Hi, I am 55 years old whose period ended Aug. 2012, so I am in the midst of my menopause. Jan. 2012, I had a transvaginal sonogram (TS) to check on my gynecological health (never had one before) which indicated 1.6 cm thickened endometrial with hyperechoic lesion in the endometrium which demonstrates blood flow and is suspicious for a polyp. I have never had any gyno problems and have had no bleeding and no symptons.

In Jan. 2013, I had another TS which indicated the size is the same as the previous TS. It also said: "The endometrium is thickened measuring 1.6 cm. Again there are findings suggestive of an echogenic heterogeneous mass with vascular core, suspicious for a polyp with increased cystic portions from previous test."

Also had hystersonogram but doctor/radiologist could not distend the endometrial cavity and this limited definitive diagnosis.

A blood test CA-125 in May 2012 was normal.

1. I am worried about endometrial cancer. With the above information can this be watched and retested in some months or must a D&C be done?

2. If I do get a doctor to agree to retest, would it make sense to do a different test, say an MRI, rather than another TS?

2. What is the threshold for endometrial size that determines if a D&C needs to be done when there is no bleeding?

3. I am worried that with the D&C, complications (not minor ones) can occur in the range of 3.6% or more. Therefore, if I wait for follow-up testing and with this endometrial size and no bleeding, what are the chances that it would lead to cancer?

Medscape: Medscape Access (http://www.medscape.com/viewarticle/440353)
Oops, that goes to a login page?
OK, here's most of the article:
" In one series of 100 asymptomatic women (mean age 39.5 years), polyps were noted in 10.[1] In another series of 60 asymptomatic menopausal women (mean age 52.7 years), polyps were noted in 19 (31.7%).[2] Polyps were apparently not resected in either of these case series; accordingly, no histopathologic information is available regarding these 29 asymptomatic polyps.
A third case series reported 19 patients found to have asymptomatic endometrial polyps on sonohysterography, in addition to 42 patients with symptomatic polyps.[3] All of these polyps were surgically resected. Of the 19 asymptomatic lesions, malignancy was noted in 1 (a 36-year-old woman). Of the 42 symptomatic polyps, 2 cases of malignancy were noted (the overall risk of malignancy in this series was 4.9%).
It is clear that endometrial polyps are common, many are asymptomatic, and most are benign. Furthermore, we know that smaller polyps commonly regress. Currently, however, we have inadequate information to assess the risk of malignancy using sonohysterographic characteristics. Therefore, routine hysteroscopic resection and histopathologic analysis of endometrial polyps is appropriate, whether the polyps are associated with abnormal uterine bleeding."


I didn't know that the risks associated with D & C were 3.6% (or more)? I would expect a much lower number.
As for what you should do, of course that depends on your relationship and discussions with your doctor in light of probabilities and your general health. It's not the sort of question that should be answered by anyone online. After reading the above article myself, I think I would have the D & C, despite how many are benign in any given group.

I am new to this online communication, so I hope I do it right.

I am Karen and wanted to thank very much for the answer given by "joypulv." I can tell from the answer that you are very knowledgeable and appreciate you taking the time to respond in such detail.

I wanted to tell you that I suffer from panic disorder and have a mother with lung cancer who had surgery (she smoked years ago but had stopped). She has lived with me for many years and I take care of her. Also, my father died about 10 years ago from colon cancer. That is why I am so distressed about having this possibility of endometrial hyperplasia/polyp which has stood the same at 1.6 cm thickness for a year.

I did see two gynecologists after the first TS in Jan 2012. As often happens, they gave me different advice with one pushing to do surgery (presumably D&C) and the other to wait and see if the endometrium reduces in thickness in a few months because I was in perimenopause. Now that a year has passed and I had another TS and also a hysterosonogram, the 3rd gynecologist at first thought I should have a D&C too. But then when examining me and seeing that I am in good condition internally and I am not bleeding, he suggested I could wait 3 months and get another TS or hysterosonogram.

I did not mention before but the results of the hysterosonogram also done in January 2012 after the TS states: "There is relatively stable appearance of echogenic distention of the endometrial cavity, up to 1.6 cm AP, containing microcystic foci. There is is a vascular stalk arising form the anterior fundai wall." It also states: "These sonographic findings, as well as the relative stability since Jan 2012 favor a benign polyp, however, the inability to distend the endometiral cavity limits definitive diagnosis. Endometrial hyperplasia is also a consideration."

1. Does it make sense to follow this last doctor's advice - wait for 3 months and then get another test? For example, might the thickening reduce or if I do wait would an MRI be more definitive in the diagnosis rather than having another TS or Hysterosonogram?

2. If I do wait, how quick can this condition turn into cancer.

3. If each subsequent test shows no significant change, would anyone leave it alone and keep monitoring it?

4. Would it make sense to consider treating the thickening by medication by a doctor (e.g. treated with progestin)? Would that be a safe approach considering that I am not bleeding and the size remained at 1.6 cm for a year?

Please reply.

You show great concern, and I will give you the same advice as I would my wife, It is normal and common if there is no change, to merely follow up in a few months and see if there would be any change. But if you have person fear or worry, get a second opinion from a local doctor, this is normal and common to want to get one.

With that D/C I will say these are common, at least in the US and should not be a issue at all

Your mother's lung cancer is from smoking, even if she stopped. Did your father's colon cancer start with polyps? I don't know of any studies of correlations. Of course some smokers never get cancer, and I assume that your father was in his 70s, so the family history does 'count,' but I don't see it falling in the realm of statistical data. Most of us are going to die of one of the biggies - cancer, heart and other vascular. My family has melanoma on both sides. Some cancers are more related than others.

1. I would wait 3 months. I don't know about MRIs showing more but would say it's not needed. I lean towards having a D & C eventually, mainly because they can't examine you more closely.
2. Answering probabilities is not meaningful. If a study of 1,000 women shows a range of say 3 months to 3 years with a median of 1.5 years (I made that up), you can be anywhere in that range, or even outside of it (since you weren't part of the study), and how is the start and stop measured, when no one can know if the women were tested at the magic moment?
3. I would have a D & C if it doesn't reduce in size in about a year.
4. I don't know. I wouldn't, personally. I'd go for the D & C over medication.