Q&A of the Week: D&C Vs Endometrial Biopsy

Georgia writes: I recently had a D&C for some abnormal bleeding. They found hyperplasia with some mild atypia. As I am 44 and would like to keep my uterus (at least for awhile) we are going to try progestin therapy. My only fear is from reading on the net that if I have atypia I may already have cancer, and that I should go ahead and get the hysterectomy.

Georgia - First of all, one of the advantages of a D&C is that the pathologist gets to look at all the endometrial tissue, and see if there is cancer there. This is not the case with just doing a small sample of the endometrium in a biopsy. The studies that found cancer with "hyperplasia with atypia" were done with biopsies, not D&C's. So you can rest your mind on that score.

Secondly, if your doctor thinks that progestin therapy is a reasonable thing to try in your case, and you are so inclined, there's no reason not to go for it. It often does work for mild atypia, and then you would avoid a hysterectomy.

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