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[anais]

I've just had my third transvaginal ultrasound scan in just over two years to investigate PMB on HRT regime of Estrogel 3x dose per day with Mirena IUS which was fitted two years ago, as well as Vagifem on alternate days. The bleeding is minimal, very occasional spotting, but my consultant said any bleeding has to be investigated, hence the scan.

What worries me is that my lining has increased from 2.9mm on the previous scan to 3.9mm on today's, and the presence of adenomyosis which was not picked up on my previous scans. My pre HRT lining was 2.1mm in 2015

Last year's scan was my first with the Mirena in place with a lining thickness of 2.9mm, so there's been an obvious increase in my lining thickness at 3.9mm. The cutoff point is 4.0mm, so I'm just within the ‘no further action' threshold — but only just. I'd never heard of adenomyosis until today. The scan result says:

The myometrium appeared asymmetrically thickened and irregular, which is typical of adenmyosis.

Should I be worried?

Apparently it's supposed to disappear after the menopause but in my case it seems to have appeared whereas it wasn't before.

My next appointment with the consultant is in February, and so that's another 4 months before I get a better explanation. I've never had a full term pregnancy, never had a caesarean and I'm post memo, so none of the online info about adenomyosis makes sense in my case.

Anyone else had adenomyosis related to HRT? I know it's apparently “benign”.

Thanks

[CLKD]

TVUS means  .........

[anais]

Sorry!

TVUS = TransVaginal UltraSound

I’ve changed “TVUS” in the title of my post to “scan”.

[CLKD]

  

Maybe put the procedure into the search box to see if other threads are here?

[NorthArm]

I too, am diagnosed with potential adenomyosis. I'm seeing a gynae at the end of this month for management. I'll probably opt for a hysterectomy, because even though it's supposed to go post meno, the only way to make absolutely sure is to get rid of the uterus. My grandmother had a total hysterectomy because of it my cousin was suspected of having it, so had a hysterectomy, but it was fibroids. I also don't get on with prog very well, so that will sort that out too xx

[anais]

Thanks, North Arm. In my case it has appeared post meno although maybe it was there pre menopause but I didn't suffer from the typical symptoms of adenomyosis during those years, so I don't know. All I do know is that it wasn't noted in my pre HRT scan in 2015, nor on my scans done in 2016 (pre Mirena) and 2017 (1 year after Mirena). Having said that, I had awful pain some weeks after the Mirena was inserted and since then intermittent pain more on one side, and often triggered by orgasm. I'm now wondering if the Mirena injured me or set off some kind of inflammation.  Yesterday the examining doctor was pressing on my abdomen on my ‘bad' side and it was OK but yesterday evening and today I'm getting some of that “Mirena pain” and a little bit of spotting.

A hysterectomy seems extreme but obviously it's necessary if you are badly affected.

CKLD, yes, of course I searched first, but all the other experiences seem to be pre meno not something that has appeared or picked up post meno whilst on HRT. I seem to be atypical. It's a condition that is supposed to settle down after the menopause - not appear for the first time - and it's supposed to be helped by the Mirena, obviously not the case for me.

Looks like I'll just have to phone the clinic nurse instead, and pass on my concerns. I'm considering having the Mirena removed. Of course this could be barking up the wrong tree

[Nairn]

Hi Anais

I too have a similar diagnosis - mine came after a failed attempt with a coil, and the following pelvic inflammatory infection.  Very little info published, but oestrogen apparently makes it worse as it ‘feeds it' - certainly minke seems to have appeared after a high oestrogen HRT , so currently reviewing that

[Hurdity]

I would push for further investigation if possible - but not because of the lining thickness but because of the pain. The lining is absolutely fine in terms of cancer risk but if you have a Mirena in place this is giving protection to your womb lining and if you have adenomyosis - presumably limiting its growth. What you want to make sure of is that there isn't something happening to your womb lining - as well as the adenomyosis - that is being masked by the Mirena,  although I presume the specialists would have picked this up from the scan? Personally due to the pain I would want to be looked at a bit more closely and this could involve a hysteroscopy and maybe biopsy? Perhaps ask for a second opinion if you are concerned?

Hurdity x

[anais]

Thanks for your replies.

I had two doctors doing the scan and a nurse was observing on another screen. Because my womb lining was below the threshold for a hysteroscopy or biopsy, they decided no further action. The pain has settled again but it started with the Mirena and it took 5-6 months for the bleeding to stop and was in bad pain 2-3 weeks later. I was told it was all fine at the time (yes! I know!) and that the pain and bleeding would pass, which it did BUT from time to time I get a bit of “Mirena pain”. Orgasm triggered some very bad pain early on, presumably because the womb was contracting and/or changing position. No mention of the myometrium was made on the previous scan, but the doctor said the Mirena was preventing getting a full picture. The senior consultant said there was no need for hysteroscopy when she looked at the pictures on the screen at that time. This time, I think the scan was more thorough in that they took more time to get a good picture of everything.

So where does that leave me? The consultant I see at the clinic is probably the most senior menopause specialist at KCH so he is very probably going to be the one who will give a second opinion. I can always ring the clinic nurse in between appointments if I have any concerns and perhaps that's what I should do. I've had other appointments for haemachromatosis recently and also attend the gastro clinic so I'm a bit fed up with all these appointments. Even so, I should really keep on top of the HRT/gyn concerns and there's no harm in asking if my usual consultant can look at my scans. My next appointment is in February. I was told by the consultant that the scan is only relevant for the day it was recorded, and that it can only be relied on for 6 months, so it's unlikely he'd order another one. I haven't noticed any spotting since the day after the scan.

I never did like the Mirena, not really. I never had these odd pains off and on before I had it fitted, and it was really bad early on. 100mg Uterogestan couldn't prevent the breakthrough bleeding. The Mirena was the next recommended option OR take 200mg Uterogestan. The last time he said there should be no bleeding whatsoever and if it continues I could take 100mg Uterogestan with the Mirena in place. I feel like a walking pharmacy.