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Ultrasound Scan Shows A Gestational Sac In Uterus. Should I Be Worried About The Thickness Of Uterus?

Posted on Thu, 7 Nov 2013

Question: I am 49 years old and not yet menopausal. I had an ultrasound scan 2 weeks ago which showed uterine thickness of 20mm and what the sonographer thought looked like a gestational sac in the uterus. I've since been ruled out for pregnancy after urine and blood tests were negative but I'm mainly worried about the uterine thickness as I've read on the internet that 20mm is very thick. My last period was 6 weeks ago and lasted 2 weeks, although only a couple of days heavy, which is why I was referred for a scan in the first place. I have just started to spot now, think my period might be on its way as I have dull aches in my abdomen. Haven't bleed at all for the past 4 weeks though. Should I be worried about this thickness. My GP is referring me to see a specialist but it could take ages to get an appointment. In the meantime I am worried. My GP could tell me absolutely nothing and didn't even seem to understand the report! Also what else could what looks like a gestational sac be if not that?

Answered by Dr. Aarti Abraham (29 minutes later)

Brief Answer:
ENDOMETRIAL HYPERPLASIA ( CYSTIC ) SEEMS LIKELY

Detailed Answer:
Hello
Thanks for your query.
Pregnancy has been ruled out in your case definitely by urine and blood tests, so that is out of the way.
An endometrial thickness of 20 mm is most definitely worrisome, especially at your age, which can be considered perimenopausal.
The echogenic thing looking like a gestational sac COULD BE cystic endometrial hyperplasia.
This is a condition where the lining of the uterus overgrows ( due to hormonal imbalance, again common at this age, more common in women who are overweight, are diabetic or have a history of polycystic ovaries ) - and multiple swiss cheese like spaces are found in the overgrown endometrium.
This COULD resemble a gestational sac.
Another possibility is adenomyosis , thickening of the wall of the uterus, which frequently goes hand in hand with endometrial hyperplasia, thickening of the lining of the uterus, which you are having.
Both of these conditions need not worry you.
Your specialist will most probably recommend the next step as a D and C or endometrial biopsy.
The thickened lining is curetted or biopsied and looked into for any remote risk of malignancy.
The condition then is easily treatable with hormones ( progesterone for example ).
So please do not worry.
Also let me know if the ultrasound was done vaginally, as abdominal scans are less reliable, and do not give proper details or visualization.
All the best.
Please feel free to ask for further clarifications.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (24 hours later)

Thanks for your reply. I had both abdominal and vaginal scans. The sonographer at the time seemed more worried about the so-called gestational sac than the thickened lining but I am worried. Also I started my period today which is quite painful as it often is the first day or two. I just worry about uterine cancer as looking on the internet is full of scare stories. Maybe I shouldn't have looked! I have got an appointment with a gyno today which I didn't think would come through so quick when I wrote my question yesterday morning! A bit worried about the urgency but relieved I should know something soon.

Answered by Dr. Aarti Abraham (7 hours later)

Brief Answer:
DETAILED BELOW

Detailed Answer:
Hi,
I am sure that it will turn out to be one of the two - endometrial hyperplasia or adenomyosis.
Do not worry at all as I can see no possibility of a cancer.
However, if it is INDEED endometrial hyperplasia, then a biopsy would further reassure you.
Do not unnecessary worry yourself or look up the subject too much, as right now , you dont even have a diagnosis in hand.
Please do get back after your appointment.
Take care, and wish you luck.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (15 hours later)

Well I went to have a hysteroscopy yesterday afternoon and a large polyp was found which was obviously the mistaken gestational sac. It couldn't be removed as it was too big so I have to go back to have a general anaesthetic to remove it and examined, at the same time an endometrial biopsy will be done. Looks like I have to wait a couple of weeks for this. Just hope and pray it's benign. Is there any likelihood of a large polyp turning out to be malignant?

Answered by Dr. Aarti Abraham (10 minutes later)

Brief Answer:
RISK OF MALIGNANCY < 4 %

Detailed Answer:
Hi again.
The incidence of malignant or pre-malignant findings in endometrial polyps ranges from 0.5 to 4.8% in the general population and from 2 to 10% in menopausal women.
I would put your risk of having a malignant change in the polyp at less than 4 %, and this is maximum, in actuality the chance of a polyp being malignant is very less.
Malignancy is more common in postmenopausal women.
Only removal and biopsy will quantify the risk as certain types of polyps ( classified on biopsy ) have higher risk of malignant transformation.
Size of the polyp has no corelation with malignancies, while presence of diabetes, obesity are considered risk factors with increased association .
Just get it removed and wait for the biopsy results.
All said and done, there is more than a 95 % chance , that it is just benign!
I wish you loads of luck and good health always.
God bless.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (4 hours later)

Thank you for your answer. I do wonder if the polyp is the cause of the thickened endometrial lining? Yes I have read that the risk is higher in menopausal/post menopausal women and although I am of that age bracket, I've not as yet shown any symptoms of being near menopause so just hope my risk for malignancy is low. I am not diabetic or overweight. The only risk factor I have read about is high blood pressure. While my doc has said it's not high enough to warrant medication, it usually sits at around 140 over 87 which I think is borderline.

Answered by Dr. Aarti Abraham (4 hours later)

Brief Answer:
DETAILED BELOW

Detailed Answer:
Hello again.
See, basically a polyp is an overgrowth of the endometrial lining.
It IS a kind of endometrial hyperplasia ( I should have separately mentioned polyp as an independent condition in the first place ) - however it is an overgrowth of the endometrium itself.
Almost one third of endometrial polyps are also associated with endometrial hyperplasia alongside .
This would be revealed when the polyp is removed, and if hyperplasia is also found, then it would be biopsied too.
You do have borderline hypertension, which is not at all a risk factor for developing malignancy.
All the best.
I am almost 99 % sure that the polyp would be benign.
Do get back once the procedure is done and your reports are in hand.
Will be praying for you.
Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Aarti Abraham (39 hours later)

Hi again, just wondered if still having period like cramps 3 days after hysteroscopy is normal. I'm still having them. I am on the 5th day of my period and although it's less heavy, the blood is still bright red.

Answered by Dr. Aarti Abraham (5 hours later)

Brief Answer:
CRAMPS MORE LIKELY DUE TO POLYP

Detailed Answer:
Hi,
The cramps are less likely to be due to the hysteroscopy and more probably due to the large polyp, which would lead to cramping during menstruation especially.

Note: Revert back with your gynae reports to get a clear medical analysis by our expert Gynecologic Oncologist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar