Atypia Is NOT An Absolute Indication For Hysterectomy

Question:

Hi Dr. Ramirez,

I'm a Canadian, temporarily living in South Africa. Greetings from Pretoria!

I'm 44 yrs old, diagnosed with PCOS at age 33, on metformin 500mg 2/day since then. I've got about 45 pounds to lose and have been slowly and steadily losing pounds since May (5 kg). I've never been able to get pregnant and throughout my 20s and early 30s, I went months without menstruation. Weight came on very quickly. I exercise regularly.

My new gyne here found a myoma in my uterus in August during my yearly exam. I had bleeding between periods almost every day for a few months. Some days it was spotting; other days it was heavier. The myoma was removed hysteroscopically and examined. The biopsy of the tumour shows atypical cells and the lab report summarizes the microscopy as "these features are most suggestive of an adenomyomatous (endometrial) polyp with focal atypia against the background of a proliferative endometrium."

I understand I need to remove my uterus.The doctor can do the surgery vaginally. Is uterus removal the best course of action? What can I do to prepare my body for no uterus? And Is there anything I can do to protect my ovaries going forward?

Thanks for your help in advance. S. from South Africa

Answer:

Hello S. from Canada and South Africa,

Atypia is NOT a absolute indication for hysterectomy, so no, you don't necessarily need to have your uterus removed. Atypia is not cancer, it is a pre-cancerous finding. It is possible that the only area of atypia was already removed, which then would have solved the problem. A repeat D&C should be done to evaluate the rest of the endometrial tissue. Also you should be cycles for three months then rechecked again by endometrial biopsy or D&C. If there is no abnormality found, then no other testing or treatment needs to be done other than keep you cycling on the birth control pill.

However, if you want you uterus out, and that is understandable, it is certainly a option for you and a vaginal hysterectomy would be fine. Make sure that your doctor keeps the ovaries intact i.e. does not remove them. You still need them to produce adequate hormone that your body needs. It's your choice. Make sure your doctor understands and is told that you want to keep your ovaries. There is absolutely no reason to have them removed.

Thank you for your question all the way from South Aftrica, addressing a problem that many women around the world face as well.

Good luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.

Comment: Thank you Dr. Ramirez! Very timely and useful.