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[Letmein]

I had post menopausal bleeding 3 years on.

Went to GP and was referred under 2 weeks wait as normal protocol. I had an ultrasound that showed thickened endometrium. 13cm. This led to a biopsy.

I was told outcome would be hysterectomy if cancer or pre-cancer or being put on the mirena for 6 months if all good.

I then received a letter, from the lead gynae consultant (the one who did biopsy was a locum), staring that there was no malignancy (yeah), and didn't need to do anything. It then added that if bleeding was regular or a nuisance, I could opt to have the mirena fitted.

That's not the case for me, the bleeding was only spotting and I would much rather not go on progesterone as previous experience was not good.

However, I have always read that a thickening endometrium was not good and even though it showed to be fine, is it indeed ok to do nothing about it? Could it be fine now but put me at risk in later years?

Does any of the experts here know? I want to trust the consultant but I don't feel 100% comfortable.

[Hurdity]

Hi Letmein - sorry to hear about your bleeding but great news no malignancy. However that would be a long way down the road. Before that happens there are various stages that can occur with thickened endometrium called hyperplasia and this can be simple or complex and whether or not there are atypical cells. I would want to know how they classifed yours, if the lining was 13 mm? Simple hyperplasia without atypia is the least to worry about as far as I recall ( haven't looked this up recently).

I'm guessing that it was not complex with atypia as that maybe classified as pre-cancer?

I still don't know the risk of one type developing into another eg even with simple hyperplasia with normal cells - if left could it develop into one of the other more dangerous ones? These are the questions I would want to ask.

In your position I would actually want to thin the lining, after all whatever caused it to thicken may still happen? It could well be that as you are only 3 years post-menopause, the thickening could just be the result of residual ovarian activity  without ovulation. Oestrogen falls rapidly during the approx 2 years following the last period and then reaches its lowest level, but I've always wondered what happens to it in terms of the effect on the endometrium and if it does thicken without being shed, whether it is gradually reabsorbed as the years go by?

Also if the thickened lining is causing the bleeding or spotting and this continues - this would be the result of leaving it, but you wouldn't necessarily need a Mirena fitted- for example you could take a course of progestogen eg norethisterone, then have a good bleed and then it would be thin again. Also I seem to remember reading that a longer course of norethisterone could lead to thinning of a thickened lining without bleeding. From ( poor) memory, 3 months might have been the length of time. This was on the of the HRT trials used to determine the effect of different progestogens - dose.duration I think,  on the endometrium.

Presumably also the doc checked for fibroids, polyps etc and there was nothing abnormal that could have cause this bleeding?


You could also write a question to DR Heather Curry the owner/founder of this website and costs £30: https://www.menopausematters.co.uk/contact-the-doctor.php

Hope this helps.


Hurdity x

[Taz2]

Thanks Hurdity for a very informative post.

Taz 

[Letmein]

Indeed Hurdity, thank you so much for this very informative post. It is exactly what I was looking for.

I was surprised not to be offered a FU appointment to discuss forward treatment. I was told to get in touch with my GP but we know GPs know very little about this.

I'm going to ask for a FU or even just email and see what happens. Thank you very much.

[Dotty]

Hi Letmein I can’t really answer your question but I’m in the same position . Just had hysteroscopy as my endometrium was over 11mm. Had a polyp removed and awaiting biopsy results. I asked gynaecologist about the thickened endometrium and what could be done ….. she didn’t really answer my question ! Just said if results were clear then there was nothing wrong x

[Letmein]

Hi Sorry, just seen your post. Have you had your biopsy results?

Interesting that you had a similar response. I was going to email her for advice. I also have some progesterone tablets left, so was debating using these to try to stimulate some shredding.

Hope your results will come back clear too.

[Dotty]

Hi Letmein I'm still waiting for the results x