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[Teresa]

Hi,
I hope someone might be able to give me some advice. Last week I had a vaginal ultrasound at my hospital’s women’s clinic, on the two week referral pathway, from my GP. I’ve been on HRT ( lenzetto) for about three years now and have a mirena coil. Since being on HRT, I’ve had a few occasions of unscheduled spotting, over past three years, all of which have been investigated with hysteroscopies and nothing was found. I had gone a year with no bleeding, but I had some spotting couple of weeks ago, which prompted the latest scan. I had no spotting at the time of the scan as it had stopped.

I haven’t had the formal results yet. I was told I’d get a call quite quickly and I’d see a gynaecologist to discuss, but I’ve heard nothing. It’s been five days. I  also had some new spotting which started today, which has taken me by surprise and worried me. It’s very dark.
Do you think the spotting I have could be due to the scan? Especially as my womb is very high up. The scan was very uncomfortable at times and the radiographers had to swap as the first radiographer was less experienced and couldn’t see anything, as I have a very tilted womb. I also have at least six fibroids, some of which are in the lining of my womb. They all vary in size. The radiographers said that everything looked as it should, compared to my last scan and my lining wasn’t thick, but the whole thing took over 20 minutes and did hurt occasionally where I had to get into certain positions because of my tilted womb. I know fibroids can bleed and was wondering if my fibroids are too.

What would you all do in my situation?

[Raisinette]

Hi Teresa

II too have tilted uterus and fibroids and have had to have many ultrasounds over the years because of post meno spotting. I had a bit of spotting after one of the ultrasounds (I mean, they do shove a big wand up there and move it all around!) and particularly if you're having a bit of atrophy and dry vaginal tissues, all that moving around can make little tears. If I were you I'd give them a call and say you're waiting on results and are surprised it's taken longer than originally stated. If you're in the US as I am, it's nearing the holidays, many health professionals are out ill as the flu and everything else is rampant... so I might guess the slowdown has more to do with that than your results!
Best wishes!

[Teresa]

Hi Raisinette,
Thankyou so much for coming back. It’s nice to know I’m nit alone in having spotting etc with a womb that likes to hide 
I did exactly what you suggested earlier and a consultant called me back. They said that the scan revealed all looked to be well, but due to me having spotting a few times now, she suggested I have a hysteroscopy  I’ve had two of this already and both showed all was well and I was none the wiser. She said if they could get to the fibroids in the lining, they can remove it, as she thinks that might be the culprit.

I am going to have to go through with this torture one more time it seems, but hope they can perhaps see what the issue might be this time.
Thankyou for your help and all the best,
Teresa

[bombsh3ll]

Spotting on hormone therapy is almost always benign and especially given you have been repeatedly investigated, I would make sure you a copy of the ultrasound report, and that cervical screening is up to date.

Thereafter I would immediately start vaginal estrogen as atrophy is the commonest cause especially when bleeding soon after an internal scan.

I would also review your systemic estrogen dose as low levels can increase the likelihood of an unstable endometrium and an atrophic vagina.

The mirena IUS is so protective against endometrial hyperplasia that it is actually being used as treatment with some early stage endometrial cancers.

Therefore I would really think about the value of rushing to the GP with every bit of spotting, as to keep doing he same and hoping for a different outcome is the definition of madness.

[Teresa]

Hi Bombshell3ll
Thankyou so much for coming back. I’m actually doing all that you suggest. I do use vaginal oestrogen and am using vagifem. I’ve been using it every other day, as I need to ( on the advice of a menopause specialist) for well over a year now. Before this, I was using oestrogen cream, so I don’t think it’s atrophy unfortunately, I wish I could blame that.
My oestrogen levels are also ok - I’m about 650 and this is an hour before my Lenzetto is due.  I was told to take a blood test just before I’m due the next dose, so that it’s optimal.
I really didn’t want to go to the GP again believe me. I had spotting in April and ignored it, then again in September. Now this time I feel I can’t.
I sometimes wish I wasn’t on top of it all as I could blame this, that and the other on this bloomin’ spotting, but as you can see, I can’t 

I think they’re probably as fed up with it as I am. I am now booked to have the torture of a hysteroscopy on the 6th Jan and dreading it. I always suffer effects during and afterwards. I just hope they find the reason this time and if it is a fibroid, they can remove it once and for all. My fear is they will still find nothing and I’ll be back to square one.