Postmenopausal bleeding

Difficult

I am so glad to see you are being proactive and assuring something is done to resolve this issue and doing it now.  I must say your issue is not so straight forward where you have an absolute answer.  Inclination to have them remove the problem but what if it is treatable and you have just had surgery and pain etc for naught...  but I tend to agree with Drieene that I would want a biopsy or something definitive to determine malignancy sooner rather than later.  After you rule out the big C then you will have a much more "sane" recovery.  

There is also the possiblity of obtaining a 2nd opinion.  Just keep up your fight for your health and you will be in my prayers.  

Patty

HRT

I was on HRT at about your age (I may have been 52) and I had some bleeding which was attritubed to breakthrough bleeding from the HRT.   When I started HRT, I was not postmenopausal, I was just tired of having periods, they were pften painful and heavy, so I was placed on continuous hormone therapy and had no periods for several years.  I loved it.  I did, however, have to have a biopsy when I had some bleeding, but it was determined that nothing was wrong and I went off HRT to go through menopause naturally.  Unfortunately, that didn't happen for me until I was 57, but I really had no symptoms, just stopped menstruating one day.  I was lucky.  Gads, I hated having periods, tho.  And I still got endometrial cancer at age 62 .  I think if a woman NEEDS hormone replacement therapy, it should be offered and used, but having had both endometrial cancer and breast cancer I am convinced that being on HRT was a contributing risk factor for developing breast cancer and now I can never have estrogen because of having had ER+ breast cancer.   And for me, it's ok.    There are so many pros and cons about being on HRT, but I feel about it like I feel about most drugs, if one needs the drug, it should be taken, if not needed, don't.  For me, being on HRT was a convenience, not a necessity.  Hope all goes well for you.   And keep pushing for answers.

Suzanne

Tamoxifen

Is not HRT.  It blocks estrogen receptors on breast cancer tumors and so it doesn't feed them and hopefully the die off.  (maybe you knew that, but "they" do refer to both tamoxifen and aromatase inhibitors as estrogen therapy, but their roles are ANTI estrogen)   I imagine she wanted you to take it prophylactically for whatever reason.   I took it for 5+ years after my breast cancer (as originally prescribed), but declined taking it for another 5 (new recommendation) with the blessing of my oncologist because (for me) I think the risks of being on the drug for 10 years outweigh the risks of my breast cancer ever recurring.  A friend whose battle with breast cancer ended with the breast cancer winning always said "we keep on doing what we have to so we can keep on doing what we want to".  If I felt I should have taken Tamoxifen for 10 years, I would have. 

S

Biopsy First

Hi Zannie!  Your story is very similar to mine.  I would second the advice to get your endometrial biopsy done first, before your surgery. It is an office procedure.  I had a fibroid with post menopausal vaginal bleeding too and I underwent a procedure to remove the fibroid in March this year.  During the fibroid removal procedure they did an endometrial biopsy.  The Myosure procedure, similar to a D&C, involved filling the uterus with fluid to operate the laparoscope, so the doctor can perform the procedure.  When the fibroid was removed, the uterine cancer cells were cut up and pushed out through my fallopian tubes and into my abdominal cavity, by the fluid under pressure, which muddied the waters for cancer staging, which looks for cancer cells outside the uterus.  The fibroid removal also changed the inside lining of my uterus, which would happen with a D&C.  One of the things they measure in staging is distance from inside edge of the cancer to how far it has invaded the uterine muscle.  If the biopsy were done first, there would not have been a need for the fibroid procedure, as the hysterectomy would have eliminated that problem.  My surgeon was surprised by my cancer diagnosis, as was I. If I had to do it all over again, I would have had the endometrial biopsy first.  I ended up with a 1B stage, but there was a lot of debate at tumor board about the staging as a result of the fibroid surgery.  The other plus, is it may eliminate having two surgeries, back to back, which is what happened to me.  I had a hysterectomy two weeks after the fibroid removal.  In the end, I was advised that the fibroid surgery done first would not affect my long term survival rate, as cancer is commonly found with D&C's and there is no decrease in survival with that group.  But you can avoid some potential issues by biopsying first.  I wish you the best with your surgery and decision making.  You are in good hands with the well informed and supportive people in this forum!  Please let us know how you are doing and how we can help you.    Linda C

Zannie said:

Biopsy first

Hi Linda and everyone. Thank you so much for your advice. Hope you don't mind more questions... did you have laparoscopic myosure or hysteroscopic? I was really freaked out reading about fda warnings against morcellation when having hysterectomy hut then couldn't find any warnings against it for use in myomectomy/hysteroscopy. It was confusing because the myosure website said it is contraindicated when cancer is known or suspected but the NICE guidelines and every other expert recommendation said there have been no published cases of metastisis from myosure. In my case I also need a native tissur sling repair (similar to the monarc procedure but with my own tissues). Stress incontinence is ruining some aspects of my life. so there's that surgery, which the Dr planned on combining with the investigation. I also have a mast cell disorder so they usually do procedures cautiously and I go under GA or alot of midazolam and such. With the possible calcified fibroid, would they need to biopsy it plus the lining? Is it hard to biopsy a calcified one? I read also that a hysteroscopy can push cancer cells out into the system and cause spread. I feel so vulnerable because I don't want to get on the wrong side of the specialist by asking for things to be done differently but am  also fairly worried about how continuous the bleeding is becoming plus the abdo pain is daily. did you get pain down the front of your legs? Maybe I should make another appt with my GP to see if she can help.mediate this issue. Is your cancer remaining stable? Did you have to have radiation and chemo? Maybe I should ask GP to speak with surgeon and find out if I can have the biopsy or biopsies first then do the repair and possible hysterectony....

 

 

 

Biopsy first

Hi Zannie.  The Myosure procedure was hysteroscopic.   I had a vaginal hysterectomy performed during a Da Vinci robotic surgery.  My uterus was removed intact.  They don't biopsy the fibroid, though it is examined by the pathologist after removal.   I went through chemotherapy, which was my decision.  It is not the standard of care with Stage 1A, but my tumor was Grade 3 with LVSI (creation of lympho vascular network to spread the cancer), so it had some high risk attributes.  My oncologists supported this decision.  I start radiation in a few days.  Good idea to have your doctors talk with each other about the biopsy sequencing.   Let me know if you have other questions. Best wishes to you for an uneventful procedure and speedy recovery!  Linda C

New Gyn/Oncologist!

Hi Zannie,

Glad there is another gyn/onc available, and also glad you have a relationship with a gync. surgeon who is well-known for reconstructive surgery. If you can go to the new gyn/onc directly for a consultation--whether it means letting your gynecologist know first or after--it would be good.  If a biopsy lets you know that you need to have a hysterectomy, your fibroids come out with the uterus as Linda C. (Pinkuke) pointed out.

As a note, I did read reports from a couple of studies that showed in-office endometrial biopsies having a greater margin of error (false negative for cancer) than do d&c biopsies. I don't know what your health insurance is like in New Zealand, but make sure they come to bat for you!!

All the best,
 jane