Complex atypical endometrial hyperplasia

Feeling a little lost in terms of where to look for help/guidelines and hoping that someone here might be able to help.

I'm 36 years old and was diagnosed with complex atypical endometrial hyperplasia following a hysteroscopy and biopsy last March. Due to my age and desire to retain the possibility of future pregnancies, my gynaecologist suggested we try hormone therapy before committing to a hysterectomy. In June this year I received an appointment with a gynaecological oncologist who stressed that hormone therapy could be a risk considering the extent of my symptoms and doubled my dosage of progestogen with strict instruction that I undergo a repeat biopsy/hysteroscopy in September.

Second biopsy/hysteroscopy happened this week and whilst I don't have results yet, I was advised post-procedure by one of the doctors present in theatre that I should prepare for the worst as things looked highly suspicious. I was also told that I was now officially an oncology patient and no longer to be treated via gynae, and that follow-up/results would happen within 6 weeks but most probably within two due to fact that I've already been diagnosed as pre-cancerous. Today I find out that I've been given a general gynae clinic appointment for nearly 8 weeks time and am now torn between preparing for a cancer diagnosis and hysterectomy or reassuring myself that perhaps the hormone therapy is having an effect.

It's been a year since I began attending appointments and tests for abnormal bleeding and I've been in increasing pain since December last year to the extent that eating and sleeping are now affected on a daily basis. Is it usual that I have another 8 weeks of waiting to find out whether it's cancer? Would really appreciate hearing from anyone that's gone through this process and can give me an idea of what's normal in terms of results and progression. Thanks in advance.

  • This still seems to be active so I thought I would post a repy to it.  Hope that's okay! Apologies in advance for the length as well.

    I'm 56 years old and still in perimenopause. I suffered from abdominal pain around Easter that lasted for nearly a month and in the middle of that I had a 15-day period after none for three months. The pain went away but then came back so I spoke to my GP, who arranged an US for me with a little push given my maternal grandmother died from ovarian cancer and my paternal grandmother from breast cancer. That showed up a small endometrioma (a type of ovarian cyst) and some cystic changes to the lining of my uterus. I was told about the endometrioma at the US and told I would need to see a Gynaecologist but my GP then told me about the cystic lining a couple of days later. I saw a doctor at an Urgent Referral clinic two weeks later in June and she booked me in for a hysteroscopy to check there was nothing untoward, reassuring me that 8 or 9 times out of 10 everything is fine. Had the hysteroscopy under IV sedation mid-July (am severely needle-phobic and suffer from anxiety) and a Mirena fitted at the same time. The Registrar told me after the procedure that there didn't seem to be anything wrong and I would get the results in two weeks, which turned into four.  Yesterday, a day early, I got a phone call stating they had found Atypical Complex Hyperplasia and I would need an MRI and a hysterectomy. I'm still in a bit of shock and am really worried as the nurse I spoke to on the phone said they don't always do an MRI before a hysterectomy and just go straight to that but they want to check things in my case and had booked me in for an MRI next Thursday and then an appointment with the consultant for the following Thursday. I was suppose to be on holiday next but they suggested I not wait as it would push things back by around a month.

    I'm now really worried they have found something concerning that warrants the MRI (and that my endometrioma might be something more sinister after all) and aren't telling me everything. I've been told to expect the hysterectomy within the next month, which is also freaking me out.  How normal is it to have an MRI? How normal is it for things to move along this quickly and have a hysterectomy so quickly after diagnosis? Don't get me wrong, I am grateful, I'm just very worried. I've seen that even with a pre-cancerous biopsy and nothing suspicios showing on an MRI, there is still a reasonable chance of cancer being discovered when they look at the tissues following a hysterectomy. All this cancer worry is making me less worried about the operation itself at the moment but I dare say that will change in due course!

    Thank you for anything anyone is able to share.

  • Hi, I am going through similar at the moment, polyp was removed beginning of November and they found complex atypical hyperplasia, got sent for an mri today and am completely freaking out. They keep saying they haven't found cancer but then they are handing me leaflets about cancer. Have you had your hysterectomy yet? How did it go?

    sorry for all the questions, would be really good to talk to someone who has been through similar.

  • Hi!  Sorry you are going through this too. I had my MRI at the end of August and got my results a week later and there were no signs of any cancer. Of course, they cannot be 100% sure until they get the pathology results back from everything they remove so will not give you any reassurance that you are 100% cancer free and will always speak about that as a possibility as they need to be careful until they know for sure. I had my hysterectomy at the end of September and, luckily, no cancer was found and they removed everything in time.

    The hysterectomy went well and I was in hospital for around 36 hours, if I remember correctly. Pain was well-controlled and I was up and moving fairly easily the next day. I had a catheter for just over 24 hours and they didn't let me home until I had passed a certain amount of urine once that had been removed and my blood test results were okay. I had a total laprascopic hysterectomy with ovaries and fallopian tubes removed as well. I was looked after really well in hospital and sent home with some strong painkillers but I ended up not needing all of them and managed with paracetemol and ibuprofen fairly quickly. The biggest thing for me was fatigue and it is still something I am dealing with, and vaginal discharge, which some people have and some don't, that is only really starting to stop now.

    Many people have issues with gas pain (this wasn't such a big problem for me) and strong mints, winde-eeze and peppermint tea are very much your friends. I was also recommended to take Milk of Magnesia for a few days until my digestive system woke-up and started to get back to normal. Of course, it all depends on what type of operation you have (laparascopic or abdominal) so your experience may well be very different!

    I had to wait a month before I got the results back as my consultant was on holiday and wanted to give them to me in person (which also freaked me out) but did say when he came to visit me post-op that afternoon that all looked okay and it was a textbook operation. I was initially told it would be two weeks before getting any results due to the pandemic (it's usually a week) as they had to send them off to another hospital. I ended up getting a letter dated 10 days after my operation telling me nothing sinister was found they day after I met my consultant four weeks after my operation so they knew at that two-week period but never told me... I should have rung them up and pestered them as it was a rather anxious wait subconsciously for me.

    Fingers crosssed everything goes smoothly for you and they find nothing nasty. Do let me know if you need any other information or need to talk further and very best of luck!

  • Thank you so much for coming back to me. As soon as they said MRI I started panicking! Now I just have to wait until the MDT meeting on Tuesday. I'm 40 which seems quite young for this to happen. I'm just sat worrying that there is god knows what going on inside my body. I have had so many ultrasounds and blood tests since I started having problems with my periods a few years ago but nothing other than cysts that come and nothing has ever been picked up. 
     

    Glad to hear than your op went well and they didn't find anything sinister. I'm hoping it will be the same for me. I'm really hoping for a larascopic hysterectomy. I have two kids and work full time so the least time out of action the better especially as I am a single parent. 

  • I was really surprised to find out that the average age for a hysterectomy is...42!

    I did exactly the same but it simply turned out that some consultants like them, some err very much on the side of caution and some, if cysts etc. are being dealt with want to check for size, growth etc., which may also have a bearing on what type of operation to perform (laparascopic or abdominal). They may also want to check for other things (for me it was also to see if my endo could be seen elsewhere and if they needed to get anyone else in). Alas, they don't always volunteer this information! I was also told I shouldn't put it off for a week as it would push everything back by two or three weeks due to clinic / team meeting dates, which also worried me, but that is because this kind of thing is all still on the urgent care pathway and they like / need to deal with it quickly even if they think nothing bad is currently going on as it could change.

    Good luck for next week and I hope you get preliminary good news as I did. Remember, they can't guarantee you are cancer-free until after they get the pathology back from your hysterectomy but they can still give you an indication of what may or not be going on. I know it's hard but try not to panic and make sure you get plenty of help post-op with childcare, housework etc. and don't let yourself be pressured into going back to work too soon either. It's major surgery and your body needs time to heal internally, even when things start to look good from the outside.

    Please do keep us updated and I will be sending positive thoughts your way.

  • Thank you for helping to ease my worries a little. I just want to get the op over and done with But with Xmas in the way it's going to delay things.