Making the hysterectomy decision

Q: My gynecologist tells me I need a complete hysterectomy. I am 50 years old with fairly regular periods, except that they are at times very heavy with clotting. I missed a period, then the next one lasted three weeks with extremely heavy bleeding. From tests, it was determined that I am producing too much estrogen and a biopsy showed atypical cells. I’d appreciate any advice you may have for me.

A: My first question to you is are you keeping up with your blood loss? You should be loading up on iron rich foods (green leafy vegetables, raisins, etc.) and taking in iron tablets – you need to maintain your hemoglobin in the 12 to 13 range. I would also recommend a full diagnostic D and C. That might well help your blood loss, and would fully sample the lining of your uterus. If your pathology showed no evidence of endometrial cancer, but only what we call adenomatous hyperplasia, which is overgrowth of the lining of the uterus, you could be treated with continuous progesterone therapy for several months. At that point, I would then recommend a repeat biopsy to make sure you cleared the hyperplasia.

If it is clear, you do not need a hysterectomy, but you will need follow up, and probably some follow up biopsies in the future. If you have questions about your management, you might want to consult with a gynecologic oncologist, or tumor doctor, because the major question here is could your overgrowth turn into a cancer? If not, we just would hope for menopause because that would take care of your bleeding. Good luck.

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