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[Alli8]

Hi Ladies,

I'm 54 and started taking HRT in 2021 (Evorel Conti) after suffering horrible mood swings, flushes and insomnia. Everything was fine except I gained a lot of weight in a short time so doc suggested it might be the synthetic progesterone and I should try Utrogestan and Evorel 50 patch. As I suspected, it made no difference. I took the combined pill most of my adult life and then Cerelle up until starting HRT and didn't have a massive problem so I think I'm fine with synthetic prog.

So I carried on anyway as it really helped with the mood swings and flushes. In March this year, I started bleeding and it continued for weeks. It wasn't heavy, a bit like the end of a period but it was consistent. Scans suggested endometrial thickening and doc said to stop HRT. I had a hysteroscopy (under GA, thank you ladies) which I was initially told was fine but I've since been informed by my gynae consultant that although they found 'normal' tissue, it was an insufficient sample for a full assessment...WTF? He actually wanted to repeat the biopsy right there in his consulting room to which I said 'no thank you' - can you believe he got the pipelle tube out to show me how small it was and said 'it'll only take a minute'. I'd driven to the hospital (40 minutes away) alone and needed to be able to drive home. I felt like a whiny child, saying 'no' and I could almost feel the chaperone rolling her eyes at me. Not pleasant.

So it's been 7 months now with no HRT and still my endometrium is thickened - I think last scan was 6.5 - 7mm in places. It's clearly not the HRT that's causing it but nobody seems to offer a suggestion. I've had the full range of blood tests too and everything seems pretty normal. I still haven't managed to lose any weight though so I'm thinking maybe it's just the menopause and not HRT?

When I went in for the hysteroscopy, before the procedure, the surgeon said 'I can fit a Mirena when you're under'. This hadn't been suggested before and my only experience with Mirena was the nightmare my sister had with one. Naturally I said I'd have to discuss it with my doctor and declined. I can't believe they just suggest this - the surgeon said 'it's a usual treatment for this sort of thing'. It probably is, but seeing as the hysteroscopy was an investigative procedure, surely it's better to check things first?

My main issue now is joint pain. I have diagnosed osteoarthritis in my hands and lately my hands are so painful it's stopping me doing things and I've had to scale back on my work - I have my own business baking celebration cakes which involves a lot of hand work plus I do seasonal work on a farm and Harvest this year nearly finished off my knees. I also 'set' if I sit for any length of time, my feet and ankles seize up and there's a lot of 'oof' and 'ow' when I start moving again. It's getting me down too, I'm feeling a bit like I'm destined for the scrapheap. I realise the extra weight isn't helping things (I've really tried but nothing is working) but that shouldn't affect my hands!

My husband says I should just go back on the HRT but I know it's not quite that simple. My doctor suggested if I wanted to go back on, to maybe try the Mirena but I'm a bit scared of the whole thing.
I thought about trying Collagen, specifically type 2, but it's very expensive and takes a long time to work (if it's going to), plus the science isn't there, no matter what Davina and Denise say.

I'm thinking I may have no choice but to go back on the HRT but would appreciate any advice. I may ask Dr Currie for a consult if she still does that, how do I go about that?

Sorry for the long ramble ladies, I do appreciate it x

[bombsh3ll]

If you have overweight or obesity and a thickened endometrium, a mirena IUS is indicated anyway.

It is used to both prevent and treat endometrial hyperplasia.

Obviously getting it in under GA would have been advantageous but it is a relatively straightforward procedure in the clinic for most women, especially if you have given birth vaginally.

This would then permit you to enjoy all the current and future health benefits of estrogen.

Regarding your weight, other causes should be excluded such as hypothyroidism.

Additionally, if you are able to afford ozempic or mounjaro, these have been shown to be more effective in postmenopausal women taking estrogen than not.

[Alli8]

I haven't given birth vaginally, I had to have an emergency c-sect as my cervix is narrow and wouldn't dilate. I also have a retroverted uterus and find smears extremely painful, even with the smallest speculum, so I'm really not wanting to have a coil inserted as I know it will probably be worse.

My thyroid is fine according to my blood test. I've gained 3 stone since starting HRT and hoped it would be easier to shift once I'd stopped but it's not budging. I avoid sugar, eat low carb and have done for years and do plenty of exercise including walking 4km every day (getting harder now with the joint aches but I'm forcing myself). I'm not sure what else I can do without opting for drugs or starving myself 

[bombsh3ll]

I can understand why insertion of an IUS would be tricky for you.

There are multiple other progestogens available however so it is not your only option.

Personally I would take the hormone therapy.

Feeling well makes exercise and a healthy diet easier to stick to.

[KittyKats]

Do they know why the endometrium is thickening? I think you can get hyperplasia without HRT. Plus it can thicken naturally a few years after the menopause.

Just to put your mind at ease - I had a hysteroscopy with no anaesthetic a week ago. I had read all these horror stories so was quite scared going in but I didn't suffer pain. The only issue was he couldn't find my cervix at first and he had to use a speculum which I can't tolerate. But I asked for a baby one and in the end he found it. I thought it would hurt going in but it didn't. They used a cold irrigation system so it felt weird but ok. They removed polyps plus did a Pipelle biopsy. I've never had children. I believe it's the skill of the surgeon to be honest. My gynaecologist was very slow and gentle. I've had awful smears before and this was much more comfortable.

[KittyKats]

I have terrible joint pain since reducing my oestrogen. In fact my mobility is going down hill at the moment.
Have a look at this article. I know it's old but I don't think your lining is that thick but obviously you need to discuss with your specialist:

https://pubmed.ncbi.nlm.nih.gov/15386607/

[Alli8]

Thanks for that, it makes interesting reading.

They don't know why the endometrium is thickening. I suspect it's because I'm overweight and can't lose the weight. I'm not massively big (size 16 top, 18 bottom) and most of it is below the waist but still a high BMI as I'm only 5'1".
When I first had the bleeding, I was on HRT but had gone from Evorel Conti to Evorel + Utrogestan as I was suffering bad bloating. I think the oral Utrogestan wasn't enough progesterone. In the first scan in April, the lining was only just over the 5mm. My latest scan (no HRT) in September was 6.7mm, so since stopping the HRT it's gotten worse. I suspect the HRT was just keeping it in check but now the fat oestrogen is unopposed, it's building up.

I can understand why they are recommending the Mirena but I'm just not sure I want to go back on hormones, especially one I can't just stop if it's not suiting me. I guess I have to prioritise and get my health in check first. Maybe if the Mirena sorts the thickening and I do get the weight off, it won't come back???

[KittyKats]

I refused the Mirena. Didn't want something permanent in me. Also had a very bad experience on the same progestin years ago. You can take oral progestins for hyperplasia so doesn't have to be the Mirena. It's very mild thickening and it may be different on the next scan. You could ask for monitoring. It's so annoying they didn't get a good sample but the normal cells they had is reassuring. My gynaecologist said they make such a fuss about linings these days causing loads of unnecessary hysteroscopies.

Losing weight can be challenging after menopause especially having joint pain. I'm putting on quite a few pounds as my joint pain is so bad. Do let us know how you get on x

P.S I think they will want another biopsy in order to prescribe HRT. My GP stopped mine because of PMB and the polyps but gynaecologist had to ok it.