A year of breakthrough bleeding, been refused an early smear test - is this ok?

[CheeeseOnToast]

I need some reassurance that my local Family Planning Clinic are doing the right thing and I don?t need to demand another smear test. I?ll explain:

I?ve been having some problems with breakthrough bleeding mid-cycle. I?m on Celeste combined pill and the bleeding mid-packet is light, and usually happens from when I have ten pills or so left of the packet. It lasts for about 5 days to a week, then tails off in time for me to have my pill free week and then have a bleed.

I?ve been on Celeste now for six months, and I was on Microgynon for about 3 years prior to Celeste. I was taken off Microgynon because I started to get breakthrough bleeding and my PMT was becoming a bit of a problem . So I was put on Celeste and after three months the breakthru bleeding stopped, for two months, but now it?s back.

When I saw the FPC to swap from Microgynon to Celeste they asked me if my smears were up to date - I had one in May 2008 which came back ok, so I?ll be recalled in 3 years. As they were up to date, she changed my pill and advised me to have a chlamydia test, which came back -ve. So, officially I?m due another smear in April 2011, so I have another 8 months to wait.

When I was switched to Celeste I went back after 3 months to get more and she asked me if the bleeding had stopped, and it hadn?t, so she said to persevere. Just after seeing her, the bleeding stopped for two months but it?s started again.

The last smear test I had was the first that had come back ok in about 4 years of ?borderline changes? and other dodgy results so I had a smear every 6 months for quite a while, so I?ve only just gone back to 3 year screening. I never had a colposcopy or anything like that.

I went again this morning, to say I was still having the breakthrough bleeding and I was told that they can?t do another smear until they?ve exhausted all other avenues of infection/problems. So I had the works, she took blood to check for hiv/syphilis, and two sets of swabs for gonorrhea, chlamydia, thrush, HPV and something else. So, if these all come back negative (which I?m assuming they will, as I had a big check about 3 years ago which checked for everything and came back negative), I am only allowed to go back when I need a new pill prescription (which will be in four months), and if i?m still having the breakthrough bleeding they MIGHT be able to do an early smear for me.

Is the bleeding very concerning? A nurse told me a few years back that I had slight cervical erosion which may mean that sometimes I bleed after sex, but the bleeding now doesn?t time with this so I don?t think it?s the cervical erosion (which may be ok now, I don?t know). I haven?t had bleeding after sex for ages and ages.

Do I need to kick up a bit more of a fuss and try and push for an early smear test before my next appointment with the FPC, assuming all my tests come back ok?

Or am I being paranoid, and I should just wait? I?m just worried because although I?m still young-ish (28) an old school friend got cervical cancer when she was 22 (they wouldn?t give her a smear until she was 25, despite other symptoms etc) and she got secondary lung cancer and generally it?s been horrific. I?m scared that leaving it longer without a proper investigation (I?ll have had the bleeding for a year when I go in four months time, which seems a long time to me).

What does everything think? Should I just accept what they say and (assuming all tests are negative) go back in four months time and hope they give me an early smear? And what if they say I should just wait to be recalled as per my 3 years, which will be another 8 months from now?

For other background, I have no children and never been pregnant. Will also say I?ve been with the same partner for 6 years and we are faithful.

Sorry for the long post but I'm a bit

[ifonly4]

Could you come off Celeste for a few months and let you cycle go back to normal. I had a smear test taken about 12 days after my last period and it showed signs of womb cells in my cervix. No one had checked when my last period was and I was referred to the hospital as womb cells in the cervix alert them to problems. It turned out I should only have a smear test in the third week and this is something that you can't do if your getting break through bleeding.

[Cass12]

I had an abnormal smear test in 2015 CIN 1 with high risk hpv was meant to go back 6 months later ( I didn’t go back) as I had other health problems. Anyway I then became pregnant last year and had Baby. I have been having bleeding for 4 months continuously. I had a smear which came bk normal this time but still bleeding. Gp hasn’t sent me to gynecologist or for a colposcopy, when the nurse did my smear test she said I don’t think I got enough from swab but should be ok. I don’t feel confident they did. My bleeding has got worse and now I’m passing small clots and have been fainting probably due to blood loss. Also my hair is coming out really badly yet I’m told I have to wait 8 weeks for a scan of the pelvis. I’m really stressed out and worried

[hildaogden99]

I had breakthrough bleeding on Cilest, had been on it for several years with no problems when it started. I went to my GP who didn't do a smear as I'd only had one a year before but did visualise my cervix & took swabs for infection etc which came back clear. I then had a transvaginal smear which showed fibroids. I had a hysterocopy to have them 'shaved back' and a mirena coil fitted which was supposed to stop the bleeding. So far its made it worse and brought me out in acne. Ho hum.....

[Cloharding]

Hello!

I appreciate this thread was started a good few years ago however everything you have said is the same as what i am experiencing.

Did you ever get to the bottom of your breakthrough bleeding, i am also on Celest but have had a smear which came back normal however still cant work out what is going on?!

Thank you

[CheeeseOnToast]

ok, thought I'd update.

All my tests etc came back negative, so I booked a GP appointment to demand a smear test (as the FPC had said they won't do anything until they review my pill, in three months time)

So I went to the GP this morning, chewed his ear off for about five minutes explaining everything and why I was so worried and my cramps had been getting worse (they have) and the bleeding in between periods is getting heavier (it is) and he said 'of course we can do you an early smear!'. I was all prepared for a fight but it was easy

So I have an appointment for next Wednesday afternoon where they'll do the smear. Relieved, but just pray nothing unusual shows up. Otherwise, I'll be seeing the FPC in three months and hopefully they'll change my pill and pray the bleeding stops. It's really annoying, I'm getting through about three packs of pantyliners a month and sex is out of the question, apart from about 5 days in the month! Rubbish.

Tempted to just stop taking the pill and see if it stops the breakthrough bleeding.... but bad time for a baby

[BelaLugosiNoir]

I have to point out here again that a smear test is a screening test. It is not necessarily appropriate if you have symptoms.
A result of borderline changes doesn't mean you have cancer or even CIN, the majority of these resolve without treatment.
CIN2 doesn't usually cause bleeding etc - neither does CIN3 - that's why screening test is useful for picking them up because those changes are usually symptomless.

Sorrento - the NHS CSP guidelines state that a family history of cervical cancer is not an indication for increased frequency of smear testing, as there is little evidence to support a familial link.

Riven - for BTB you need further investigation, have they tried a different type of hormones? A smear test is not necessarily the answer.

[purplepeony]

Riven- the answer is no, not really.

I have had pelvic scans for 2.5 years- going from every 3-4 months, to 6 monthly then annual intervals as I had an ovarian cyst.

I had transvaginal scans as they show up everything inmore detail and yo u don't need to drink and have a full bladder so they are actually more comfortable.

However, I have also had post meno bleeding and although the scan shows a little info, the dr also had to do a biopsy of my uterus lining.

so to be really blunt- no, a pelvic scan would not show up very much.

If you have irregular bleeding you might have a cervical erosion, a uterine polyp or just iffy hormones.

Worst case of couse are cervical cancer issues.

can is ask why you need a GA for an internal exam?

Have you been referred for hypnotherapy or CBT? If it is purely a psychological issue then you can ask for treatment for it.

[von81]

I had one to check for pcos they said I didnt have it ....

[von81]

omg your poor friend!! Hope shes doing well

cant beleive they havent done a coplcoscopy even though they are showing borderline!! Ive had loop diathermy done in november for cin 2, at my 6 month check up they did smear and colcoscopy and got all clear- and now they do hpv screening with the smear. Which they say I have a dangerous strain of it.
It is worrying when they say youre clear when u still have symptoms!! My big symptom was spotting all the bloody time and it didnt stop after treatment (on depo), only thing that controlled it was combined pill which they wouldnt let me carry on with cos of my bmi!! so I had cerazette and bled! Changed to copper coil now, I think all them fake hormones are probably the cause of it - especially depo.

Defo push for at least a smear and tell them to piss off with their sti swabs!! They did about 4 in a year all -ive before a light bulb came on and did a smear!!

[BelaLugosiNoir]

I always worry

[BelaLugosiNoir]

Well I would say don't be fobbed off, keep trying to get an answer to your problem; with referral to gynae and/or colposcopy.
I always about women just having a smear test because as I said (and cass) there are other causes of symptoms and sometimes no further investigation takes place.
Have a good read round on the NHS CSP website which has loads of useful info.

[CheeeseOnToast]

thanks cass, giraffes and bela - sounds really sensible advice. I didn't really think of it that way (about smears being screening for those without symptoms). I think I will def go the GP. Really useful links too bela, I'll have a good read.

I really appreciate your help everyone. It's so difficult to know what to do, how far to trust people without questioning.

[BelaLugosiNoir]

Cass66 you are correct, thank you.
I work in a screening lab and the guidelines are clear. If you have symptoms you need referral.
They've done the right thing in taking samples to rule out infection, and trying a change of pill type may also be a consideration.
Per-vaginal bleeding isn't necessarily coming from the cervix so that's why doing a smear test won't really answer your question.

Further information is here re screening age, guidance re management of young women with abnormal bleeding

[giraffesCantDanceInBrokenHeels]

I'd go to the GP. Mine cant seem to stop giving me smears, they are obsessed with them here!

[cass66]

Actually you don't need a smear, you need someone (a GP) to visualise your cervix, and then referring to colposcopy if there is concern (which there is). A smear is only a screening test for people WITHOUT symptoms, and you have symptoms, so in a way the FPC are right, but a smear is not always the best option.

HTH, Cass.

[CheeeseOnToast]

thanks PP. The woman I spoke to did mention that if everything came back clear, including smear if i get one, then she'd look at changing my pill. Thanks for suggesting a private scan, I may well consider it if the GP won't. I assumed they'd be really expensive but £50 is nothing for peace of mind/answers.

So in terms of pills are 'combined' pills generally quite weak? Do you think I need a stronger one? Are mini-pills stronger? Maybe I should just ask when I go back

[purplepeony]

Two things to consider:
1 You can book a private smear with your local private hospital- if they do well-women clinic which they most probably do, or go to a Marie Stopes clinic. Cost is about £50. I always go privately as under the old system I was being recalled every 5 years due to my age ( 50+).

1. You might want to talk about whether your pill is actually really effective. Break through bleeding is usually a result of low hormones and maybe that pill is not right for you.

[CheeeseOnToast]

That's exactly what I felt like Sorrento, she told me off too for asking for one. As I went into the FPC they have this tick list of things you want to discuss with a nurse, and I'd ticked 'smear', sat down with the nurse and she said 'so why exactly have you come here asking for a smear test?'. She was quite dismissive of me really.

She just kept on saying 'but you're next due one in April 2011 so you'll have one done then - you can't just request one sooner'. She did warm up a bit, after I tried to charm her, then she said she'd test for all the other things to rule everything else out first. Doesn't exactly fill me with confidence that the reason they won't do one sooner is because of money, despite the fact I've had quite a few dodgy results in my time.

[sorrento56]

I pretty much got told off for going for a smear before I was due for one but I shut her up with family history which wasn't great. I think smears should be yearly if that is what the woman wants.

[CheeeseOnToast]

Thanks everyone, you've backed up what I was thinking. Rosa, I had a private scan about a year ago about something non-related (a bout of urinary incontinence, oh the glamour ) and they did a full pelvic ultrasound which showed up that everything in there looked healthy. I'd forgotten about that till just now actually.

I hadn't thought of going through GP to request another smear - I think I'll do that if I get the all-clear from the tests.

kathyjelly hope your DSD is ok. I still can't believe they raised the lower limit for routine smears to 25, I was lucky and was one of the last few to have them when we were first sexually active (so my first was when I was 18).

My best friend had to have surgery last month too due to very highly suspect cells and is appalled that they won't just give me another smear. Hopefully I can push for one earlier. Thanks everyone.

[ProfessorLaytonIsMyLoveSlave]

I'd skip the FPC, go to your GP and explain that you are having mid-cycle bleeding. I don't think there's anything wrong with being paranoid where cervical cancer is concerned, because pre-cancerous cells are so easy to treat and the risk of waiting so comparatively high.

[Rosa]

I would ask for another smear and also a scan to check that all is right. I had mid cycle /after cycle bleeding for ages and ages and my gyno did all the tests to eliminate everything.

[sorrento56]

I would go for another smear test and then follow up if that comes back fine. I am not on the pill but have had mid cycle bleeding for a couple of years and have had investigations. Good luck.

[Kathyjelly]

I'd kick up a fuss and demand a smear test.

I only say that because my DSD has just had op to remove cervical cancer (she's 21 for God's sake) and when faced with the reality, it's really scary and doing a two minute smear and BEING SURE has to be worth it.

If your FPC won't co-operate, go to your GP. They get paid for doing them as well, so explain how worried you are and lay it on thick.

I hope all is ok.