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Author Topic: HRT and womb lining thickening  (Read 2320 times)

Grumpymum

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HRT and womb lining thickening
« on: March 20, 2018, 02:10:13 PM »

Hello. I've been on HRT for about 4 years now, 2-3 years on estradot 75 patch and utrogestan 200mg day 15-26 orally. For the last six months or so I didn't have a bleed and was feeling 'heavy' down there and so took the utrogestan vaginally for that cycle (as is often suggested on here) and had a good bleed, quite clotty and dark at first, (sorry - too graphic!) then red, then tailed off. I had made an appointment to see my GP before the bleeding started, it started the day of the appointment. She decided to refer me to a gynaecologist who I saw yesterday as an urgent referral. I had an external and internal ultrasound and then saw the gynaecologist. He said my lining was 6mm when it should be 4mm and I had a polyp and so did a hysteroscopy to remove the polyp and took a sample of the lining. He said he wasn't worried as it looked healthy. However even though I explained about the HRT, he never asked where I was in my cycle. I thought the lining varied in thickness through the cycle or am I totally wrong. I was on day 7 of the utrogestan, so I thought the lining would be building prior to being shed. Can anyone of you enlightened ladies help one confused lady.
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Mary G

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Re: HRT and womb lining thickening
« Reply #1 on: March 20, 2018, 07:55:18 PM »

Grumpymum, I'm a bit baffled by this.  If your lining was 6mm on a cyclical HRT regime at that part of your cycle then I can't see the problem.  It is normal for it to build up otherwise where does all that blood come from when you shed?  In many cases, it goes considerably higher than that and then after it has shed, it goes back down to something like 3-4mm.  If you were on day 7 of the Utrogestan then 6mm sounds about right, did he assume you are on a continuous combined HRT regime perhaps?
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Grumpymum

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Re: HRT and womb lining thickening
« Reply #2 on: March 21, 2018, 09:36:14 AM »

I was baffled too Mary G, pleased I'm not alone! I'm pleased he took off the polyp anyway and I suppose taking a sample of the lining is a precaution but it seems rather odd he didn't ask. I specifically told him that I'm on a cyclical cycle and that I only take the utrogestan on day 15-26. Surely a consultant gynaecologist would know about HRT?!! Thanks for your reply anyway, made me feel much better. x
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Hurdity

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Re: HRT and womb lining thickening
« Reply #3 on: March 21, 2018, 08:24:01 PM »

Hi Grumpymum

It is strange how even specialist gynaecologists do not make the link! The same thing happened to me - I had some odd spotting (after intimacy) and was referred to gynae and then had to have a hysteroscopy and biopsy partly because she said my lining was overthickened at 7.5 mm or thereabouts - but I was several weeks into a long cycle HRT so only to be expected. It seems like they have their boxes and if you tick them - off you go.

Re the development of the lining - most of the thickening and building takes place on the oestrogen only part of HRT (which is the proliferative phase of a cycle). Progesterone changes the lining structurally (ready for fertilised egg) and sometimes there is a slight increase in thickness during this time (this is the secretory phase) - but not substantially from what I recall. The fact that it was only 6 mm on Day 7 of utro is actually amazing! It would not grow much more than this for the remaining days.

As you have discovered - vaginal utrogestan is better than oral prog for thinning the lining because the amount of progesterone actually getting to the uterus from oral use is subject to the vagaries of the digestive process and metabolism by the liver.

It is always good to get checked out anyway - even if it is perhaps as a result on insufficient knowledge. I am puzzled as to why your referral was urgent though  :-\.

Hope all is well re the biposy anyway - do let us know :)

Hurdity x
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Grumpymum

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Re: HRT and womb lining thickening
« Reply #4 on: March 22, 2018, 10:05:45 AM »

Thanks Hurdity. I think I did tick the boxes and I suppose better to be safe than sorry. The GP put it through as urgent because it fell into the cancer aware box, and I was seen within two weeks of referral which is great, but made me worry too!

I don't feel that the HRT controls my symptoms particularly well (brain fog, low mood, aching bones/joints, no energy/motivation) and would the thickness of the lining indicate I'm not getting enough oestrogen?

Your advice is always so reassuring and knowledgeable. Thanks again.
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Hurdity

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Re: HRT and womb lining thickening
« Reply #5 on: March 22, 2018, 06:31:50 PM »

Well it is certainly not over-thickening on this regime - but your symptoms should be more of an indication of whether the oestrgoen dose is sufficient. For example if the utrogestan could be controlling your lining very well even though your oestrogen levels could be high. Are your symptoms worse at any particular point in the cycle? Some of those symptoms could be due to progesterone and progesterone withdrawal, but a higher oestrogen dose may also help. Finally testosterone can be the missing link for some women and if deficient could also cause those symptoms. Underactive thyroid could also be a factor - but you would be feeling unnaturally cold and have difficulty with your weight if this was a problem.

Yes the urgent referral was somewhat unnecessary - I mean it was a normal withdrawal bleed as expected with cyclical HRT!  However the fact that you hadn't had one before (ie a bleed) may have indicated further investigation would be appropriate but certainly no cause for undue alarm!

Hurdity x
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