Dear Healthy4now ,
You are having asymptomatic endometrial thickening.
To rule out abnormality, your doctor is planning endometrial tissue assessment by hysteroscopy and D&C (dilatation and curettage).
When she will insert the hysteroscope, your cervix will be open before that, so you do not need separate surgery to open cervix. Cervix can be opened with the help of dilators just before any procedure and does not require a surgery. There is no need to keep the cervix open always for future access.
D&C is not problematic if done by an expert and at good centre.
Most common cause of endometrial thickening in postmenopausal women is proliferative endometrium, polyp and hyperplasia. All these are treatable, so do not worry and go ahead.
Hope that this information helps and hope that you will get better soon.
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Dr. Meenakshi Titoria Sahu
I'm still not clear about your response regarding my closed cervix opening. How in the future will my doctor be able to do a pap exam in the office if my cervix opening is closed? Also, is there any issue to keep taking the Vagi Fem given the possibilities you mentioned: proliferative endometrium, polyp and hyperplasia?
I apologize for not being clear in my previous response. Let me try to explain again.
Cervix is the lower end of uterus which is 2.5 cm long and has an internal and an external opening. Cervical stenosis is the medical term used to refer to a closed cervix. Most of the time it is the internal opening which is closed. In women with cervical stenosis (closed cervix), an instrument cannot go inside the uterus but microscopic cells in the cervix itself can be collected. Pap smear is taken from cervical cells shed off in upper part of vagina (fornices). So I do not think cervical stenosis will pose any problem while performing Pap smear in the future.
As far as cervical stenosis is concerned, it doesn’t cause much problem in future. As per my understanding, your doctor is planning to perform a hysteroscopy and D&C to rule out pathologies such as polyps and hyperplasia that might be the cause of your thickened endometrium. A closed cervix can be opened using an instrument called a dilator. It is a simple procedure. It does not involve surgery, i.e making an incision as such. You do not require any surgery to keep your cervix open at all times. Your doctor can open it with dilators if needed. But it won’t be needed for performing investigations such as a PAP smear.
As for Vagifem, it should be taken under supervision of a Gynecologist. Your gynecologist would be able to suggest if further use of vagifem is right for you after the hysteroscopy and D&C that is planned now.
Dr. Meenakshi Titoria Sahu
Well I had the procedure last Friday, and my follow-up with the Doctor yesterday and she told me she was not able to dilate my cervix opening, that there was scaring from lichen schlerosus and she had to make an incision to get in and do the biopsy of the cervix, up close to the uterus, which came back negative. She also was not able to get into the uterus, so she could not do the D & C because it is so small without concern she might puncture it. She had to use a pediatric speculum to get in that far and she said the surgery center did not have an ultrasound so she could go further. I'm not sure I understand what that means, maybe you can explain. She said the fact I am a lesbian and haven't had intercourse for over 40 years could also have an impact to why I'm so small. I'm also 5'2" and 140 lbs, so I'm not a really big person to begin with.
My concern is that she wants to wait 3 months, have me do another one of those painful vaginal ultrasounds and see if there has been any more thickening.
So basically, I went under General Anesthesia, spent all this money to essentially not get the procedure done that I went in for (D&C and possible removal of polyps), and have nothing conclusive.
She said if I have bleeding, then that would be a problem and now that she made this incision in the cervix, the blood should come through, but I'm wondering if that is true since she couldn't get into my uterus, how is the blood suppose to come out? If I wait until I have bleeding symptoms, does that mean if it is cancer, it could progress to a stage that would be more difficult to treat? What would you recommend I do?
Confused & Concerned