Apprehensive re: endometrial biopsy; periods after chemo-pause

1in8

I know everyone's experience is different. I started sudden, heavy bleeding 3.5y after chemo-pause.
If your periods resumed, were they much different than before chemo-pause?
Any tips or suggestions for endometrial biopsy?
Pros / cons of oophorectomy and / or hysterectomy?
Thank you for any feedback.

My story:
I was premenopausal and just turned 44 when diagnosed. Found out I had hemorrhagic ovarian cysts just before chemo and having transvaginal ultrasounds (TVUS) every 6 months since then. Chemo started a few days into my cycle that became unusually heavy and long. Then had a week break before a very light, shorter than usual 4-day period. Chemo-pause started in 8/08. Had hormonal assays done w/ each blood draw through 2/10 when my MED ONCO declared that I was postmenopausal since I've been in chemo-pause for 1.5y at that point.

While on 1y 9m of tamoxifen (2/09-11/10), the TVUS revealed the development of a uterine fibroid and endometrial polyps. The ovarian cysts gradually shrank. Endometrial stripe remained thin.

Started having sudden out of control diarrhea in 9/10 and finally told to temporarily stop tamoxifen as a last resort. That wasn't the cause; turned out to be a combination of fructose malabsorption and small intestinal bacterial overgrowth possibly exacerbated by chemo and rads though no GI trouble at all during active treatment. Go figure. Better now on a very restricted low-FODMAP diet but still have unpredictable GI issues though much less severe.

Anyway, MED ONCO decided it was time to switch me to an AI (anastrozole / generic Arimidex). Now 1y 3m of anastrozole and 3y 6m of chemo-pause later, I feel a sudden gush and by the time I made it to the bathroom (thank God I was at home), blood is running down inside my pant leg. Sorry if too graphic. I had absolutely no warning. I track my basal body temp (BBT) and pre-cancer, my BBTs would indicate when I ovulate and when my period is imminent. My BBTs have been on the low side (in the 96s and 97s ever since chemo) and only in the weeks before my "period" finally hit 98 a time or two. Since then, it's been all over the place w/ no pattern whatsoever.

This "period" also doesn't follow my usual pattern. Instead, I gushed for 3 days anytime I moved or shifted position and it lasted about 10 days. I just happened to have hormonal assays done in DEC and my TVUS in JAN. So PCP and MED ONCO order hormonal assays again and have me go see my GYN. Fluctuating hormones and my pelvic exam show signs of my body recovering from chemo. Apparently, my ovaries might be making a comeback. Finally, my MED ONCO deems it necessary for me to stop all anti-hormonal therapy. I had another TVUS last week which showed more endometrial polyps in the 1.5m since the last TVUS. Endometrial biopsy scheduled for WED. If everything turns out to be benign, then I will be put back on tamoxifen as my bone density has dropped. I've been osteopenic and now I have full blown osteoporosis probably from combo of AIs and restricted diet and exercise ban when my diarrhea and weight loss were at its worst.

I was delighted to "get through" menopause so quickly and easily. According to my GYN, if I'm now becoming perimenopausal after 3.5y of chemo-pause, there's no telling what to expect. It will be like going through puberty all over again and then before my body falls into a rhythm again, I'll most likely be going through menopause since my 48th B-day is approaching in a few weeks. Ugh! Puberty and menopause again.

In the meantime, my GYN told me to gather my thoughts about uterine preservation. I have a strong family history of colon cancer (twice on both sides). Mine's was the first BC case in the family. Then an aunt closest in age to be got diagnosed. If it weren't for the fact that I shudder at the idea of any more surgery (I ended up w/ 4 surgeries w/in 2 years as a result of my BC), I'd go ahead and have the whole kit and kaboodle removed. Sure if it turns out to be cancer, I'll tell my doc to take it all out ASAP. But if not cancer, I have to continue w/ the inconvenience and "stress" of watchful waiting. A few of the GI docs I consulted suggested that if HNPCC runs in my family (I can't afford the genetic screening right now), not only is my risk for colon cancer elevated, but also for any gynecological cancers. I can have colonoscopies every other year or so (it's the colon cleanse I dread more than the actual screening) but there are no definitive screenings for ovarian or uterine cancer.

I typically don't stress out over doing labs or other procedures. It's the waiting for the results that I'm impatient for. If it's good news, then great. If it's bad news, then I'm glad we caught it so we can take care of the problem ASAP. This time around, I'm OK w/ whatever my results might be--I'm not crazy about the idea of getting my periods back nor am I crazy about the idea of having a new cancer though having been through treatment once, I know I can get through it again. Instead, I'm a bit apprehensive about the endometrial biopsy procedure itself since I have no real idea what it entails. From what info I could find online, it can be just a bit unpleasant to downright painful. My biopsy will be done w/ a pipelle. I was told that driving myself would be no trouble since anesthetic is not used. I can take some ibuprofen beforehand to minimize any cramping.

Thank you for any feedback.

elimar86861

All I can say is that if you have been thru' labor and childbirth, getting an endometrial biopsy is about 1/1,000th easier.  It pinches a bit at the time, and some cramps can follow along with minor bleeding for a day.  I know it depends on individual pain threshold, but IMO it was not that bad.  Taking ibuprofen could cause more bleeding, so I would suggest acetaminophen, if anything.

jdeking

I agree, the biopsy is not too terrible. A small pinch, then some menstrual cramp type feelings, then back to normal. I have had 2 so far, as well as an abdominal myomectomy to remove 12 fibroids (they had a party when I started Tamox and started growing like wildfire).  My gyn strongly strongly recommended a total hyst w/ooph, but at 36 I just was not ready for that.

My cycles were also extrememly heavy when they first came back after nearly 18 months of chemopause. They did lighten up considerably and now I have light cycles approx every 8-10 weeks.

 I agree, take ibuprofen or tylenol before hand. The biopsy really is a piece of cake compared to a lot of the BC stuff. Good luck!