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[Starfish]

Hi everyone,

Just wondering if anyone could share advice or reassure about polyps and a thickened lining? This is all new to me and I know so many women on her have gone through this.

I’ve not had a natural period in years — I’ve been on sequential HRT, and the only bleeding I’ve had has been while taking progesterone, not after. I raised this a few times but was told it wasn’t anything to worry about.

I recently tried switching to continuous HRT, but I ended up bleeding constantly and feeling really low, so I stopped after two months.

My GP asked if I wanted to go for a scan — said it was probably fine but might lead to “further investigations.” I went ahead with it, and the scan (last Friday) showed 4 polyps and a thickened endometrium. I got a call yesterday asking if I wanted a referral to gynaecology — which of course I said yes to. I was a bit surprised it was framed as optional?

Anyway, I now have an urgent gynae appointment next week and I’m wondering:
   •What should I expect at this first appointment?
   •Has anyone else had bleeding like this while on progesterone?
   •Any reassurance or advice from people who’ve been through this?

Thanks so much — I’m feeling a bit overwhelmed and would really appreciate hearing from anyone who’s been in similar shoes.

[CLKD]

If U have been offered investigations, take them.  Result will give U a base line from which to work.

Out of interest, why did U alter your regime     

[Starfish]

Thanks CKLD,

My Dr suggested I was post menopause since I went into an early menopause in my early 40s, probably peri from my mid to late 30s. She thought it would stop the bleeding associated with utrogestan. I was silly to think that would work.

I had been going to my Dr  about my symptoms since about 35 but told I was too young. I ran into infertility problems at this time too and I was told, due to blood tests, that I would likely have an early menopause. My mum had hers at 40. My sister was the same.

I’m sure all is fine, but I’m a little worried about the polyps and thickened lining. Worried about having to get them removed, do I have too? Blood tests consistently show my
oestrodial levels are  not overly high.

[CLKD]

I had a polyp that bled on contact, my Gyane wanted to remove it - but I was seeing him privately and decided not to fund his next holiday  .  At peri it shrunk, all on it's own 

You've been given conflicting info from various GPs  . 

Is bleeding typical with utrogestan?

[Starfish]

Yes, various gps just kept saying I was too young for menopause. Then the infertility consultants told me I would have an early menopause. Do you think it’s a good idea to have them removed? I’m 47 now, on hrt for 5 years

[bluebird68]

I had repeated bleeding polyps during peri. I was up and down to hospital as I became anemic so they removed them and put in a mirena which resolved the matter. It's not a pleasant experience but it was over quickly and I was advised to take pain relief. If it's just an investigation they usually like to look and invite you back to remove them. I'm glad I went and had the mirena as it has stopped the issues with bleeding. This takes time to settle. Good luck!

[Starfish]

Thanks Bluebird, that’s good to hear that it helped you. I am nervous as I’ve never had polyps before, nevermind 4. The fact that I’m being seen within a week is a little worrying. suppose it would give me peace of mind too.

[Clovie]

Starfish, are you definitely menopausal any chance you could still be peri?

I can't help about polyps but I can say my experience with Utrogestan, (being peri).

When I was on sequi with 200mg Utrogestan on 12 days per month, like you, I always bled whilst taking the Utrogestan. For me, I bled before the 12 days was up. It never led to a withdrawal bleed as such, as in , starting a bleed a few days after I stooped it. Also for me, it never stopped my own periods, so, because I could never synch the bleeds I had both a lot of the time. Anyway I ended up anaemic.

Even though I was still peri they put me on to continuous , to take 100mg Utrogestan every day which was supposed to stop my 'bleeding' . (Long story but the doctors didn't recognise my regular predictable bleeds as periods but I know they were). 

As I say this was supposed to stop my 'periods' but it didn't. I still bleed regularly, predictably, for set length with PMS beforehand and no spotting in between or anything worrying besides my age alone, so yeah, still periods.
The reason they don't recognise my bleeds as periods is purely down to age. I'm 61 now, still bleeding on continuous but they are getting lighter each time so fingers crossed will finish soon. They have just put me up to 200mg per day so hoping that MIGHT stop the bleeding.

So, just to say, IF you are still peri at all, it likely won't stop your own activity, if you still have it going on,  as utrogestan is quite a weak progesterone compared to synthetic at controlling bleeding, so I understand.

Good luck and hope you get sorted!

[Starfish]

Hi Clovie,

Thanks for your thoughtful reply. I don’t get any periods at all. Only bleeding during the second week of utrogestan, when I had been taking it every two weeks, this last five years. I don’t get a withdrawal bleed or any other bleeding during the month. Then when I went on continuous I didn’t stop bleeding or spotting for two months.

[CLKD]

These procedures should never be offered without anaesthetic!  It's a time issue - trying to get as many patients dealt with in a certain time!  Discussion B4 U decide whether these require removal.

[Jules]

Are the polyps in your uterus or cervix? I had a tiny polyp removed from inside my cervix in outpatients when I was referred after a scan. I agree with CLKD, to discuss fully before you agree to anything. I was somewhat bamboozled into a hysteroscopy and I wouldn't have that procedure again without a GA.

[chopsuey]

Hi Starfish

Last year, when I was on sequential Oestrogel and a low dose of Utrogestan, I had a scan done to check my lining. I'd had no bleeding other than the regular Utro withdrawal bleed but the scan showed a thickened lining and several polyps.

I was then referred on the urgent pathway to gynaecology for a hysteroscopy with polyp removal. I was sent the info on it in the post, so I knew that's what would be happening. I went ahead with it with strong painkillers and local anaesthetic and it was tolerable but I know that is not everyone's experience and you should ask to be consulted first on your options, including GA. The polyps they were able to remove were sent for biopsy and they came back fine. I was happy to leave the others there but I was strongly advised to have them removed, which I had to have done under GA. I then had a Mirena coil fitted at the same time, as increasing Utro wasn't an option for me due to intolerance. I have been fine with this.

You have been put on the urgent pathway because you have had unscheduled bleeding, which needs investigating, but is most likely nothing of concern. As Clovie says, Utrogestan in a weak progesterone and not always effective at keeping the lining thin. I also did not have high oestrogen levels but I was on a lower then now recommended dose of Utro and it was not enough to control it. 

I wish you luck with it, I know how concerning it all can be. 

[CLKD]

In the NHS a 2-week pathway may well turn into 3,4,5 ..........

Let us know how you get on.

[sheila99]

Hi Clovie,

Thanks for your thoughtful reply. I don’t get any periods at all. Only bleeding during the second week of utrogestan, when I had been taking it every two weeks, this last five years. I don’t get a withdrawal bleed or any other bleeding during the month. Then when I went on continuous I didn’t stop bleeding or spotting for two months.

It's the withdrawal of progesterone that triggers a bleed so it would be unexpected at this time of the month unless it was your own cycle triggering it. What is it that makes you think it isn't a period? If you do have your own cycle a thickened lining would be expected unless the scan was soon after a bleed.

[Starfish]

Thanks everyone for the advice. I will have a discussion about what the next steps are. I’m scared of anything invasive as smears do hurt for me. I don’t think the bleeding on progesterone is a period as it’s every month and prior to hrt five years ago my periods were 4 months apart. Even before this in my late 30s they were unpredictable.