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[Grumpymum]

Hi, I've just returned from the doctors. I feel my HRT dose isn't right as I am still getting symptoms, especially feeling down, anxious, no motivation, no brain, some hot sweats, aches, dryness down below etc. I'm currently on estradot 50 and Utrogestan 200mg from days 15-26. I'm been on this regime for two months. The first month I didn't bleed at all and last time I only bled a little (old brown blood - sorry!). I now have dull period-like pain nearly all the time. My doctor examined me and said I don't have a prolapse (which is a family problem) and has referred me for an ultrasound to see if my womb lining has build up. She doesn't want to adjust my HRT until she knows what is going on, which is fair enough. Coming home, I am now starting to worry. I didn't ask what happens if my womb lining has thickened and how this is treated. I don't know if they use more hormones to 'expel' it or something like a D&C. She said she is being cautious as cancer of the womb can be a problem.

I did admit I had been experimenting with wearing one and a half patches for a week or so to help with symptoms, but she said this is not a good idea because of the matrix design of the patch, and you can damage the patch by cutting it! News to me, I hear about it a lot on here.

I wondered if some knowledgeable ladies out there might be able to put my mind at rest a bit as I'm concerned. Thank you.

[Grumpymum]

Any advice gratefully received please.

[Taz2]

Hi Grumpymum. It's easy to say but please try not to worry. If your womb lining is seen to be a little bit thicker than it should be then a biopsy will be taken at the time of your scan to check for any changes in the cells. If the thickness is uniform - the same all over - then this is generally felt to be ok. If you have been upping your oestrogen but not increasing your progesterone then this may cause a build up of the lining (I believe) as the progesterone dose might not be high enough to trigger a proper bleed. I'm sure someone else will be along soon who knows more about it.

Great news about not having a prolapse - you really don't want one of those!

Taz x

[Dorothy]

It's not the same as your problem, but I had thickening of the womb lining following long-term use of the pill for period problems.  I had the continuous dragging feeling & period-type pain plus continuous bleeding.  I had a D&C and 6 years on, it hasn't recurred.  Apparently, thickening of the lining is very common if you are taking any hormones, so please try not to worry.

[Hurdity]

Hi Grumpymum - firstly your doc is wrong - it's absolutely OK to cut the patch - it's only the reservoir patch type that shouldn't be cut and I haven't come across anyone using these.

Secondly you would only build up lining probably if you weren't absorbing the progesterone or if insufficient in some way - as Taz says. It sounds from what you say too, as if the oestrogen dose is still too low, so more likely that you would need to increase this as well to alleviate symptoms.  Still need to shed any lining that does build up. Actually when the lining gets overthick the first sign is often breakthrough bleeding (proper blood) as the lining comnes away by itself - that's usually when women start to worry, rather than not bleeding. However it's odd that you are getting pain though, so all in all good to be referred ( I would never refuse the offer of a scan to check all was OK  ).

However because when you are taking cyclical HRT your lining will thicken over the course of the first two weeks and then eventually be shed - it's best for the scan to be straight after your bleed if you get one, and before the lining has started growing again. That way it would be at its thinnest.  I was scanned and mine was found to be too thick but I was on a long cycle and it was only to be expected. They still referred me on though despite this! If you get a date then I suggest you re-book if it comes at the "wrong" time.

A slightly thickened lining would normally be treated with a course of progesterone - often a strong synthetic progestogen like norethisterone, which would thin it through a decent withdrawal bleed.

Hurdity x

[Grumpymum]

Thanks for your replies, and especially Hurdity, I take note of your advice about the timing of the scan. I will try not to worry, but it's a shame anxiety is a meno symptom! x