What's a gyno supposed to do re uterus while on tamox?

SophiaMarie

My MO told me to make sure I saw my gyno - to keep tabs on the uterus because of being on Tamox. So I went yesterday and he just says "feels normal". Is that it? I questioned it because I seriously don't know the protocol - he said he could do a biopsy but that wouldn't really be necessary. Then he decided to send me for vaginal ultrasound since I've also had ovarian cysts in the past so both could be checked. But then I read that unless you have bleeding, there's nothing to check for. I'm confused! What should a gyno do be doing??

Lojo

I don't really know, but have the same question. Saw my ob/gyn in the fall, after about 6 months on tamox, she did a pelvic exam and said it felt fine. She said that as long as I was going 25 days or so between periods ( No bleeding)then it was fine. But now I'm 60 days plus with no period and I'm not sure if I should go back. MO didn't seem too concerned when I saw him (at about 45 days without). Mostly curious at this point.

coraleliz

Not sure if sharing my experience will help here. I was 52 when I started Tamoxifen. I was still having regular periods(regular for me anyway-about 10 a year). My periods stopped for almost a year & I started spotting, which turned into bleeding. I ended up having an ultrasound and then a hydrosonogram. My lining was thick & I developed a couple of polyps. One was extending out the end of my cervix. That was the reason for my 1st Tamoxifen related D&C/polypectomy. I've had a total of three since starting the drug. A cyst was found on one of my ovaries & that led to ovarian tumor markers being checked(blood test). The cyst went away on it's own. I have fibroids but for some reason mine remain unchanged.

My PCP tells me that the GYN issues on tamoxifen are well documented but she's never had a patient with all the problems I'm having.

I was concerned about starting the drug because of my fibroids & being prone to uterine cysts(for years). Those 2 things haven't been too bad for me.

SophiaMarie

that’s basically it - they feel for the size, and see if you’ve had any abnormal bleeding. Honestly, don’t do a biopsy unless you have some real reason for concern. I had been having cramping (in menopause), and so my gyno did a biopsy. I have a high pain tolerance, took some pain pills beforehand, and was still surprised at how very uncomfortable that was. I really don’t know why they don’t knock us out first. If it were done to men, they for sure would! If any question, I’d go with an ultrasound first

Rah2464

My Gyno ( a BC survivor herself) only does ultrasounds if there is in her words a "significant change in the pattern of bleeding". So occasional spotting for her doesn't prompt testing. Only if I go from spotting to a bleed. Or if I have significant cramping or pain.

If warranted, she does an ultrasound, then if the ultrasound shows a thick lining, a biopsy.

Palesa2018

I see my gyn every 6 months to do a vaginal ultrasound. Through the ultrasound he measures the endometrial lining. Any thickening could indicate endometrial cancer. 5mm and below is good. But the baseline is your normal which could be higher.

I can't imagine that just feeling it would be sufficient but different protocols in different areas I guess

All the best

flashlight

Hi SophiaMarie, I'm wondering if you are premenopausal and without any symptoms if your yearly routine visit would be enough. I'm 68 and started tamoxifen last April. I made an appointment just to have things checked out. My Gyn did a pelvic and ordered a 3D vaginal ultrasound for a baseline. My fibroids are still there!!!, but my ovaries have shrunk and my lining had thickened. They tried doing a biopsy in the office but one darn fibroid got in the way and they couldn't get enough. I'm scheduled for a D&C on the 22nd. I'm hoping this will put this fear to rest. I don't have any symptoms. I'm hoping I can go yearly after this.

Jelson

Here is the American College of Obstetricians and Gynocologists's statement on Tamoxifen and Uterine Cancer

https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Tamoxifen-and-Uterine-Cancer?IsMobileSet=false

read the article, but my take-a -ways are - pre-menopausal women need no special protocol. Post-menopausal women might discuss a pre-tamoxifen transvaginal ultrasound to get a baseline and check for polyps. For anyone - The key symptoms to look for are staining and unexplained bleeding. New tamoxifen protocols which reduce the dosage might reduce risk of endometrial cancer.

flashlight

Hi Jelson, Thank you for that interesting article.