Provera experience, please...

Hi. ?

49. No period since October of last year. Uterine lining not where it should be per bloodwork. 7.15. Should be under 4. According to the gyn I've been with for 25 years.

Thank you Louellen! Was thinking that a second opinion may be in order. No cysts. My thought is to just let this process occur on its own. Doc said if the lining isn't shed, risk of cancer is a concern. But I don't understand? Expected to be put on HRT, which he will do temporarily. For a few months. I was in a frail state at the time of the appointment. I didn't handle it right. I REALLY appreciate your advice! Not sure what to do at this point?

Nancy, any time that the lining builds up, they ALWAYS say that it's a "risk of going to cancer"...especially if you're not shedding that lining.  However, being so young (yes, you are young), I'd say that you truly need a 2nd opinion as to how to handle this situation.  If the 2 docs agree...then, you know what to do.  If not...choose what feels right to you.  Get as many opinions as you feel that you need to form a decision.  

As a final note...sometimes, what one doctor can't see, another will.  Being with someone for 25 years makes one feel comfortable, I'm sure but, it may not answer your questions.  This doc seems to only have certain answers/treatments.  And, YES...they want to try something non-invasive first because surgery is a bit more of a big deal.  

Have this doc done an in office biopsy to see what type of cells are there?  It could be that you have a polyp which can appear like a thickened lining.  (I've had 2 removed in 2010).  Sadly, a regular ultrasound can't decipher what is a polyp and what is thickened lining.  

My bet would be that a D&C with pathology and a scoping (hysteroscopy) will do a few things.  First, it will tell them whether you have polyps and they can remove them at the time (99% of the time...benign...like fibroids).  Secondly, it can tell them what the pathology is (ie: Hyperplasia...which if not atypical does NOT turn to cancer in more than 1% of the time...low probability...but, if it's atypical...they will deem it more of a risk and do a hysterectomy if needed/deemed necessary...just not at the time you're in for the D&C).  Lastly...*IF* you truly are in menopause, it'll thin the lining and likely not build up again at this point.  That's why I say that perhaps, you want another opinion?  

Are you bleeding any?  Even a spotting is enough to warrant at least an FSH and LH as well as thyroid and estradiol level check on top of the other things mentioned above in my response.  If not...you have time to get a 2nd opinion.  

I don't have enough details on your specific situation to say (as a lay person..not a professional) what you should do but, I would certainly get another opinion or at the least, insist upon further diagnostics being done before I'd embark upon taking hormones without knowing what's going on.  Maybe, you already have had more done but, we're unaware of what you know already?  Usually, they do more than an ultrasound.  

Hope this helps some???  Write more if you're unsure and tell us what you have had done.  

HUGS XO XO XO 

Oh, Louellen, YOU are SO very helpful in trying to help me! I've been without a bleed for almost 10 months. Always struggled with endometriosis since age 22. Depro shots then. 2 Laparoscopic surgeries, a laparotomy at age 25. Doc said I had 10 years to have a child. Had my 1 and only 2 months before I turned 33. D & C for a miscarriage when my son was an infant. Heavy bleeder since just before I turned13. All of the women in my family have had a hysterectomy. They all say that I'll be a new woman after. I wanted to keep my organs, thinking that was best and natural was the way to go. Now the doc says I need a bleed. Scared to take the Provera for obvious reasons. I have uterine fibroids. They're small. Was 3 years ago. Now doc says there's just 1, and it's not enough to cause issues. I'm anxiety riddled and broke down crying when I saw my gyn last month. Terrible health anxiety now, so don't even want to adress the issue of NOT taking the Provera. Ugh! Just at my wits end with this! Thanks again for listening and taking time to reach out. I too feel like I've been there, done that. Labor took 27 hours. Hormones have always been my enemy. 😲😒😕

HI Ya Nancy...me again LOL.  

I know what you mean.  I also have health phobias and fears.  I think a lot of people do but, don't necessarily talk about it.  It's actually quite common to have.  No worries here because I completely empathize and understand why you are so full of worry and fear.  

First off, being without a bleed for "almost 10 months" does NOT put you into a "Post Menopausal State". In actual fact, you are still considered as being "Perimenopausal" UNTIL you have been an entire 12 months without a bleed.  I know of women who have gone almost 12 months without a bleed and WHAM...there it is. LOL. That means that you could still build up a lining because your estrogen levels are not falling at the same rate as your progesterone is falling (this is common for most women in perimenopause and thus the long, heavy periods or shorter cycles etc.).  

Secondly, the Depro shots are heavy duty things.  It's essentially the SAME thing as Provera except...it's in shot form AND, it gives the body 20 mg/day of Medroxyprogesterone (aka Provera).  If you could tolerate the shots...this will be a walk in the park for you at 10 days at 10 mg/day for that time and off again.  So, think about that and see what you think about it.  You can write back and I'll see it.  . 

Yes, of course, having a hysterectomy would bring all of this to an end, providing that you keep your ovaries for now.  You wouldn't have to worry about the bleeding or lining build up BUT...here's the kicker...it's a drastic step to take if you don't need to do it.  It's a last resort for those who have tried just about everything else and it's failed (you're reading the words of a woman who has had the Provera, Prometrium, Mirena, 2 D&C's, Polypectomy, Endometrial ablation and so much more over the past 9 years and all have failed).  

Now, all of that said, I think (just a layman's personal opinion and not a professional opinion of course), it's sounding as though you are at the brink of possibly going into Menopause but, may or may not be there yet.  Thus, the questioning about doing an FSH, LH, Thyroid etc..  My Sister-In-Law also has endometriosis and she's been through the proverbial wringer too.  She's 13 years younger than I am so, about your age.  She's still menstruating with HEAVY periods some months. I'm wondering if perhaps, you might ask about an endometrial ablation or D&C which would thin out the lining?  About the only thing that I would think *MAY* be a problem is what's left of the fibroids...which most women have at your age and beyond.  If it's not bothering you, leave it alone.  No bleeding is a good thing.  

Ok, so here's the deal.  The doc is worried about the lining build up but, it's not bad.  Really, it's not.  It's not bad enough to warrant panic and fear.  It may even be a polyp as I've said before.  She/he just wants your lining to thin to 4 mm or less because they are putting you as menopausal and you may not be.  Only time will tell.  

Here's the simplest ideas for now from me from experience but, not a professional opinion.  

1). Have a blood test done.  Test the FSH, LH, Estradiol (the estrogen), Progesterone levels, even Prolactin and Thyroid levels to get a ball park figure of where you are in the grand scheme of things.  Taking you down to 4 mm if you're NOT in menopausal ranges is totally uncalled for as far as I am concerned and I think another ob/gyn would agree.  See where you're at, roughly...that's all that it is....even with a HIGH FSH, you can still menstruate and build up a lining.  

2). You *COULD* have an in office biopsy which will cramp for a second or so and you'll spot for a few days but, it will be an in office thing and rule out anything sinister.  (The fact that you're NOT bleeding IS a good thing and a good sign that there's nothing horrific going on...just perimenopausal stuff).  

3). You *COULD* go for a D&C and Hysteroscope where they will see the uterine lining, clean you out and get a biopsy as well as rule out polyps.  

4). Get another opinion...as hard as that may seem to be to do with health phobias/fears.  She/he may want to do any of the above but, I think that you're being put under stress unnecessarily by this current doc.  

5). Probably the simplest thing to do *IF* you can tolerate it is to just take the Provera since you've already had the shots which are longer lasting and double the strength that you'd be taking.  If you didn't tolerate the shots well...ask about Prometrium.  You can use it vaginally too...same pill...just inserted vaginally and less systemic effects.  

The last thing that I can say is that you don't really need to do anything with this at the moment.  You have TIME to think about it and what you wish to do.  You can wait it out the 12 full months and see what happens.  You may get a period anyway and on your own???  

Now, what would I do if I were in your shoes, well....I think that I'd run this past another ob/gyn and see what their opinion is before I did anything...unless of course, I bled or spotted.  If I did that...I'd see if it's a normal period or just spotting.  I'd likely see what another ob/gyn suggests and if you like that one...you can switch or you can stay with the same one you're with.  Either way, a 2nd opinion may net you a "what do I do" type of answer and stop all of your wondering and worrying.  

In short...because you are NOT bleeding (the potential for troubles but, also just could be hormonally induced bleeding and nothing to worry about), I'd say that you have time right now to just wait and see what happens on your own and perhaps, get another opinion, even if you just have a consult with another ob/gyn.  Remember though...they are all going to err on the side of caution to save their own rears and a malpractice suit.  

A hysterectomy doesn't sound like it's required right now.  Save that as a "last ditch issue" and stop worrying if you can.  You're YOUNG and have time.  Any bleeding on your own though, should at least cause you to make a call and see what she/he wants you to do.  I do NOT think this is thorough enough though from your ob/gyn.  I think that you are being worried unnecessarily right now.  

Hey...there are even online ob/gyn's that can be consulted BUT..they are pretty vague and speak in generalities.  It's also costly to do (about $40 US to $60 US for a question that may or may not answer your question.  They will usually say..."be seen" LOL. Don't be alarmed.  That's them covering their legal rear ends. ). 

Keep talking if you wish to.  . I know what this feels like.  I'm a mess today because of my own bleeding at 62 years of age and an upcoming hysterectomy with White Coat Phobia now.  Once bitten, twice shy, huh?  Keep your cool.  You have TIME!  Just think about what feels best for you.  You do NOT have to please a doctor.  You only have to do what feels right to YOU!  Remember that.  

I'm here! . XO XO XO 

I thought hysterectomy was the answer for me as well. Still not sure it isn't. Thanks for the response! X

Amanda, I have a hysterectomy booked for the 13th of September of this year too.  Like you, I've had enough of this bleeding, worrying and upset (anxiety).  I've tried Provera, Prometrium, Mirena, 2 D&C's, 2 hysteroscopies and so many biopsies that I can't count them nor, the ultrasounds.  I have "Simple Hyperplasia NO atypia" but, I'm 62 years old and just tired of daily bleeding and sometimes (like today) a period like flow.  Enough is enough now.  I'm scared but, I need to get this done with now.  

Nancy, there are all sorts of things that they can try before resorting to hysterectomy.  Don't go that route unless you truly need it done.  Get another opinion.  Go with your gut and mind, not just familiarity.  You may find yourself feeling more assured as to which path to take.  Aim for a "Non-Invasive Surgeon" (one skilled in non-invasive treatments and surgeries if you can).  

Hi Amanda:

No...I haven't had Zoladex but, if I am correct, it's similar to what we call "Lupron" whereby it sends someone into a menopausal state???  Am I right on that???  

If so, my Sister-In-Law has had it.  It put her into full blown menopausal symptoms...hot flashes/flushes, mood swings and all of the goodies.  She took it for Endometriosis, in the hopes that it would "starve" the endometriosis from growing.  I remember her dripping sweat and being really a mess.  

They offered me that type of thing as well but, I didn't see the sense in going through all of that or another drug in my system as it was a "temporary fix" so to speak and wouldn't solve the issue permanently.  

What are you/did you take it for?  (If you don't mind me asking that is. )