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[Deeble]

Hi
I've been referred by gp on 2 week wait for scan and biopsy - appt on Thurs. Hospital letter does not say scan/biopsy, just to attend gynae dept - no advice re pain killers or drink water.
I'm 62 last period 2012.
Tried Elleste Conti, Femseven patches - struggled with the progestogens (low mood and high anxiety my worst meno symptoms).
Been taking femoston Conti low dose (and have tried the ultra low dose at times) since 2016. Last 12 months plus on low dose felt it 'too strong' for me and planned to talk to gp and try the ultra low dose.
In the meantime I forgot a couple of tablets in one week of high stress. I got a little random spotting  - Brown/stringy at times (sorry)over 3 weeks - say a tiny dot one or two days nothing for three etc
Some to go. Said missed tabs relate. Asked to go back to ultra low femoston Conti - all approved.
Before starting on the ultra low version the spotting woke up again. And I was sore down below.
Called gp as advised. Examined, took cervical swab - quite painful (prolapse, retroverted uterus).
Swab came back as thrush ...
Told to did not want to come off her and already had scrip for step down to ultra low dose femoston Conti. She said she had to refer me for scan and biopsy and in the meantime I was to stop using vagifem ...
Used Canestan pessary and cream. More comfortable- I'd got used to being uncomfortable I think.
Now 5 days no bleeding.
Doing ok on ultra low femoston Conti (a few anxiety wobbles but I know that will settle).
Question is: does this scenario seem to justify a hysteroscopy for example (take it that's the biopsy element)? Is it likely that the decision about need for biopsy would be made on the day, after the scan of womb?
I'm anxious anyway and definite it want to avoid an 'unjustified' invasive procedure.
Thanks for reading this.

[Cazikins]

Hi Deeble, crikey this sounds similar to my probs atm.
No advice really as I'm having a scan tomorrow & I don't know what to expect either. The email sent to my GP just says " under the 2 week rule an appt has been made with the gynaecological oncology dept. I had a phone call last week with no mention of if I need a full bladder etc so I'm going with one anyway...

[Deeble]

Cazikins - thank you so much for your reply. I hope all goes well for you at your appointment and your mind is put at rest. I've been in a bit of a spin and just trying not to get over-anxious l. I've read your posts. It really helps to hear another's story. X

[Uptick]

Hi Deeble, can you ring the hospital to have this clarified? I suppose postmenopausal bleeding is a 'justified' reason for hysteroscopy. I understand that in your case the bleeding has 'justifiable' reasons (thrush and forgetting to take a couple of tablets), but the NHS follow a standard procedure instead of interpreting individual situations. Anyway, good luck and keep us posted.

Hi Cazikins, good luck to you and keep us posted.

[Deeble]

Hello Uptick
Many thanks for advice and to ring hospital - will call them tomorrow.

[shrosphirelass]

I have has bleeding on and off since starting evorel conti. I had a massive bleed in the summer which left me anemic and scared so I was referred on the 2 week pathway. I was advised to have a full bladder for the external scan and to take pain killers. I went for the scan which was clear apart from a fibroid which they weren't concerned with and a lining of 5mm which they said justified a hysterocopy and biopsy. I asked for waking sedation / relaxant which they refused so I went home. The cut off for a hysteroscopy is over 4mm.  At a later date I was offered a biopsy under GA but negotiated a follow up scan to check the lining. At this appt the lining was within norms but they still recommended a biopsy as I was still experiencing bleeding at times. Because of covid and general anxiety levels I decided to wait for 6 months and have yet another scan. I was advised by the dr it was not risk free but very low risk.
 
So I would say that they will first do scan before doing a hysteroscopy , you may not need one. I would check re the full bladder as I asked the scan technitions why this was necessary when they were going to do a internal one anyway and was told they can see different things from different routes. If you are happy to have the hysteroscopy / biopsy I would take pain killers in advance as other women I know have had it done found it was some help.
Good luck

[Deeble]

Thank you for the really helpful reply Shropshirelass. I'm getting my nerve up to call the hospital and see just what it is they have me down for ...
Thanks for sharing your story. I'm a bit over-anxious anyway and it has helped a lot.
I've finished the thrush cream now (and pessary) and am more comfortable. Never knew I had thrush ...
Gp told me to stop vagifem when I had my exam and she booked the 2 week appt scan. I hope I can start back on this afterwards.
I've had no more spotting since 30th Dec (I started the ultra low dose hrt on 24th Dec).
Hope Cazikins is doing ok today.
Thanks again.

[Deeble]

Hi - just an update re Uptick's advice to ring clinic and find out what procedure I'm having at gynae dept appt (2 week referral).
A nurse called me back to say a tv womb scan, then an internal and discuss with consultant after. As on hrt she said I may need hysteroscopy but would be called back if so and not on the day.
Said bladder to be empty for tv scan.
She said 5mm was the cut off for hysteroscopy referral though mine might well be higher since I'm taking hrt.
So - one step at a time. Thank you Uptick - I feel much more prepared for Thurs now.

[Katejo]

Hi - just an update re Uptick's advice to ring clinic and find out what procedure I'm having at gynae dept appt (2 week referral).
A nurse called me back to say a tv womb scan, then an internal and discuss with consultant after. As on hrt she said I may need hysteroscopy but would be called back if so and not on the day.
Said bladder to be empty for tv scan.
She said 5mm was the cut off for hysteroscopy referral though mine might well be higher since I'm taking hrt.
So - one step at a time. Thank you Uptick - I feel much more prepared for Thurs now.

My lining was 5.5 mm  so they insisted on a hysteroscopy but failed to get a biopsy because there was barely any lining. Consultant described it as scanty.

[Uptick]

Sounds like they're doing the right thing, good luck 

[Deeble]

Hi - the scan showed an area of thickening at fundus of womb of 7mm which was thought to be polyp. So' hysteroscopy to remove/sample? the polyp. Biopsy of lining to be taken then as well.
I did not ask the measurement of the rest of the lining ...
Exam after this - cervix appeared ok apparently. Not the discomfort of my previous exam at gp on Xmas Eve, but apparently thrush can make it painful so maybe that was it. 
Was also swabbed for thrush again to be sure it has cleared.
Appt for hysteroscopy on 13 Jan.
Told to stop hrt (been on ultra low  .5mg femoston conti for about 2 weeks prior to Xmas Eve gp appt). Prior to that low dose femoston conti 1mg.
Also told to keep off the vagifem too for now ...
A bit anxious about the polyp and my guess is the rest of lining is over 5mm which is their cut-off.
There's been no spotting since I stopped hrt after the scan.  A few missed tabs a month before and the recent step down to ultra low tabs could have triggered the spotting apparently.
So painkillers before hysteroscopy next Weds. They say there is gas and air if needed.
Brain's in a bit of a fog and I probably need to get off the internet.
For info. the internal scan was not painful and the exam was nowhere near as bad as expected and everyone was kind.
Practising my deep breathing for next week to keep as calm and positive as I can!
D x

[skkb]

Hi Deeble, just been reading your posts regarding this. My situation is that I’m due in for a scan, hysteroscopy and consultation on Thursday!! Not too happy to go into the hospital environment with the present situation regarding COVID. I had a vaginal scan last November which showed a normal uterus with a lining of 3.1mm. On the mornings of the 18/19th December I had a “slight” bleed, only first thing then nothing more and none since, but I had tinkered with my HRT. I had. Gynaecologist telecon after the two week referral letter because of post menopausal bleeding and she seemed happy and could either monitor me again in six months or “for my peace of mind” send me now, which I opted for. Should I defer the hysteroscopy???

[Deeble]

Hi skkb
Just replied but lost it ...
I called the clinic and spoke to a nurse beforehand to find out the process on the day. If my lining had been under 5mm I would not have needed hysteroscopy. Perhaps you could call to see what they do. It might help you decide whether to go ahead or take the option to defer. Re covid - I did not feel much more anxious about that than in a busy supermarket or post office (Southwest clinic).
With best wishes whichever you decide. I'll update after my appt. X

[shrosphirelass]

skkb, If it was me I would defer. I have another scan booked for April ( 6 months after the last one) as I keep having spotting ( have done off and on sonce starting evorel conti). They really want to do a hysteroscopy just to make sure everything is ok, but Im reluctant due partly to anxiety about the procedure and also due to covid. I am sure the hospital environment is safe, but I worry about this too, but then I don't go to shops,. So personally I'm avoiding hopspital appointments unless absolutely necessary. Everything is a risk, so its a matter of weighing up which you are happiest with. Good luck with what ever you decide.

[Uptick]

Hi Deeble, good luck, thinking of you.