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[KittyKats]

I've been on HRT for 5 years and have been tracked with ultrasounds for fibroids and post meno bleeding. Had my first scan for 1.5 years and they have said my endometrium is thickened. Can't remember how much. Think it's 4.5mm but it's the first time it's got this thick. I was always 1 point something previously. I've been told I need an urgent hysteroscopy to rule out cancer and have to stop HRT immediately. I have bad atrophy and it was very painful today having a speculum examination. So they said I will need a GA. I'm really worried as I have autonomic dysfunction with labile blood pressure which can go high or low and I've been told by my autonomic specialist that sedatives and GA are tricky. Has anyone managed to tolerate a hysteroscopy without sedation or GA with atrophy? They said never having children makes it really difficult.

[CLKD]

I don't think that U need to stop HRT.  Some Health Authorities are picky but my query would be when ringing the dept to check, is how long will I need to wait, what if the appts keep being cancelled etc..

I am sure that others will be along to say yah/nay about stopping. 

GA is probably essential, mayB your Specialist could discuss with the scanning Dept his/her opinion?  There needs to be more joined up thinking between medication conditions which seems 2 B very lacking these days.

The thickness used to be 5 now it's down to 4? 

[KittyKats]

Thanks for getting back CLKD! I had to look it up and it seems to vary. I think the NHS cut off is 4mm.What I don't understand is on my last scan of Aug 23 it said Endometrium: endometrium clearly visualised, thickness (total) 1.6 mm.

The gyn was worried back then about vaginal Utrogestan as she said it was such a weak progesterone and I'd only been using it alternate days so I stepped up to taking it every day in Sep 23 and have dropped to 2 pumps of Oestrogel from 2.75. Now the endometrium has thickened. It makes no sense! Also the sonographer yesterday said everything was ok during the scan and the endometrium was thin but then the gyn said it was thickened.

I am so worried about having a GA as never had one before and have the dysautonomia plus narrow angle suspect in my eyes. But I guess it must be done. I'm a big baby!

The gyn I saw yesterday was just a stand in as I was seen in a private hospital as the NHS had no capacity so they were sending ladies to the Portland. But the op will be at UCLH.

[CLKD]

Morning. It bothers me when there is disagreement between sonographers and specialists.   

Will U be contacting the Specialist overseeing the autonomic dysfunction?

[Dotty]

Hi NICE guidelines clearly state that you do not need to stop HRT.

A hysteroscopy is not usually needed for a thickness of 4mm.

Can I ask, what was the reason for the scan?

[KittyKats]

CLKD - Yes I am concerned and very much hoping there might have been a mixup. The sonographer clearly said no hyperplasia. I have decided to use my work BUPA and am seeing the fibroid consultant I saw in 2023 this Tuesday. My autonomic specialist had emailed me a booklet to give to any anaesthetists I see with info on meds and BP. Not very reassuring!

Dotty - Thanks for this info. I can't believe i was told to stop. So confusing. My thickness was over 4mm I think it was 4.3mm but can't remember. Very worried as always had nice thin endometriums. I have had lots of post menopause bleeding since 49. I only went 13 months without a period at 49 and then I started bleeding almost immediately on the HRT. My original consultant thought I might not have gone into menopause yet as she said if periods stop before 50 then can return more than 12 months later and I was almost having monthly bleeds right up to two years ago. What was weird is on my last bleed I felt PMT'd. Very hungry and very tired.

So yes the scan was for post meno bleeding and fibroid uterus.

 

[Dotty]

Hi prior to Hrt, when you went 13 months without a period, were you on any form of hormonal birth control ?

[KittyKats]

Hi Dotty - no I last took the combined pill when I was 31 in 2000! I have had heaps of problems with heavy bleeding and severe pain since my late 30's. And I've been growing fibroids for the last ten years with about 18 now. The two largest measured 3.5cm each yesterday. I'm just worried about the bleeding and the endometrium thickness. I've started spotting again bright red this afternoon 

[KittyKats]

Endo was normal in August 2023 just lots of fibroids. They seem to be bigger now though. This was my old scan:
1. 18 mm x 17 mm x 14 mm; intramural, left lateral wall.
2. 8 mm x 8 mm x 7 mm; intramural, right lateral anterior wall.
3. 6 mm x 6 mm x 4 mm; intramural, anterior.
4. 22 mm x 19 mm x 19 mm; intramural, right lateral posterior wall.
5. 9 mm x 8 mm x 7 mm; intramural, fundus.
6. 13 mm x 12 mm x 9 mm; intramural, anterior.
7. 17 mm x 14 mm x 13 mm; subserous, right lateral wall.
8. 9 mm x 8 mm x 8 mm; intramural, anterior.
9. 16 mm x 14 mm x 12 mm; intramural, fundus.
10. 29 mm x 24 mm x 20 mm; intramural/subserous, fundus.
11. 16 mm x 14 mm x 12 mm; subserous, right lateral wall.
12. 8 mm x 7 mm x 6 mm; intramural, anterior.
13. 11 mm x 8 mm x 7 mm; intramural, anterior.
14. 17 mm x 12 mm x 9 mm; intramural, anterior.
15. 14 mm x 13 mm x 10 mm; subserous, right lateral posterior wall.
16. 18 mm x 16 mm x 12 mm; intramural, posterior.
17. 16 mm x 9 mm x 8 mm; intramural, fundus - posterior.
Endometrium: endometrium clearly visualised, thickness (total) 1.6 mm, structure: thin postmenopausal
endometrium, endometrial cavity: shows normal appearances.

[Dotty]

Hi KittyKats
I’m no expert, but the bleeding is probably caused by the fibroids.

I’ve had lots of problems with bleeding but didn’t have a hysteroscopy until my lining was 11mm….all was ok. Up to 10mm I had pipelle biopsies …. all were ok.

[KittyKats]

Thanks Dotty. Can I ask what was the pipelle biopsy like? Is it like a hysteroscopy? I have VA so find any examination painful 

[CLKD]

Morning.  What R U using for the VA symptoms?

Gyanecologists often don't know as much about menopause as mayB they ought to.  Make a list of worries to take with you. 

[Dotty]

Hi in my experience, it depends who does the Pipelle biopsy. I've had 3 of these....one was easy; one was ok and one wasn't very pleasant at all!

I had my hysteroscopy under General Anaesthetic, so I can't compare the two.

[KittyKats]

Hi CLKD

I am not using anything. I had moderate atrophy in 2023 but think it's severe now as it hurts to bend and sit down. I can hardly get the Utrogestan applicator inserted. I've even wondered if it's not absorbing as I am applying it lower down. They said I can't have any hormone help for atrophy with a thickened lining and I'm not sure if I can use vaginal moisturisers with the Utro 

[KittyKats]

Dotty - thanks for that info. I think with the atrophy it will all be abominable!