Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Meeka on September 06, 2023, 11:56:03 AM
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Hi everyone ,
I’ve been using Oestrogel and utrogestan cyclically for around 10 years . Recently noticed my bleeds were getting heavier and bit longer .
Just had a uterine internal scan at ultrasound direct which measured thickness at 9.6mm .
I think that is too thick ?
Any advice or experiences would be appreciated . But sure what to do next ?
Thank you
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5mm is usually acceptable. Were you not given any advice with the results? Who referred you?
Is there a Nurse Practitioner at the Surgery to talk to?
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Ultrasound direct is self referral and sonographer thought result was acceptable for someone on HRT .
I would say this service is good for giving a result but not sure they are qualified for any real follow up advice .
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I wasn't aware that we are able to self refer .......... sonographer though is a technician, I think that to put your mind at rest: as well as letting us know ;) : what a specialist would consider apt for your HRT regime.
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https://www.menopausematters.co.uk/forum/index.php/topic,61216.15.html
I just found this discussion which helps .
Not sure if the link works
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Hello Meeka
At an NHS scan a few years ago I was told that 4mm was the safe limit. Mine measured a little more than that so I had a hysteroscopy and all was okay. I had been referred due to post meno bleeding and I had recently increased my HRT patch from 50mcg to 75mcg. I was informed that the highest dose patch was likely responsible for the bleed and that I should go back to a 50mcg patch which I did and all the bleeding resolved.
Fast forward a few years and many experiments with different HRT types and strengths and yet again I was referred for a scan due to bleeding. Again all okay and my lining was 2mm which the consultant said was right for a woman of my age( 66) and post meno. Once again I lowered my dose of Oestrogen and the bleeding stopped.
Apologies for the long winded reply but I think my story indicates that your lining is a little too thick and is probably due to too much Oestrogen. Perhaps take your scan results to your GP so that he or she can work out a treatment plan with you for the future.
Wishing you well and take care.
K.
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I wasn't aware that we are able to self refer .......... sonographer though is a technician, I think that to put your mind at rest: as well as letting us know ;) : what a specialist would consider apt for your HRT regime.
We have a growing private sector that we can refer ourselves to, which I think is great.
Meeka, the link worked and probably answered your question going forwards.
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Hi Meeka, the other thread you posted the link for is helpful. Like Kathleen, some years ago & several years postmenopause, I was told by a Cons Radiologist (private hospital) that 4mm was the magic number above which further investigation (hysteroscopy & biopsy) was required. I had gone nearly a year on low dose sequential HRT without any bleeding but had suddenly started to get spotting & though bleeds were of course to be expected on a sequential regimen, we were not sure why the sudden change from no bleeds to spotting, hence the scan. My lining was only 1-2mm at that point, so no further investigation.
A year later on higher dose oestrogen, I had a little spotting after sex & was fast-tracked for another abdo/TVS, this time at an NHS hospital. Lining was 6mm straight after a scheduled bleed, so I was somewhat shocked & expected a hysteroscopy & biopsy, but the sonographer said she thought that measurement was acceptable on HRT, especially as the endometrium was regular with no abnormalities of concern, bar a small fibroid I'd had for many years. My GP & Gynae both deemed the outcome fine to my surprise & I wasn't required to have a hysteroscopy on that occasion. Like yours, my bleeds then got heavier over time on a long cycle regimen for progesterone intolerance. I suspected the lining was becoming thicker & for that reason reduced my oestrogen dose & cycle length while waiting for hysterectomy, the histology from which, albeit benign, proved my suspicion was right. I would speak to your GP, gynae or menopause specialist for expert advice on your particular situation.
Wx
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Hello Meeka
At an NHS scan a few years ago I was told that 4mm was the safe limit. Mine measured a little more than that so I had a hysteroscopy and all was okay. I had been referred due to post meno bleeding and I had recently increased my HRT patch from 50mcg to 75mcg. I was informed that the highest dose patch was likely responsible for the bleed and that I should go back to a 50mcg patch which I did and all the bleeding resolved.
Fast forward a few years and many experiments with different HRT types and strengths and yet again I was referred for a scan due to bleeding. Again all okay and my lining was 2mm which the consultant said was right for a woman of my age( 66) and post meno. Once again I lowered my dose of Oestrogen and the bleeding stopped.
Apologies for the long winded reply but I think my story indicates that your lining is a little too thick and is probably due to too much Oestrogen. Perhaps take your scan results to your GP so that he or she can work out a treatment plan with you for the future.
Wishing you well and take care.
K.
Many thanks .
Yes I think I will go to GP . They are not that great with HRT and always seem to have reservations . Their knowledge is quite limited and I have a feeling their reaction will be to stop the HRT .
I have consulted with Michael Savvas in the past but the cost is always a factor . I think I’ll ring and get a costing moving forward . He was excellent last time I saw him .
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Hi Meeka, the other thread you posted the link for is helpful. Like Kathleen, some years ago & several years postmenopause, I was told by a Cons Radiologist (private hospital) that 4mm was the magic number above which further investigation (hysteroscopy & biopsy) was required. I had gone nearly a year on low dose sequential HRT without any bleeding but had suddenly started to get spotting & though bleeds were of course to be expected on a sequential regimen, we were not sure why the sudden change from no bleeds to spotting, hence the scan. My lining was only 1-2mm at that point, so no further investigation.
A year later on higher dose oestrogen, I had a little spotting after sex & was fast-tracked for another abdo/TVS, this time at an NHS hospital. Lining was 6mm straight after a scheduled bleed, so I was somewhat shocked & expected a hysteroscopy & biopsy, but the sonographer said she thought that measurement was acceptable on HRT, especially as the endometrium was regular with no abnormalities of concern, bar a small fibroid I'd had for many years. My GP & Gynae both deemed the outcome fine to my surprise & I wasn't required to have a hysteroscopy on that occasion. Like yours my bleeds then got heavier over time & I suspected the lining was becoming thicker, which proved to be the case on (albeit benign) histology following hysterectomy. I would speak to your GP, gynae or menopause specialist for expert advice on your particular situation.
Wx
Many thanks ,
Could I ask why you decided to have a hysterectomy and if you still use HRT now ?
I just wondered why as the histology was ok .
Thank you
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MayB get on2 a waiting list for a dedicated menopause clinic if GPs aren't au fait, do U want to stop HRT ?
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At my NHS clinic for post menopausal bleeding anything over 5.5 mm you have a biopsy especially if you are on hrt. My first one was 5.5 so they did a biopsy came back clear. I started bleeding again 10 months later fast tracked again womb lining was ok nurse still did a biopsy which came back abnormal. I’ve just had a total radical hysterectomy for womb cancer luckily caught very early. I was only on a low dose of hrt for 5 years. You definitely should be having a womb biopsy good luck
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Tnx for the update Donna-paul - how is recovery going? :foryou:
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Hi Meeka - I'd revised my earlier post not knowing you were posting, so the post you quoted has been changed!
The hysterectomy was agreed for extreme progesterone intolerance that worsened over time, making me very unwell & for debilitating heavy bleeds, which meant I was becoming low in iron. I also found cyclical HRT difficult to combine with my unusual thyroid replacement regimen. The histology showed several benign conditions that explained the heavy bleeding, which incidentally I'd also experienced throughout my fertile years, long before HRT, though no abnormality other than small fibroids had previously been found despite various investigations.
Yes, still on HRT.
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MayB get on2 a waiting list for a dedicated menopause clinic if GPs aren't au fait, do U want to stop HRT ?
Thanks ,
No I don’t really want to stop HRT as I have low bone density . when I consulted with Prof Stud over 10 years ago he was most insistent that I should always take it . This is a new situation though so I need to re asses .
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Donna-paul, I'm sorry to know of your experience & hope you are doing well post-hysterectomy. :hug:
Wx
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Hi Meeka - I'd revised my earlier post not knowing you were posting, so the post you quoted has been changed!
The hysterectomy was agreed for extreme progesterone intolerance that worsened over time, making me very unwell & for debilitating heavy bleeds, which meant I was becoming low in iron. I also found cyclical HRT difficult to combine with my unusual thyroid replacement regimen. The histology showed several benign conditions that explained the heavy bleeding, which incidentally I'd also experienced throughout my fertile years, long before HRT, though no abnormality other than small fibroids had previously been found despite various investigations.
Yes, still on HRT.
Thank you for your reply .
May I ask how you found the hysterectomy experience ?
I find progesterone difficult to endure , hence I take it cyclically . A private
Gynae once offered me a hysterectomy but I declined at the time .
Thank you
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At my NHS clinic for post menopausal bleeding anything over 5.5 mm you have a biopsy especially if you are on hrt. My first one was 5.5 so they did a biopsy came back clear. I started bleeding again 10 months later fast tracked again womb lining was ok nurse still did a biopsy which came back abnormal. I’ve just had a total radical hysterectomy for womb cancer luckily caught very early. I was only on a low dose of hrt for 5 years. You definitely should be having a womb biopsy good luck
Many thanks for your reply ,
I hope you have a good recovery and thank you for sharing your experience
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Meeka, Nick Panay told me that he was ok with a lining up to 10mm if the woman is on HRT. At one point I went over 10 and at that point was sent for a hysteroscopy and biopsy which were fine
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Meeka, Nick Panay told me that he was ok with a lining up to 10mm if the woman is on HRT. At one point I went over 10 and at that point was sent for a hysteroscopy and biopsy which were fine
Many thanks laszla ,
That’s reassuring ,
I know if I start to take utrogestan I invariably start bleeding within 7 days of taking it so thinking of inducing another bleed to see if it reduces the lining . Then I think I will consult with Mr Savvas to see what he thinks . He did a scan for me in his office last time I consulted with him a couple of years ago and lining was ok then .
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Hello again ladies.
I agree that it is good that we can self refer to the private sector, I am a patient of Newson Health so I am aware of the need for these services however the NHS is still needed for complete care.
With Newson Health I have found that their care began and ended with consultations about HRT products and for anything beyond that I had to rely on the NHS.
Meeka - I hope you get sorted soon and please keep us updated.
Take care ladies.
K.
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Meeka
May I ask how you found the hysterectomy experience ?
I'm probably not the best person to ask for experience of hysterectomy alone as I had several other gynae procedures at the same time & was advised in advance this considerably magnified the major nature of the op, necessitating a longer recovery period & could increase the post-op pain for some weeks. The surgeon, a lovely & very experienced gynae, was pleased with the way the op went & said it was straightforward, post-op pain was manageable with paracetamol alone & not especially long-lasting. It was much needed & I'm pleased I had it done, but it's also true to say the recovery period was not as straightforward as anyone had hoped. If you want more detail please feel free to PM me.
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Hello again ladies.
I agree that it is good that we can self refer to the private sector, I am a patient of Newson Health so I am aware of the need for these services however the NHS is still needed for complete care.
With Newson Health I have found that their care began and ended with consultations about HRT products and for anything beyond that I had to rely on the NHS.
Meeka - I hope you get sorted soon and please keep us updated.
Take care ladies.
K.
Thank you Kathleen
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MeekaMay I ask how you found the hysterectomy experience ?
I'm probably not the best person to ask for experience of hysterectomy alone as I had several other gynae procedures at the same time & was advised in advance this considerably magnified the major nature of the op, necessitating a longer recovery period & could increase the post-op pain for some weeks. The surgeon, a lovely & very experienced gynae, was pleased with the way the op went & said it was straightforward, post-op pain was manageable with paracetamol alone & not especially long-lasting. It was much needed & I'm pleased I had it done, but it's also true to say the recovery period was not as straightforward as anyone had hoped. If you want more detail please feel free to PM me.
Many thanks
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Hi Meeka, just thought I would add my own recent experience. I have self referred to the Surry Park Clinic for the past 8 yers or so - I decided to have trans vaginal scans annually to check on the lining as i was taking hrt cyclically but trying to maintain the minimum dose of progesterone. The results have always been between about 5 and 6.1 and the lining was smooth and consistent. I was always told there was a greater tolerance when hrt was cyclically.
I started seeing an hrt consultant privately last summer and in December I started Utrogestan 100 vaginally continuously. I was on Estradot 50mcg and at start of year this was upped to 75mcg. I also had my annual scan and the lining was about 5.5 and all good. I was told that oestrogen patches at 75 and above meant 200mcg Utrogestan would be needed nightly. So I started on the one capsule of 200 and all was fine. With still low oestrogen levels I went up to Estadot 100 in the spring and a little while after I started to get light bleeding. I went for a further scan and the lining was now irregular and was 7.1.
The sonographer wsas great and said that as a precaution I must have this investigated. The hrt consultant said anything above 6 had to be referred to a gynae. I had been thinking of having a coil fitted as I was so fed up with the discharge from the Utrogestan (no other side effects from this 200 dose) and so within a few days I was booked in for hysteroscopy, I had the coil fitted, and had a smear test done while it was all going on 'down there'!
The gynae found glandular cells at the entrance to the cervix which, to use his words, he 'burnt away" (diatherm treatement??) and he said these were likely to have caused bleeding. I'm pleased to say that the biopsies all came back fine.
I hope yours proves to be straightforward. I continue with Estradot 100 for the time being - it does seem to be a high dose compared to what others are taking on this forum but I don't seem to have any of the side effects you may get from too much oestrogen.
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I’m doing ok and have to thank the NHS fast track clinic and being operated on by a great surgeon within 4 weeks of the results. It’s not fun going through menopause again😌 night sweats and hot flushes are the worst symptoms. It’s so important to get any post menopausal bleeding checked even just a bit of spotting.
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That's good advice Donna-paul, thank you. I so hear you on the night sweats - those & the related insomnia are the bane of my life. I hope you soon begin to feel better.
Wx
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Hi everyone ,
Thank you for all the replies .
I’ve been debating wether to visit my GP to ask for a referral to NHS for a hysteroscopy
as I appreciate the advice on here was to get checked . Just wondering if this will trigger my GP to stop my HRT ? Does this usually happen do you think ?
My GP practice is not very progressive regarding HRT and are very risk averse .
Just wondering if you could advise what the procedure usually is regarding HRT .
Many thanks
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Hi everyone ,
Thank you for all the replies .
I’ve been debating wether to visit my GP to ask for a referral to NHS for a hysteroscopy
as I appreciate the advice on here was to get checked . Just wondering if this will trigger my GP to stop my HRT ? Does this usually happen do you think ?
My GP practice is not very progressive regarding HRT and are very risk averse .
I didn’t have to stop my hrt for both my biopsies I did unfortunately when the biopsy came back abnormal.
Just wondering if you could advise what the procedure usually is regarding HRT .
Many thanks
-
Hi everyone ,
Thank you for all the replies .
I’ve been debating wether to visit my GP to ask for a referral to NHS for a hysteroscopy
as I appreciate the advice on here was to get checked . Just wondering if this will trigger my GP to stop my HRT ? Does this usually happen do you think ?
My GP practice is not very progressive regarding HRT and are very risk averse .
I didn’t have to stop my hrt for both my biopsies I did unfortunately when the biopsy came back abnormal.
Just wondering if you could advise what the procedure usually is regarding HRT .
Many thanks
Thank you , that’s helpful