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Women's Health

Uterine Fibroids

10/30/2009

Question:

During my annual pap smear/exam, my family doctor noticed a a possible cervical polyp and ordered an ultrasound. Result: small cervical polyp and uterine fibroids and I was referred to a gynecologist. She removed the polp(benign) but could not get into the cervix to scrape a sample of the uterine fibroids. She prescribed misoprostol - 2 tablets inserted vaginally in evening and morning of doctors visit...along with a valium. She was unsuccessful again. Her office performed another ultrasound (this was now 2 mos after first one). Result: endometrium with several cystic areas, two uterine wall fibroids with the left one calcified. Rt ovary has several calcifications. She has scheduled me for an outpatient hysteroscopy and D&C. I am 62 years old, postmenapausal for many years and have not experienced any bleeding or pain. Is this really necessary?

Answer:

When a woman goes through menopause, the lining of the uterus (endometrium) shrinks and becomes very thin, because there is no longer any hormonal trigger for it to grow and bleed.  So when a sonogram shows the endometrium to still be very thick, or contain cysts or polyps, there is a suspicion that it is due to some tumor of the endometrium.  Many polyps or growths are benign, but because of the possibility of cancer, a D&C is often recommended to remove them. 

Fibroids are smooth muscle tumors of the uterine wall.  They do not cause the endometrium to grow and are not associated with cancer.  While they, too, shrink after menopause, they usually don't disappear, so there may always be some present on ultrasound well into old age.

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Response by:

Jonathan  A Schaffir, MD Jonathan A Schaffir, MD
Clnical Assistant Professor of Obstetrics & Gynecology
College of Medicine
The Ohio State University