as others. Most importantly, who is the patient? Her age, menstrual status? Symptoms? Why and when is the sono being done? (Don’t answer these questions, I am just making a point.)
A thickened endometrium in a younger woman could be caused by early pregnancy, anovulatory cycles, or be totally normal depending on the phase of the cycle. In a post menopausal woman, it could just be anovulation (ie, she is not really done with her menopause tranition and may be getting another menses), or it could be endometrial hyperplasia, a polyp, the wrong angle on the sonogram reading (technical error), uterine anomalies such as bicornuate or septum creating a falsely thickened appearance on sonogram, tamoxifen use, etc, etc. Cancer is just one possibility when discussing thickened endometrium in apost menopausal woman, but it is the one diagnosis we do not want to miss.
As with all tests, the sonogoram results must be interpreted in light of the clinical scenario.
It is best to discuss your results with your doctor.
Thanks for reading
Peggy
I stumbled across this website when doing research so hope I can still post a question. I am 54 and 12+ months past blood work that showed post menopause. 2 weeks ago I felt like I had PMS and had 1 day of bright red bleeding. Went to GP next day and she did exam said looked ok and sent me for transvag. That came back abnormal and now scheduled for EB in 2 weeks. I feel like I have terrible PMS,really bloated and moody and now some light spotting again. Is this expected if have thickened uterine lining (I don’t know how much mine is yet-just told it is thickened). Of course worried about uterine cancer but the PMS symptoms are really annoying!
Kim –
I hope you understand that I cannot give out health advice on a blog or answer such specific questions. I would discuss your concerns with your doctor.
Thank you for reading.
Peggy
Thanks.
Dear Kim,
In June 2012 I had blood on dipstick at gyno, sent me to urologist who did a clean catch and said there was red cells and bacteria. Now in 2013, June, I go to the bathroom and there is blood. Gyno send me for TVUS and it came back with .043cm thickness, no tumors or cysts. Had cystoscopy to rule out bladder issues. New urologist sent me to another gyno for 2nd opinion. When the Dr. walked in with my sonogram in his hands he said that he wanted to do an emb. I freaked, and panicked inside. He said the tissue came out easily which is a good sign. I called my regular gyn and told him what the Dr. did, and that he gave me estrogen suppositories? My regular gyn told me to lose weight as my estrogen levels were to high, and to come back for another TVUS in 2 months. I didn’t sleep last night, and am so anxious about the thickness thing. If it’s not a cancer, what would cause the thickening and the bleeding? I know you can’t give out medical advice, but anything you could give in words of comfort would be appreciated. By the way, the blood in the toilet was a day after I had intercourse with my Husband. I am 56 years old, and in a state of sheer panic.
Thanks so much,
Paula
I don’t really know where to begin, but here’s a start….. I’m so confused and would like to hear any thoughts on my experience or if your’s was similar. I woke up last week with a “bloody discharge”. I’m almost 51 and haven’t had a period in over 4 years. Had the ablation procedure to stop it about 5 years ago. Called my dr, she examined me, I had an ultra sound, then the dr. did a endometial biopsy. It was just as bad as labor pains!! horrific experience! Finally felt better the next day, but not I’m having extreme cramps like menstrual cramps, the bloody discharge has completely stopped, but now I’m very nauseated with cramps. If anyone has had the “last period” post Menopause like me please reply. Also, the dr. said that my endometrial lining has thickened.I did not know to ask the # of the thickned until now. Could the lining be too thick just because of the “last period”?? Well this is why I had the biopsy. Get results on Wednesday.I have researched and read and asked others, I am a little confused, Can anyone help to explain in general?
Thanks in advance for your replies and prayers for a good report!
Rebecca
I just finished reading the thread of responses from other women. I, too, have had post-menopausal bleeding. I went into my gynecologist to have her check it out. She proceeded to tell me that I needed an endometrial biopsy and that I would experience “mild pain.” Instead of “mild pain”, I would describe it as “excruciating” and “barbaric.” I trusted my doctor and when she continued doing the procedure (as I was grasping the sides of the table with large tears, but being non-vocal), I asked her if she was “almost done.” She said “No. Do you want me to stop?” and I said “yes.” From there went to have the vaginal ultrasound and then the D&C and hysteroscopy. Now awaiting results. I guess what I have learned from this whole experience is that everyone’s body is different and those that have experienced no pain during an EMB, they should be extremely thankful! For others like me, having experienced such horrific pain, I would speak up and let the clinician know verbally what is going on. You DO NOT need to experience such violent pain. Ask to have a D&C with hysteroscopy with IV sedation. It’s thorough and although there was some pain breakthrough, very tolerable. Thanks for your blog. I appreciated reading your comments as well as the others’ responses.
Hi, my mom recently had an ultrasound done due to bleeding, and her endometrial thickness is 7.7mm. I’m awaiting a call back from the Dr., since the person I spoke to was the nurse. She also has a polyp. Are the chances of that being cancer low? She went through menopause two yrs ago and I’m hoping that the thickness is not too serious. Thank you for your time, I’m so worried and it means the world!
I see that some named Rebecca has posted before me. You could refer to me as Becky so that its not too confusing! Thank you again!
Can I ask a question. I have had two C-sections and have a retroverted uterous. Can that make the endometrium thicker e.g scar tissue from c-section.
I have a endometriam thickness of 4.2mm. I have no symptoms–no vaginal bleeding. Should I be concern.
Forgot to say that say that I am post menapause
How did your test turn out?
I just had a trans-vaginal ultrasound. It was neither painful nor uncomfortable (you know, except for being in the stirrups and all!) A biopsy followed as my lining was 12mm post-menopausal. The EMB was a little more painful than a pap smear but not much. I know we’re all different but don’t stress – its not that bad and though I don’t have the results back, there is little chance it is cancer so I will wait and worry when and if there is actually something to worry about. 🙂 Good wishes for good health ladies!
Hi,
would a 62 years old woman in post menopause with 8,5 mm of endometrium thickness and no bleeding be considered to further medical action ?
Hi Dr Peggy, UK patient here. Your website is wonderful. I have just received results for endometrial biopsy on National Health Service. The sample taken under general anaesthetic was too small to analyse. Has anyone heard of such a problem occurring before? Looks like I will have to have the procedure repeated. The womb lining had been 14.5mm when the transabdominal scan was taken but it had receded to normal by time of the biospy & hysteroscopy. I am a 51 year old & having a good old panic tonight. Lots of love to all your
contributors xxxx
My lining was 17mm with a tvus and receded back to normal by the time of my d & C and hysteroscopy what happened to you? I am baffled and waiting for results of the biopsy.
I went for a pap and my dr sent me for a pelvic and transvaginal ultrasound. This showed a 6 millimeter uterine lining which they say is high for post menapausal, no period for a year and sporadic for a few years before then. I went earlier this week for office endometrial biopsy. Dr could not get to my cervix and even had another dr try. I was in the office for 45 minutes of poking and prodding and being miserable and no results. Now scheduled for a d & c next Thursday. Very confused, concerned and frustrated. If it isn’t normal size and not sure about cancer what else could it be? Need answers.
I am 64 yrs. with an episode of 3 days vaginal bleeding which was initially thought to
be urinary due to history of kidney stones.
I have had a CT scan with contrast;Cystoscopy ;Trans vaginal Ultrasound & endometrial biopsy.
My lining is thickened to 18mm & I have asked my new gynecologist for a D& C & awaiting same.
I am a retired RN & since my husband & I have never had children the EMB was painful. On a scale of 1-5
with 5 being most painful it was 3 for me. It would be brief but the Gynecologist could not obtain results & did it twice. I took Alleve 2 hours prior & I carried a cold gel pack
in the car. The cold pack really helped cramps.
Jeanne
Hi there thank you very much for this blog.
My situation is 15mm thickening, pmb a week after noncompliance
w/estrogen patch+therefore progesterone, postmenopausal for 1 year(last period
Thanksgiving time 2011).
I probably need a variety of tests but my situation is
complicated by vaginismus- i have tried but never had
gyno exam& i am early 50’s now.
I also had an incident as a kid regarding anesthesia( at dentist)
where i felt but couldn’t communicate that.
However I did really well with colonoscopy 2 yrs ago
Propofol&Midazolam.
My questions are:do you know of any colleagues that treat patients
similar to my situation? Thank you very much for
being here .
I forgot to say of course no transvag just the abdominal ultrasound.
Last year , aug 2012, 8 months after last period, thickness was
7.7- not yet on the hrt…That was prescribed starting march2013.
Have you seen/ heard of 15mm due to noncompliance or even mistaking my ovary for part of the uterus?
By the way the tech saw my left ovary but report says couldnt see ovaries;
adnexal images suboptimal YET states no adnexal masses seen!??
I am indeed having pains like hit & crampy in left ovary almost like
I have to use the restroom#2 but i don’t( sorry
for the graphic).
Anyone else in same situations too.?
I HAD POST MENOPAUSE BLEEDING FOR A MONTH. I WENT TO THE DR AND HE REMOVED A POLYP FROM CERVIX. HAD A ABOM. SCAN WHICH WAS OKAY. ALSO HAD INTERVAGINAL SONGRAM WHICH SHOWED FIBROID AND 6MM ENDO THICKNESS. = HAD AN ENDO BIOPSY.
I am 62year of age with a 5mm uterus lining no bleeding what does that mean can you explained in a ball park way my gyn want to monitor me every 6 months
Second EMB Yesterday. Ultrasound came back both times 6mm in 2012 (perimenopausal) and again in Dec 2014 (menopausal). Can’t my measurement just be normal at 6mm.? Post menopausal came later than normal at age 57. I feel great.not obese or heavy. I had spotting just twice one day after the other last month,hence the trip to GYN. Ultrasound showed fibroids – 3 of them, 2 of which are the size of golf balls. One of which I had in 2012 that could not be removed during an ablasion as it was deep into the uterine wall. The one from 2012 hasn’t grown but it hasn’t shrunk either. All 3 are in the uterine wall so can’T be removed. I guess none of this sounds good. I eat healthy. Only natural sugars in fruit and vegies. No processed foods. Menopause symptoms are very minimal. No family history. Good libido still. No dryness which may have explained bleeding. Could never take contraceptives as they made me sick -even low estrogen. I was hospitalized with both pregnancies during first trimester. Sick, lost weight. Darn if it wasn’t for that spotting. What is with these fibroids? I am caucasion, Canadian-born, of Finnish decention – I was told that people are more prone depending on race and nationality so that’s why I added that. Waiting 1 Mth to get results. Hate the idea of a hysterectomy And messing around with hormones. How can you feel this good and have this happening inside you?
I think its been over year and a half sense my last menstral cycle had a very very light spotting called my gyn had a vaginal ultrasound a few small fibroids a little thickness in the endo lining he wants to do a biopsy in his office but he wanted to check but he said its probably not cancerous I am scared
Don’t be scared Sharon! I have not had a period for 1-1/2 years and I started again and had a normal period. I had a transvaginal and everything looked good but my endometrial lining was 8mm. My dr wants to do a biopsy! I keep reading they hurt really bad but my Dr said they did not.
I wonder. EMBs are taking a bit of the endometrium and looking at it in the lab. Yet the clotty tissue that postmenopausal women often get with those odd periods are the same tissue. Can’t a post-menopausal bleeding woman insert a sterilized diaphragm (using sterile gloves) and collect that bloody tissue and place the sample in a special container and bring it to the lab to get that biopsy? That would be less invasive, way less painful so why can’t a protocol be set up for that similar to the stool samples people take home and do?
Wow.. now that I read all these comments I am more frightened than ever.. I didn’t learn anything except that having the biopsey hurts really bad…I so don’t understand this blog at all. Oh well .. I so wish I could help all you ladies and something to help calm everyone. I send out my prayers to all of you and pray for good health and nothing but cures and a happy happy future and long life for everyone. GOD bless everyone… all my love..
Just a question, when is the best time to do a transvagnal ultrasound to check the thickness of the Uterine lining? Is it after the abnormal bleeding has stopped in a post menopausal women?
Best to discuss timing with your doctor.
MMP
Ladies, please don’t alllow yourselves to literally die of embarrassment. Agreed, many tests and procedures are not pleasant, but neither is cancer.,We are very fortunate to have doctors and treatments out there to help us keep well and healthy as we can be. I have an endometrium measuring 19 and a few other symptoms that have given my doctor some concerns. It may be nothing at all, but if it is, I will have every test and procedure that is offered. I am one of these people that will do my own research and then trot back to my doc with my questions. I’ve reached my 57th birthday and have plans for reaching a good many more. I see my doctor as my ally and anything that she suggests, using the benefit of her experience as well as other healthcare professionals, tests and procedures will be fine with me, especially when I do my own research, ask my questions and have informed choices. May all those affected and going through treatment have a good and happy outcome. Thanks too, to all the busy health care professionals who give of their time to educate and inform.
Wow. I read all notes. Have to say that I had an EMB today. I was worried, given what I had read. But it was fine! I do have thickening and fibroids – which is also very normal and can cause the post menopausal bleeding. I wanted to add this comment to provide balance on the EMB procedure. What I did find valuable in reading all the comments above was that I am very normal with my problems – so for that I am thankful – despite the outcome 🙂
I am 51 and postmenopausal having gone through menopause at 43. One month ago had 3 days of spotting (mostly light brown a little reddish). Vaginal ultrasound showed endometrial thickening of 5mm. Was told nothing further to be done unless more spotting or bleeding. Today, however, when presenting for annual exam, NP suggested EMB. Now have to go back to doctor for consult and then schedule EMB which they will do under “light anesthesia” due to severe pain with previous EMB. By the time all is scheduled could be up to 6-8 weeks after Spotting had occurred. Should I be concerned about the amount of time elapsing between biopsy and initial presentation of issue?
Sorry I cannot give direct advice on this blog.
Be well.
MMP
I am 58 this August. Menopause at 49. Bleeding, vaginal. Also blood in urine abdominal pain and if thats not all swollen lymph nodes in my legs?…. In between primary care physicians…waited for for 6 weeks for appt. After already waiting 6 weeks!!! OBGYN suggests ultrasound, to determine if endo biopsy is necessary. My endo lining is > 9mm. And the technician saw something else that looked “funky” wtf is funky……. too scared to ask I guess. Waiting for phone call today to schedule d/c for biopsy! Oh thats because at the sametime I was diagnosed with Lychen Sclerosis! funtimes.
I posted this to the wrong site………
I am 58 this August. Menopause at 49. Bleeding, vaginal. Also blood in urine abdominal pain and if thats not all swollen lymph nodes in my legs?…. In between primary care physicians…waited for for 6 weeks for appt. After already waiting 6 weeks!!! OBGYN suggests ultrasound, to determine if endo biopsy is necessary. My endo lining is > 9mm. And the technician saw something else that looked “funky” wtf is funky……. too scared to ask I guess. Waiting for phone call today to schedule d/c for biopsy! Oh thats because at the sametime I was diagnosed with Lychen Sclerosis! funtimes.
I am 61 years old and post menopausal at 55. I had bleeding 3 years ago. Had Transvaginal Ultrasound, biopsy and D&C/polyps. Bled a tiny bit again 1 year later. Ultrasound and biopsy normal. Bled a tiny bit again 1 year later (a couple of weeks ago), ultrasound lining shows 5mm. Doing biopsy next week. I would suggest to those who are afraid of the biopsy pain, not to worry. I take 3-4 Advil a few hours before the test. I feel it but not horribly. Better to find out that all is well or medical attention is necessary than to ignore it. I just wish I could find answers. I am high risk: no children, no birth control pills, no HRT. Thank you all for being so brave on this website. It’s nice to know we’re not alone. God Bless…
Thanks for breaking this down in such a clear way. I’m curious about the comparable statistics for perimenopausal women. I had abnormal bleeding, insisted on a transvaginal ultrasound prior to biopsy, and it came back looking great with only 3mm endometrium. I am loathe to go through the invasive and painful process of a bioposy, even though my doctor has emphasized that this is what is needed for 100% certainty. I do have the risk factor of never having been pregnant and of my aunt having had uteran cancer, but other than this, no risks or symptoms beyond the one-time extended bleeding, which I’m assuming was probably hormonal- and stress-related. But I’m wondering what the likelihood of cancer is in peri-menopausal women with this 3mm cutoff rule, as most articles I’m finding seem to focus on post-menopausal women.