Passing blood from bowels (previous colon polyp) and postmenopausal bleeding

[blackdogatmyheels]

I had a thread the other day, but things have changed a bit.

I'm going to be 55 in a few months. I've had spotting intermittently since Sept 23 (no period since Oct 22). Last month I had a moderate bleed lasting a couple of days, this month a very, very heavy bleed, complete with clots, that lasted 8 days.

I had a colonoscopy in 2018, after I was passing mucus and blood. They discovered a 1.5cm adenomatous villous polyp and removed it and tattooed the area. I was told I would need colonoscopies every 3 years.

Fast forward to now, they've refused to do a repeat colonoscopy as the guidelines changed and they only repeat them in patients with polyps large than 1cm (which the letter confirms my polyp was larger). Still never mind.

I've had on and off constipation and watery diarrhoea. My stools are always very thin and like a pencil in angles around them, just accepted this as normal for me.

Today the bloody mucus has started again. Yesterday I had several watery diarrhoea episodes, today I went to the loo and thought I'd gone, but it was just mucus and blood.

I've got a FIT test from my GP (had it for a couple of weeks, before the bloody mucus, unable to use because of period bleeding). The only thing that worries me is last time I had a FIT test, but it was negative, so I guess a polyp won't be discovered, as if FIT is negative, then you are low risk, even though polyps can turn into cancer, so surely better to remove them when asymptomatic?

I've also just started with spotting from vagina again. Not enough for a liner. I'm unsure what to do about that, as I had a scan just before my periods stopped, and the GP said it was fibroids causing heavy bleeding then, so expect them to say it's just that again. I'll include the scan report below.

• An anteverted uterus which was of normal shape but bulky in size and
• heterogeneous in reflectivity. It measured 96 x 61 x 63 mm. A couple
• of fibroids were noted, which were as follows:
• .
• 1) Anterior subserosal fibroid, measuring 34 x 33 x 29 mm
• .
• 2) Right lateral intramural fibroid, measuring 15 x 15 x 17 mm.
• .
• There was a very poor endometrial-myometrial interface and it was
• therefore not possible to adequately assess the endometrium or obtain
• an endometrial thickness.
• .
• Both ovaries were of normal size, shape and echopattern.
• .
• No free fluid, cysts or adnexal masses were seen. The pelvic organs
• were mobile and non-tender during the scan.
• .
• Impression: Uterine fibroids. Poor endometrial-myometrial interface so
• not possible to adequately assess endometrium.

So I guess a repeat scan is useless as I stopped periods for two years, so it wouldn't have got worse, and they couldn't measure my endometrium, so waste of time anyway.

I think you need to go back to your GP. I would really emphasise both the vaginal and rectal bleeding. I’m currently undergoing cancer treatment (literally sitting in pre-op ahead of my 3rd surgery as I write this). I got fobbed off by the GP for 6 months before I got referred on the 2 week pathway. I wish I’d been more pushy back then. It may ultimately have saved my life. If they don’t budge, I’d consider going private for another colonoscopy at a minimum.

The worst part of this is

a) your polyp was 1.5 cms and yet they say no more scans unless over 1cm- query that? It's 6 years ago that you had an investigation! it needs doing again.

b) they couldn't get a clear picture of your endometrium. That's not good because the spotting is likely directly related to that.

Not being able to get a good picture can be down to the experience of the doctor (I hope it wasn't just a sonographer because they are not a consultant) or poor imaging equipment. The endometrium can carry on growing post menopause because you still have some estrogen.

You need to go back and insist on another scan and another colonoscopy asap.

@mindutopia I think you replied to my other thread. I'm so sorry and wish you all the best with your surgery

@LemonSherbertDabs it was a sonographer, no one suggested a consultant, the GP just wrote that my bleeding (then) was caused by fibroids. Thank you, I will try to get hold of the GP.

I looked at your other thread (the menopause one) and it says you're using HRT @blackdogatmyheels

Are you?
In the early days of HRT you can expect bleeding for up to 6 months if you're using the continuous (no bleed) sort. HRT causes the endometrium to grow.

You really need your bowels looking at with another colonoscopy. All the symptoms that should be checked out asap. The FIT test is for people with no symptoms because it finds microscopic blood. You have symptoms. Go to your GP and insist on the 2-week pathway.

@LemonSherbertDabs I've been on HRT since June, I haven't had any bleeding until last month and just this week gone by

I will definitely ask for a colonoscopy. Thank you

@blackdogatmyheels You said you were on Evorel Sequi. Is that right? Sequi is the type of HRT that gives a withdrawal bleed every month but not always at the start of taking it.

Evorel Conti is for women post menopause but for the first 6 months you can get odd bleeding. Your GP should have explained this. It should also have been noted in your scan report that you were on HRT and which sort.

This could explain that bleeding, but not the bleeding from your colon.

I hope you can speak to your GP today and get an fast-track appt. I genuinely don't understand why your GP didn't send you for a colonoscopy straight away rather than the FIT test. It seems negligent, to be honest, given your symptoms now and your history of a polyp 6 years ago.

Just wanted to add that you've two different things going on here.

The bleeding you're saying is a period is possibly from the HRT and could be normal for the type and time you've used it.

So your scan from years ago isn't relevant.

The biggest issue is your bowels. None of what's going on is normal.
Hope you get an appt very quickly.

Thank you. I've had to do the FIT test as the GP insisted it was the only way I could be referred on. Still waiting on results, but when I had a polyp before the FIT test was negative. The GP said if it is negative I can be referred as a non urgent case, as the chance of anything serious would be minimal.

I wasn't on HRT when I had the scan, the scan was for heavy periods and I was still menstruating every 28 days. I stopped having periods about 4 months later. I guess another scan now would be pointless as it was impossible to measure the endometrium when I was having periods due to adenomyosis (which is what I figured out the scan to mean), so would be more pointless now that I'm not having them. I've stopped now, so will ignore it and really don't want to change HRT as this has helped me to feel human again.

Will update if I hear anything from the FIT test, it takes a couple of weeks, but as I only had the mucus/blood for one day, I imagine it will be negative, so I won't be referred unless I get lots of blood and a positive test (as apparently you can't have a colonoscopy without a positive test, or so my GP has insisted).

Hey, have you had any answers from this yet?

The FIT test I took back wasn't processed. Apparently the GP was supposed to do a form to go with it, but didn't, so I chased and chased, until last week when I was asked to do another and I took it back yesterday. Unfortunately I didn't have bleeding at the time, so although I get intermittent bleeding and mucus, I've been told if the FIT test is clear, then I won't be referred further, so I guess it will be just one of those things and blood and mucus is normal for some.

The vaginal bleeding stopped, so I'm 100% sure it was just hormones and even if it happens again I won't worry (my much younger friend had uterine cancer last year, but her bleeding was persistent and heavy, as mine stopped after a week and hasn't happened again, even if it happens this week, it will fit hormones more than something more sinister).

Have you got something similar?

@blackdogatmyheels

Ah okay, thank you for the update.

Yes really heavy bleeding (waiting for a biopsy but still have to wait over a month for this) and my bowels have changed. A mix of constipation and diarreah and some bright red bleeding. In a state of panic.

@pinkbloom I can understand being really anxious about it.

Have you had a scan? It's horrible waiting, but hopefully the time will fly and you can get an answer (and hope it's something easily treated).

Have you seen the GP about the bowels? You really need a FIT test and caloprotectin test.

Both can be caused by hormones, but they both need to be investigated separately. The tests are pretty simple and it could be something like IBD (Crohn's or colitis), or a polyp, or even just hormones, but it definitely needs testing.