Hello doctor, My wife usually has a period for six to seven days. On the first two days, she has pain. At times, she has heavy clots also. The doctor had asked us to do the scanning and some test. The scanning report is attached. 'There is anteverted and bulky uterus which measures 11.7 by 10.3 by 5.7 cms in size. The fundal endometrial thickness is 6.6 mm.' The doctor says the reports are fine. He has asked her to take Regestrone tablet (5 mg) twice a day for 15 days. My questions are:  Are the scan reports fine? Is her uterus fine? Should she take the Regestrone tablet?
Hello. The scan (attachment removed to protect patient identity) shows a bulky uterus which can be due to adenomyosis or possible fibroids in situ, but the absence of fibroids is evident. She is likely to experience painful menses and heavy bleeding due to adenomyosis as well. Again the report shows an endometrial polyp which can often be the cause of irregular spotting as well and pain in the abdomen. This can be removed by hysteroscopy. Adenomyosis is a form of endometriosis and can grow with each menses. So, ideally, the perfect treatment is to control menses by GnRH analogs or Progesterone-only pills (medical management) and if still not controlled medically and the patient is symptomatic and in unmanageable pain, then hysterectomy is suggested. The plan for giving cyclical Progesterone for 15 days will not apparently help much in her case, as it has been given seeing the thin endometrial wall thickness if she has irregular shedding during mid-cycle which she does not. Also, she is nearing her perimenopausal period. So, the thinning endometrium can be attributed to that. But in either case, cyclical progesterone will not help as the cause is adenomyosis and endometrial polyp for heavy bleeding in her case and not hormonal. Please discuss it again with your doctor and make an informed decision. Regards. For more information consult an obstetrician and gynaecologist online -->