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[Rockpea]

Hi everyone, gosh I find this forum so helpful! I’ve just used the search function to find several posts that have been interesting(worrying!) to read. But I still have a question I’d like to ask about a referral I had today for a ‘suspected cancer scan’ of my womb.

I was called to my GP three weeks ago as they wanted to talk to me about my HRT - apparently guidelines have recently changed? And because I’m on a relatively high dose of Oestrogen (2 x 1mg sachets of Sandrena a day) they wanted to up my Progesterone from 100mg to 200mg. Which I’ve been doing since.

At the appointment I mentioned that I’d recently had a 4-week-long bleed. Not particularly heavy, just long! (And this has happened a maybe 3 times over the last 12-18 months, in addition to some much shorter bleeds on occasion). I really hadn’t been worried about it as I know that abnormal bleeding happens during peri-menopause, but I’m glad I did mention it! Because I had a message two days later from my GP saying that she wanted to refer me for an ultrasound to just check all’s ok.

This morning I heard from her again, she’d given the hospital details of my situation and they’ve asked that she refer me for an urgent suspected cancer scan. (I wish they’d called it something else! Even ‘possible cancer’ would be better???!!)

How likely is it that something’s seriously wrong? I haven’t found anything that gives any sorts of statistics! Interestingly I haven’t had any breakthrough bleeding since my Progesterone was upped…so is it likely that the bleeds were because I wasn’t on a high enough dose before??

Any reassurance much appreciated! I also thought it was worth mentioning here because I really hadn’t thought breakthrough bleeding was as worrying as my GP clearly things it is.

[shrosphirelass]

I'm not sure of the protocol for unscheduled bleeding during peri as I am menopausal. Bleeding post menopausally is generally investigated on the 2 week pathway (which they seem to refer to as cancer pathway). I have had this happen to me many times. Last time my scan showed abnormalities and I was rung up by the consultant on the same day telling me he was very worried and suspected cancer and I may need a hysterectomy. After a long wait and a lot of anxiety, that time like all the others, there was nothing wrong and it was put down to the HRT which I suspected anyway.

My understanding is with peri your own hormones could be playing a part and along with the HRT unscheduled bleeding may result at any time but I'm no expert, sorry.

Try not to worry, easier said than done, I know. It's good you'll have a scan and hopefully get the results through quickly. The scan is a really easy exam if you haven't had one before.

[Rockpea]

Thank you for your quick and reassuring reply!  Yes, as a rule I’m a big fan of being scanned and tested - it’s always good to know things are being given a thorough check :-)

I shall try not to worry until I know more. Frustratingly this is all happening a week before we’re due to go to Spain! My doctor knows that and has asked them to try and fit me in before next Tuesday. We’re not back til 21st June, so if the scan isn’t soon then I guess I should delay my trip… although I’m very hopeful this is nothing, it doesn’t feel like something I should wait to get checked out! Ah well, nice problem to have…a month in Spain was being greedy anyway ;-)

[cazb78]

I’m sorry to read you are worried but I’m sure it will most likely end up being nothing. Usually it’s after 3 episodes of ‘abnormal’ bleeding that they tend to refer on a fast track, and as you say you’ve had about 3 episodes then maybe that’s all it is. Also they are fast tracking a lot these days because there’s such a backlog.

I’m having some extended bleeding now too and am anxious about it so am referring myself back to my gynaecologist. It’s so anxiety producing, it’s horrible but as you say it’s best to get checked and hopefully it’s not anything serious. Xx

[Rockpea]

Hi Caz (sorry I haven’t figured out how to tag people or reply to specific posts!) I’m sorry to hear you’ve got this to worry about too. But yes, definitely better to know that it’s important to get checked out - and then get it checked out!! These are definitely situations to decide not to worry about unless there’s something specific *to* worry about though! Because, it seems, most of the time things turn out to be okay. Sending a few spare vibes over to you!!! Take care! x

[Birdbrain]

I'm sorry to hear that, it must be very worrying. It's not that unusual to get an urgent 2 week cancer referral for things, just in case. I've been referred for a 2 week urgent appointment before for something (not gynae-related) and I too panicked but turned out to be nothing. Hoping for the same for you.

[Dotty]

Hi are you in peri menopause or are you post menopause ? Do you take Utrogestan continuously ?

[Rockpea]

Hi Dotty, I’m peri - well I assume I am, because I’ve been having bleeds so often? It certainly hasn’t been anywhere close to 12 months yet without one.

I was on continuous Utrogestan, supposedly with a 5 day break at the start of any bleed. But this got very tricky to stick to with so many/long bleeds. So I was pretty much continuous for the last few months.

[Dotty]

Hi if you’re in peri menopause then bleeding on continuous hrt is very normal.
 
2mg of Sandrena is a moderate dose so you shouldn’t need to increase the Utrogestan. There is a new document that discusses all unscheduled bleeding on the BMS website.

Have you tried taking 200mg of Utrogestan for 12 days of every month ?

[Dotty]

https://thebms.org.uk/wp-content/uploads/2024/04/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-APRIL2024-F.pdf

Here’s the link to the document.

[Mary G]

Rockpea, I doubt you have anything seriously wrong and it's probably down to the oestrogen/progesterone ratio.  Do you take the Utrogestan vaginally?

I would urge you not to cancel your trip to Spain and if anything, use it to your advantage.  If the NHS can't offer you a scan before your scheduled departure date, why not book an appointment with a private gynaecologist at a clinic over here in Spain?  They are very good and gynaecologists actually carry out the transvaginal scans themselves (no third party sonographer like the UK) and give you their findings there are then.  They can immediately identify any problems which they will discuss with you at the appointment so no waiting around for results.  If they did take a sample for biopsy you would get the results in a few days.

[CLKD]

Good idea from Mary G.

Enjoy your holiday because appts can be postponed/cancelled here in the UK!

[Rockpea]

Hi Mary - gosh how interesting that you’ve written this! We’re actually going over to our house out there - and although in the 8 years we’ve had a place there I’ve heard SO many good things about the Spanish health system, I’ve never had reason to use it.

Do you think it would be relatively easy to set this up? I’m very drawn to the idea if it comes to it - I believe the Spanish healthcare to be very thorough and fast! There genuinely doesn’t appear to be *any* sort of waiting list! I’ve had friends referred for scans from their doctor the very same day, where it would take weeks (months!) of wait time over here.

Thanks, I’ll look into it for sure.

Rockpea, I doubt you have anything seriously wrong and it's probably down to the oestrogen/progesterone ratio.  Do you take the Utrogestan vaginally?

I would urge you not to cancel your trip to Spain and if anything, use it to your advantage.  If the NHS can't offer you a scan before your scheduled departure date, why not book an appointment with a private gynaecologist at a clinic over here in Spain?  They are very good and gynaecologists actually carry out the transvaginal scans themselves (no third party sonographer like the UK) and give you their findings there are then.  They can immediately identify any problems which they will discuss with you at the appointment so no waiting around for results.  If they did take a sample for biopsy you would get the results in a few days.

[merrygoround]

Good idea to get the scan done in Spain as it sounds like a strange thing for the doctor to be worried about in peri.

I was over a year post meno when I first asked for HRT. The GP gave me Evorel Conti, it made me bleed so they changed brands of conti a few times but I bled on all of them.

Stopped HRT and no more bleeding, started it, bled again. My mum had been exactly the same.

I wasn't referred because even if you are post meno they allow bleeding during the first six months of any treatment and I didn't try any single HRT for as long as six months, I couldn't convince myself to continue with the mindfrick they seem to all create.

Fast forward and I got tibolone, unlike HRT it actually made me feel better not worse. (Some doctors call it HRT while others will eat your face off for calling it that.)
I stayed on tibolone for eight months and the bleeding didn't alter (five days once a month like a period) so I was referred to gynae for a scan and taken off tibolone.

About 4 months later I finally got a quick scan under the 2WeekWait (is the name for irony?) and the all clear. No follow up except the gynae told me I could have any HRT I like.

So once again I asked for tridestra and again my GP said no

These days I'm still bleeding each month on tibolone, three years post meno and it's all fine apparently.
Except now I'm red flag for CRC, booked for a colonoscopy in four weeks time, already waited two, again under 2WeekWait, lol, always something to worry about.

You'll get better care in Spain.

[Mary G]

Rockpea, yes, it will be very easy to set up the appointment from the UK.

I would start looking for local private (not state run) clinics in your area and sound them out.  I would suggest you make an appointment for shortly after your arrival date to allow time for a follow up visit if necessary. 

The gynaecologist will give you a print out of the TVS scan and a written report.

The Spanish health system is excellent.  It's a two tier system that would never be acceptable to British people in the UK (there would be howls of derision) but it works extremely well, particularly the private sector which I use.  When I went to book an appointment with my gynaecologist late last year, the receptionist said "there's a slot in 20 minutes if you would like it".  I jumped at it and the whole annual check and scan were over with for another year!

I think you will get the reassurance you need from a gynaecologist over here.  I definitely would not cancel my trip for the NHS appointment which will probably consist of a scan and no actual information until a later date.