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[Loubie4]

Hi everyone

I had a private scan after I had a bit of spotting after just under 12 months without a period. She said I had ovulated and had an endometrial lining measuring 5mm. 5 weeks later I had one on the NHS and my lining is 11mm so inow it looks like I'll have to have a biopsy. I am 48 and thought I had to be without periods for 2 years to be post menopausal. I am so confused and worried 😕

[bombsh3ll]

These are completely benign findings and do not require a biopsy.

Menopause is diagnosed after 12 months of amenorrhea in the absence of any other cause. This is arbitrary and they could easily have chosen 10 months or 18 months, but 12 is generally what we use.

If you have ovulated and menstruated 5 weeks ago you are not postmenopausal.

However if you are untreated and skipping multiple periods you are likely to be hypoestrogenic at this point and should consider addressing this with hormone therapy.

You do not need to wait until your cycle has stopped before starting treatment.

[Loubie4]

Many thanks for your reply.

I have experienced very few symptoms of menopause, my periods just got less frequent and lighter before stopping for nearly a year. I'm not on any HRT as I haven't felt the need due to lack of symptoms. The reason the GP referred me is because I had an FSH OF 94 which she said meant I am post menopausal! I'm trying to tell myself it's fine but the scan results were sent to my GP as an urgent unexpected result 😕

[bombsh3ll]

That's nonsense, menopause is a clinical diagnosis and checking FSH levels in age-appropriate perimenopause is not helpful as these can fluctuate wildly and do not preclude further ovulation.

In a menstruating woman, depending on whereabouts in the cycle the scan is done, the endometrium can be up to 16-18mm at its thickest.

[Loubie4]

Thank you, that's what I thought! Labelling me as post menopausal has triggered the urgent pathway 😌

[bombsh3ll]

As you don't want hormone therapy, the doctor has no leverage to coerce you to have a biopsy that is not clinically indicated if you don't want to.

I would simply explain that as you are not postmenopausal your endometrium on the scan is an acceptable thickness and you don't wish to have an invasive procedure on this basis.

[CLKD]

Periods wax and wane.  Mine disappeared for months then returned on a regular basis - 4 about 2-3 years. I knew that it was The Change so wasn't worried.

Your GP isn't au fait with what classes as menopause  - usually when we haven't had a bleed/show for 12 months but Mother Nature can throw in the curved ball so we need to begin at 1 again.  Apparently we are supposed to be into menopause by age 51 or 55 depending on which info 1 reads.  Peri-menopause can begin at least 10 years B4 meno proper and some ladies are having regular periods into their 60s.

This is your body so U don't have to undergo the biopsy .

[bombsh3ll]

I think there is a culture of such fear within the medical community that doctors are practicing increasingly defensively.

Back in the day, with less overwork and burnout and more continuity of care and access to appointments, a reasonable GP would take a watch and wait approach to a benign history like this in a low risk individual.

Now however they have 8 minutes with someone they've never met before, they don't necessarily know that patient has always been slim and both parents lived to 100 etc, and if they don't refer you STAT you may really struggle to get a further GP appointment if the problem persists. Also there's much more litigation generally now.

This situation creates a burden of over investigation and overwhelms waiting lists for people with actual cancer.

[Loubie4]

It was a registrar that I saw so I assumed they'd be up to date with all the latest recommendations etc but I think maybe they've ended up covering all bases!

[Minusminnie]

I think there is a culture of such fear within the medical community that doctors are practicing increasingly defensively.

Back in the day, with less overwork and burnout and more continuity of care and access to appointments, a reasonable GP would take a watch and wait approach to a benign history like this in a low risk individual.

Now however they have 8 minutes with someone they've never met before, they don't necessarily know that patient has always been slim and both parents lived to 100 etc, and if they don't refer you STAT you may really struggle to get a further GP appointment if the problem persists. Also there's much more litigation generally now.

This situation creates a burden of over investigation and overwhelms waiting lists for people with actual cancer.

I guess we are where we are in 2025 but this just makes me so sad.

In many walks of life now too much signposting and a** covering.

[Clovie]

Just to say - I agree with all this. Being over the top cautious, and yes, I can kind of understand it to a degree...
I am having a very late menopause and because of my age they have 'treated' me as post menopausal, with all the resulting worries of bleeding being 'unscheduled' when it isn't because my periods have never stopped,.
It causes so much extra worry when something doesn't quite fit into the text book scenario.
Extra worry to some women manifests as extreme fear and debilitating anxiety to others. I know from first hand experience.
Sending support your way x

[Loubie4]

Exactly, I'm trying to be rational, and you have all helped hugely with that 😊 It's just the use of words like 'urgent' and 'unexpected result' that sets off the anxiety

[bombsh3ll]

The problem is that the "textbook" was written by men, about a hundred years ago!

Also, within medical research any subject who deviates from very rigid and narrow parameters is usually discarded from studies because it makes the results neater and more likely to be published.

[Clovie]

The problem is that the "textbook" was written by men, about a hundred years ago!

Also, within medical research any subject who deviates from very rigid and narrow parameters is usually discarded from studies because it makes the results neater and more likely to be published.

Again, I agree wholeheartedly!