Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: kateJ on August 25, 2019, 07:43:17 PM
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Hi everyone,
i am really appreciative of all the information on here and I am looking for some advice and reassurance please.
I am 55 and have just had my second internal scan in a year to check the thickness of my endometrium. The first result was 6mm and the second, done about a week ago, was 6.4mm, taken 7 days post bleed. The radiographer said that all looked fine and was within the range for a woman on HRT that is, below 8mm.( I have been on HRT for about ten years and changed to the Estrogel/Utro regime in January of this year. However, my 'consultant/specialist registrar at the C & Westminster has advised that I need a hysteroscopy if my lining is above 5mm.
i am confused as i was told that i was in the normal range my the radiographer and research supports her assertion:
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12150
In this study, it clearly states:
A 10‐year study of endometrial appearance in women on sequential or combined HRT compared with no treatment concluded that women on HRT had a thicker endometrium and a higher incidence of bleeding. No difference in the incidence of endometrial cancer was identified between the two groups, however it concluded that women with unscheduled bleeding on HRT require further investigation by hysteroscopy and biopsy if the endometrial thickness was greater than 8 mm.50.
I am symptom free and I had a colposcopy to rule out anything sinister late last year for post intimate bleeding. I would like to avoid this incredibly invasive and painful procedure if possible, but really don't know what do now.
I would be very grateful for any clarity or advice.
Many thanks
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Hi Katej, welcome to the forum.
I would ask your specialist why you need a hysterocopy if all the info you have says you are in the normal range. Definitely get a full explanation and do ask all the questions, before going forward with it, so you are confident that it is actually needed, if that's the case.
It's true that hrt does cause extra thickness, bleeding etc and in my case it caused a fibroid to grow. I believe the added estrogen hormone encourages the lining to thicken and the progesterone encourages the shedding of the lining. So it's important to have the right dosage of both..
You will feel better if you make sure you have all the info explained. Maybe you can email him/her?
I think there are a few ladies who have had to have hysterocopy's so they will be able to give you more info. X
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Hi KateJ, this is interesting for me as I am coming up to 3 months on my current HRT regime (Everol 75mcg patches & Provera 5mg daily) since starting I have been having fortnightly bleeding (at time of period fresh blood, much lighter than normal period, mainly during the day little if any at night, the other two weeks its old blood for around 4 days) the cramps are getting really annoying, more often at night & bloating also. Was planning on making a GP appointment when I got to collect my prescription tomorrow as it has been going on for so long. I'm assuming it's the Provera that's causing the issues. I've never had any scans, investigations re endometrial lining etc but assume that will be the suggestion from GP. It's such a rollercoster this menopause what helps with some symptoms then causes others, hope you find a solution that you are happy with kate. x
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Also Kate, if you go back to the home page and then enter hysteroscopy in the search area, then you will see a number of other threads with posts about hysteroscopy. There might be some good info there, you could make some notes and email the specialist to find out?! X
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Hi KateJ :welcomemm: I agree with Jari about querying this with the C&W. I had similar differences in opinion from relevant professionals - Gynae said my lining was too thick on HRT, but menopause clinic said it was fine & well within range. I did not have another hysteroscopy at that point as I was stopping HRT for other reasons & the lining reduced of its own accord within weeks.
However, I had had a hysteroscopy for persistent bleeding on a conti regime, 6 months or so after starting systemic HRT & though it's over in minutes it's not something I would want to repeat unless absolutely necessary. If it turns out it is recommended for you I would insist on local anaesthetic. I had one in fertile years under general together with a D&C, one in fertile years under local (which was fine & not at all painful) & one without any anaesthetic or sedation well postmenopause & with poorly managed VA, simply because no anaesthetic was the hospital's policy at the time. I would not recommend that to anyone!
Foxy - I'm on MPA too, but currently only 2.5mg & find it has a greater tendency to cause cramps than norethisterone or Utrogestan.
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Thank you so much everyone for your replies.
I intend to query the recommendation from the meno clinic at C & W like you say. i would prefer to wait a few months and have another scan to see if there's a 'trend' in the thickness. i only changed HRT recently and suffered during the transition ( back to terrible night sweats, anxiety and depression mainly). I realised that I was probably not having enough pumps of estrogel - 2 pumps daily - as well as the effects of the daily utrogestan, so I didn't take the utrogestan for a month and felt much better, but still very low mood. then started following Prof Studds regime as i put everything down to the utrogestan.
Then at my first consultation at the meno clinic, blood tests revealed that my estrogen was low ( 135) and i was told to up it to 3 pumps and to try to increase my utrogestan as they don't approve of Studd's advice. So for the last two months I took
( vaginally) 200mg for 7 days and the following month 200mg for ten days. ( yucky moods!). This month I will now increase this to 12 days as per NHS guidelines.
Sorry for so much detail - this is in case anyone else has a similar issue. And the bottom line is is that I really don't want to subject myself to a hysteroscopy if it is unnecessary.
I will call the hospital tomorrow and ask for advice.
Thank you all again. Enjoy the bank holiday sunshine :)
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KateJ please don't apologise for giving detail - this is what helps us all understand another's situation. :) With any luck, increasing your progesterone will have the desired effect. Good luck in your dealings with C&W!
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Thanks wrensong, I assumed it was the provera rather than Everol. x
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Hi katej. I had to have hysteroscopy last year for post meno bleeding and I was terrified. After internet research I decided to ask for it under a general anaesthetic. I got one no problem, but I did have to ask. I was home the same day and so glad I did it that way. Some women have no problem with hysteroscopy and some do so it's worth considering.
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Hi katej. I had to have hysteroscopy last year for post meno bleeding and I was terrified. After internet research I decided to ask for it under a general anaesthetic. I got one no problem, but I did have to ask. I was home the same day and so glad I did it that way. Some women have no problem with hysteroscopy and some do so it's worth considering.
Thank you Suzysunday and everyone again.
I have called the C & W today and on a lovely lady's advice I am going to email my concerns for clarification.
The more I think about this, the more i worry:( - but thank you for the recommendation to ask for a general anaesthetic.
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Regarding hysteroscopy, I found a freedom of information site called What do they know" run by Katherine Tylko and Elaine Falkner. They campaign for informed consent so that women know what's available regarding the procedure in hospitals across the country. They have a Facebook page "Campaign against painful hysteroscopy". I found their help invaluable at a time when I was SO stressed.
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Hi Katej
I can really understand your concerns. I'm 52, been on HRT for 7/8 years. My lining was thick due to use of sequential HRT (view from the consultant), and I was changed to conti HRT to try and reduce it, when 1st measured it was 6mm and then increased to 10mm within 6 months - don't know what it is now. However the view after a biopsy (negative) was that the original type of HRT was causing build up. The gyno was clear with me that as the biopsy was negative I did not need to worry, especially as HRT was being changed so you are right to check out your concerns and really think this through. I have to say since changing HRT I have lost lots of strange stuff in periods so they may well be right that the lining is reducing. I would also add that the biopsy without anesthetic was v.painful for me (I have a super sensitive cervix), so if going for something more intense I would definitely go for a general, not just for the pain but its awful having the sensation as well - however i think my pain threshold down there is pretty low now! Hope you get the answers x
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Regarding hysteroscopy, I found a freedom of information site called What do they know" run by Katherine Tylko and Elaine Falkner. They campaign for informed consent so that women know what's available regarding the procedure in hospitals across the country. They have a Facebook page "Campaign against painful hysteroscopy". I found their help invaluable at a time when I was SO stressed.
Thank you for this. I've had a look and there seems to be a lot of concern out there regarding how we are treated as women re pain relief. This is an incredibly invasive and painful procedure, yet it is only now being considered important to offer adequate advice about what to expect.There is even now an online petition demanding that women are offered more pain relief.
Thought people might find this interesting to listen to https://www.bbc.co.uk/sounds/play/m000612b. About 33 mins in there's a discussion about hystersoscopy and how women are not given enough information.
I have now emailed C & W for advice and will update the forum when I hear back. But it is a stressful time, as you say.
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And thank you, Nairn for your advice. I think I will have to have a GA too especially after my research!
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Suzysunday - that sounds very interesting - had no idea it existed. In retrospect, I did feel my last hysteroscopy & biopsy, without the option of either pain relief (other than the recommended paracetamol beforehand) or sedation, was a bit much to expect a 5 years postmenopausal woman with inadequately controlled VA to endure. The nursing staff were clearly uncomfortable that I had to have it done that way too, but I think it was hospital policy. The biopsy was OK but the cramps were intense. They apologised for the discomfort & the shock of it, combined with their kindness, made me cry, which was embarrassing! I was not especially anxious about it beforehand, so hadn't been terribly tense to cause access to be more difficult.
KateJ - with any luck it won't be necessary for you to have the investigation, but if so, do push for either local or if you're happier with the idea - general anaesthetic. I prefer to avoid the latter if I can, as it usually doesn't agree with me, so feels like overkill for a short day case procedure. This is a quick procedure & I know some women find it OK without any medication, but I think better to be cautious & get whatever help is on offer & that way you go in feeling less anxious. Good luck, whatever happens.
Sorry - our posts crossed!
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Hi KateJ, this is interesting for me as I am coming up to 3 months on my current HRT regime (Everol 75mcg patches & Provera 5mg daily) since starting I have been having fortnightly bleeding (at time of period fresh blood, much lighter than normal period, mainly during the day little if any at night, the other two weeks its old blood for around 4 days) the cramps are getting really annoying, more often at night & bloating also. Was planning on making a GP appointment when I got to collect my prescription tomorrow as it has been going on for so long. I'm assuming it's the Provera that's causing the issues. I've never had any scans, investigations re endometrial lining etc but assume that will be the suggestion from GP. It's such a rollercoster this menopause what helps with some symptoms then causes others, hope you find a solution that you are happy with kate. x
Foxylady - it is normal to bleed for the first 6 months on continuous combined HRT and how much you bleed will depend to some extent on what regime you were on before ie the lining could have built up previously and the Provera is now dealing with it. Any bleeding beyond 6 months should be investigated or any bleeding you are worried about that appears abnormal or very unusual before this time period has elapsed. Are you actually post-menpause because you are referring to "at time of period"? If you are post-menopausal and on continuous combined HRT then none of it is a period as such - natural or artificial and there is no due date nor cycle. It's all abnormal bleeding - which as has been said can be expected initially. I hope your cramps and bleeding ease soon!
Hurdity x
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Hi kateJ - when you say 7 days post bleed - do you mean post the start of your bleed or post the end of your bleed? If the latter then you definitely do not need a hysteroscopy I would agree, and if the former well it's borderline. I've had a scan on what I thought was Day 7 (since start of bleed) and had lining of over 7 mm which sonographer said was normal - no action (last year). By contrast a few years ago i had a scan a little later in my cycle and was 7.4 mm and despite my saying I was on cyclical HRT the gynae insisted on referring me for hysterosocopy - mainly because a small abnormaility was noted (turned out to be a small fibroid).
A friend on another forum sees a private consultant and her lining is never less than approx 7 mm post bleed and her gynae is quite happy with that (she has them done annually) for the very reasons you say and those studies that have been done.
Also to give a contrasting view with my experience of hysteroscopy. Mine was offered either at a small local hospital where they only did them under GA or larger city hospital where I had the choice. Having never had a GA there was no way I was going to have a GA for what I saw as a small investigative procedure - saving that for if/when I needed an op of some sort. I wasn't worried about it at all. The instructions were to take two paracetamol and two ibuprofen an hour before the time of the appt which I did and I did not feel the hysteroscopy at all and barely felt the biopsy ( just a tiny pinch). It was done expertly by an experienced ?consultant or registrar and I wouldn't hesitate to have it done again.
I agree I would question in more detail but if nothing abnormal has been noted on the scan (TVS) then maybe not needed with a thickness so low, as you say. It is frustrating when even the experts disagree! In addition if you hasve been using less progesterone than recommended this could be the reason for the slightly thicker lining which should reduce - but perhaps your gynaes are offering this precisely because you have been taking insufficient - just to make sure all is OK as there is an increased risk of endometrial hyperplasia with less than recommended progesterone dosage.
Hurdity x :welcomemm:
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Glad you posted with your experience of hysteroscopy being OK Hurdity - I thought I remembered you saying some time ago that your procedure had been fine, but couldn't be sure who it was! Hence my saying some women don't have any probs with it.
Wx
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I'm so glad you posted this as I was told yesterday that my gynae is requesting one for me.
She mentioned it BEFORE she sent me for my scan - which showed a thickness of 6mm. She won't see me unless I have the hysteroscopy.
Okay, I fully admit I'm a complete wimp. Long story short, I'm an abuse survivor. I'm still seeing a specialist counsellor despite this happening from my early teens to my thirties. I take diazepam and painkillers for my smear tests and still find them incredibly painful.
I'm a wimp about the pain, but also about anyone between my legs!
I'm thinking of stopping my HRT and just cancelling everything. I cannot bear the thought of this procedure even if they give me GA. My abuser ex forced me to have an abortion which was the last time I had GA.
Having tears and a meltdown just thinking of this.
But back to your query. Can you not request a few scans to keep an eye on things? My scan was done abdominally despite the gynae requesting TVS. I had gone prepped for TVS (painkillers and diazepam - which are hell to get hold of from my GP despite my neuro telling them I was to be prescribed them for back spasms linked to my TM) and can't say I wasn't relieved but now I'm getting doubts at whether an abdo would have showed everything.
I'm also wondering if there's a financial push for these to be done. Why would my gynae have mentioned it before sending me for a scan?
I hope you get some answers and that you (or anyone else here) doesn't need to go for one of these unnecessarily. Good luck.
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Don't say you are a wimp onion relish, as said on here we are all different to coping with these things. What you have endured with the abuse must be horrendous to cope with.
I was sent for a Trans vaginal scan and a hysteroscopy in the same week. My lining was 5mm which the scan picked up. The hysteroscopy did not get enough tissue for the biopsy so the gynae (who was a totally uncaring man) wanted me to have another. I refused and they settled for another tvs. This was several weeks later and the lining had reduced to normal thank goodness. That was because I had stopped systemic hrt, tibolone. Now I stick to local hrt. It's hard to know what to take, I need something for atrophy otherwise life is unbearable.
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Hi Hurdity, I'm peri and was on everol sequi for 3 months before starting everol 75mcg & Provera 5mg. If it is 6 months then that's fine as long as I have an idea what to expect. For both regimes I was started on it following a phone call by the GP (I had seen him earlier that day & he then emailed local mono specialist who advised him & then he phoned me). It has meant I haven't had the opportunity to discuss what I'm about to start & expectations etc. I know there are ladies here with personal & professional experience who are able to share with me. x
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Don't say you are a wimp onion relish, as said on here we are all different to coping with these things. What you have endured with the abuse must be horrendous to cope with.
I was sent for a Trans vaginal scan and a hysteroscopy in the same week. My lining was 5mm which the scan picked up. The hysteroscopy did not get enough tissue for the biopsy so the gynae (who was a totally uncaring man) wanted me to have another. I refused and they settled for another tvs. This was several weeks later and the lining had reduced to normal thank goodness. That was because I had stopped systemic hrt, tibolone. Now I stick to local hrt. It's hard to know what to take, I need something for atrophy otherwise life is unbearable.
Thank you, Suzysunday.
I often wonder why men want to go into gynaecology, especially those who apparently have no empathy towards women. Having said that, I've had the misfortune of coming across a few uncaring/harsh/downright unpleasant female medical professionals lately.
I wouldn't be able to see a male as it would be too triggering for me. My new gynae is lovely - I couldn't wish for better - however, I do wish she'd give me a bit more time to settle into the regime and maybe send me for a scan before sending me for this.
I hope you manage to find something less unpredictable for your atrophy. I'm all too familiar with physical problems making life hell - I hope you don't feel like that ever again.
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I have recently had my 4th hysteroscopy/biopsy , i have them to check on my endometrial hyperplasia , i find them very painfull i would say maybe worse than giving birth . Taking painkillers didnt seem to help atall :'(
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Hi Hurdity, I'm peri and was on everol sequi for 3 months before starting everol 75mcg & Provera 5mg. If it is 6 months then that's fine as long as I have an idea what to expect. For both regimes I was started on it following a phone call by the GP (I had seen him earlier that day & he then emailed local mono specialist who advised him & then he phoned me). It has meant I haven't had the opportunity to discuss what I'm about to start & expectations etc. I know there are ladies here with personal & professional experience who are able to share with me. x
Foxylady - you may well bleed for far longer than 6 months if you are peri-mnenopausal. The 6 month rule is for post-menopausal women starting continuous combined HRT. It is basically your period coming through if ovulation has not been suppressed which it may not be when on HRT. Not sure why you have been given this type? You would be better off taking the Provera cyclically 10 mg 12-14 days per month which if you sync with your cycle should mean you only bleed once per month. Once you are near menopause then you could try conti again although you won;t know when this is - you will just have to trial it every now and again if this is what you prefer.
Hurdity x
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Thanks Hurdity! Think I will speak to GP just to clarify why I have been put on the continuous combined HRT, he took advise from Meno specialist! x
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Hi kateJ - when you say 7 days post bleed - do you mean post the start of your bleed or post the end of your bleed? If the latter then you definitely do not need a hysteroscopy I would agree, and if the former well it's borderline. I've had a scan on what I thought was Day 7 (since start of bleed) and had lining of over 7 mm which sonographer said was normal - no action (last year). By contrast a few years ago i had a scan a little later in my cycle and was 7.4 mm and despite my saying I was on cyclical HRT the gynae insisted on referring me for hysterosocopy - mainly because a small abnormaility was noted (turned out to be a small fibroid).
A friend on another forum sees a private consultant and her lining is never less than approx 7 mm post bleed and her gynae is quite happy with that (she has them done annually) for the very reasons you say and those studies that have been done.
Also to give a contrasting view with my experience of hysteroscopy. Mine was offered either at a small local hospital where they only did them under GA or larger city hospital where I had the choice. Having never had a GA there was no way I was going to have a GA for what I saw as a small investigative procedure - saving that for if/when I needed an op of some sort. I wasn't worried about it at all. The instructions were to take two paracetamol and two ibuprofen an hour before the time of the appt which I did and I did not feel the hysteroscopy at all and barely felt the biopsy ( just a tiny pinch). It was done expertly by an experienced ?consultant or registrar and I wouldn't hesitate to have it done again.
I agree I would question in more detail but if nothing abnormal has been noted on the scan (TVS) then maybe not needed with a thickness so low, as you say. It is frustrating when even the experts disagree! In addition if you hasve been using less progesterone than recommended this could be the reason for the slightly thicker lining which should reduce - but perhaps your gynaes are offering this precisely because you have been taking insufficient - just to make sure all is OK as there is an increased risk of endometrial hyperplasia with less than recommended progesterone dosage.
Hurdity x :welcomemm:
Thank you for this Hurdity, and to everyone who took the time to read and respond.
I just thought I would update everyone.
It is exactly as you said, Hurdity: 'It is frustrating when even the experts disagree!'
I had a follow up appointment today( brought forward by at least a month because of my email to them) at the Chelsea and Westminster Hospital with a consultant nurse who knew my name but nothing else about me or my case as I sat down. Very frustrating to say the least. Then, after my detailed explanation as to why i was there, she then agreed that there was nothing to worry about regarding the endometrium and discharged me back to my GP! And despite me asking why the Dr I had originally seen had recommended a hysteroscopy, she could offer no explanation.
I am obviously relieved and happy that they now think that I don't need a hysteroscopy, but frustrated at the nurse for not knowing anything about my case as I sat down in front of her. And I think it terrible that there are such inconsistent opinions about the need for hysteroscopies in the gynaecological field. I am also concerned that she didn't think it necessary to monitor my endometrium further.
The NHS is fantastic on the whole, but this falls a little short of best practice.
I think we just need to have confidence to ask more questions; it is after all. our bodies.
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Thank you for the update.
I don't know whether I will attend my appointment yet. Obviously, if I don't I'll let them know so someone else can have it.
Am I missing something? Did you not have it done because you explained what was going on and it (sensibly) didn't go ahead?
I'm interested as if I go and explain what's going on will they try to insist I have it? Can I say no and walk out without risking future care? I worked in the NHS many years ago and am aware that with some "nuisance patients" they get punished down the line.
I'm losing sleep and am on verge of becoming hysterical several times a day over this.
Thanks and sorry I'm so dense - I had to search through my posts so everything is out of order.
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Thank you for the update.
I don't know whether I will attend my appointment yet. Obviously, if I don't I'll let them know so someone else can have it.
Am I missing something? Did you not have it done because you explained what was going on and it (sensibly) didn't go ahead?
I'm interested as if I go and explain what's going on will they try to insist I have it? Can I say no and walk out without risking future care? I worked in the NHS many years ago and am aware that with some "nuisance patients" they get punished down the line.
I'm losing sleep and am on verge of becoming hysterical several times a day over this.
Thanks and sorry I'm so dense - I had to search through my posts so everything is out of order.
Hi Onion Relish,
The nurse seems to have decided against the hysteroscopy after our discussion.
I think you really should get a clearer reason as to why you need a hystersoscopy. And the thought that the people in charge of your care, be it in a hospital or GP centre, would be so vindictive as to ' punish ' you for taking charge of your own body, is terrible, but I can not say that that does not happen.
Please let us know what you decide to do.