QuestionI am 32 yrs old and suffer from PCOS with insulin resistance. I recently began treatment again after a lapse of 2 years (1000mg metformin/daily %26 12 day provera cycle). My physician did an ultrasound to determine my endometrium thickness. It measured a 14. The next week I had an endometrium biopsy done and was diagnosed with Endometrial Hyperplasia w/ Atypia. My doctor immediately began drug therapy (400 mg of Depo Provera/monthly for 6 mos) to reverse the hyperplasia. I just received my first shot yesterday. I have read EVERYWHERE on the internet that the recommended treatment is a hysterectomy unless, like me, the patient is of childbearing age %26 wishes to conceive. My question is three-fold...1) What can I expect to happen after receiving the shot? (Will my menses begin or not?) 2) Can hyperplasia be "reversed"? and 3) If it is reversed, statistically speaking, what are my chances of conceiving and how soon after treatment ends? Please help me shed some light on this new diagnosis.
Thank You so much for your time...
AnswerHello Jaime from the U.S.,
Endometrial hyperplasia with atypia is considered a pre-cancerous state because if left untreated, it will turn into uterine cancer. You doctor is correct in not doing a hysterectomy if you want to retain your fertility in order to have children. Usually, the treatment is D%26C followed by progesterone for a minimum of three months. Then the biopsy/D%26C is repeated to verify that the hyperplasia is resolved. Prolonged progesterone treatment could work as well, but I think most would want to do the D%26C in order to get a better specimen of tissue and make sure that cancerous changes have not already occurred. That is what I would recommend. Once the hyperplasia resolves, then you can begin trying for pregnancy.
Depo provera ia a long-acting progesterone so is usually given every three months, not every month. Your doctor must be using a different progesterone since he is giving it monthly.
Once you are resolved of the hyperplasia, and your cycles return (sometimes up to six months after the last Depo provera shot), and your cycles return, you can begin trying for pregnancy. Your chances of pregnancy should be the same as it was before and is age dependent. This treatment process should not influence your chances for pregnancy.
Good Luck,
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.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf, and follow me on Facebook at http://bit.ly/9Iw9oV
