Just had a text from GP that she has put me on a 2 week fast track referral

[TFM]

I have had some post menopausal bleeding and so was sent for an ultrasound to check my womb lining. Text says it showed some thickening so GP has referred me. But fast track referral?? Is this normal for what she calls 'a small thickening'? I'm feeling slightly alarmed!

Yes it is. Totally normal. Could indicate endometriosis cancer which treated early is one of the easiest to treat. Many other reasons for it.

I was referred after bleeding. Ultrasound found thickening significantly above what is normal. Had biopsy and all fine. 6 months later despite no more bleeding and without medication, it was totally back to normal. All cause by perimenopausal changes.

Don't worry, it's quite common to bleed after the menopause and all post menopausal bleeding should be referred under 2 weeks wait.

@vivainsomnia Thank you, that is very reassuring x

I was recently referred on the two week pathway for some lumps in my breasts. It was a scary moment because I didn’t expect it, but in fact they were very thorough and kind, and as it turned out everything was fine anyway. But it set my
mind at rest and mean I wasn’t waiting for ages not knowing.

Don’t panic. I’ve had two of these referrals recently - one for weird boob (absolutely fine) and one last month for uterine bleeding (again fine)

The nurse practitioner told me for anything like this it goes under the two week referral - not because they suspect every case is cancer. But because they don’t want to miss one and other symptoms are often absent.

my clinic were also really good at reassuring me (they rang 24 hours after the referral)

The two week referral, in my experience for post menopause bleeding, is completely normal.

I had a vaginal ultrasound that showed some slight thickening. I had a hysteroscopy 2 weeks later and got the 'all clear' at that appointment.

I hope everything turns out well for you OP 🌻

I've was discharged from the hospital today after weeks of scans, bloodtests, MRIs and several nurses peering up my nether regions with cameras and microscopes
Fortunately nothing more serious than fibroids which prevented them getting measurements of the womb lining.
But my understanding is that endometriosis cancer is very treatable in the early stages.

Totally normal. I’m eight years post menopause and have had lots of incidences of bleeding- at one point it didn’t stop for a year. Every time it happens I dutifully trot off for my ultrasound and go through the 2 week pathway. Every time it comes back as “just one of those things”. Sometimes there’s thickening, other times not. It’s quite reassuring to get the check ups. Don’t worry, it’s protocol.

Take as many painkillers as you can in advance, and as much anaesthesia as they’ll give you if you have to have a hysteroscope, I’ve heard they can be ‘uncomfortable’, as doctors like to phrase it.

Standard- or should be. More often than not women wait ages to be seen or taken seriously for gynaecological matters. I'm eternally grateful that they treated what turned out to be endometriosis and a cyst as potential cancer, given the symptoms I had. Though it was a worrying time, all the best to you x

Hi yes it is normal - and good.

Post meno bleeding must be checked out.

There is usually a trans vaginal ultrasound test (less invasive than a smear because there's no speculum or scraping), with a gaget like a metal tampon that sits in there while it sends ultrasound waves that allow the operator to see the inside of your womb. If the lining is thickening or there are polyps forming, that can cause the post meno bleed.

I was told that 90% of cases are not cancer, so of course I want the 10% possibility closely examined.

I've been there twice and both times had procedures that were all clear. It's likely I will have others.

A word of warning. If the gynaecologist casually says they want to take a little look and get a little sample - beware. A pipelle biopsy is a surgical procedure and you will need pain relief.

If they say they can see polyps and recommend they pop them out there and then - beware. That is a bigger surgical procedure and you will need more pain control.

I had both my procedures under general anaesthetic - I'm post meno, no children and a stenosed (ie tight) cervix, so I am not a candidate for hysteroscopy (looking into your womb with a camera on a rod) and polypectomy (inflating your womb with water and cutting out the polyps) without anaesthetic.

There is pressure on the NHS to coerce women into consenting to cheap outpatient hysteroscopy procedures. Say no. You have 'Montgomery Rights'.
All the very best

I had that. Hysteroscopy showed a fibroid which she removed there and then

I had 2 week referral for bleeding. I had an ultrasound which showed 2 fibroids but nothing suspicious. Then a hysteroscopy which showed some thickening of the womb and a polyp. They took samples for biopsy and everything was clear. The consultant did say at the time that nothing looked suspicious.

GPs have a list of what is to be automatically referred on a 2 week pathway. It doesn't mean that what you've got is serious. The vast likelihood is that it isn't but they're erring on the side if caution.

In my case they didn't know what caused the bleeding and put it down to it probably being a sudden release of hormones. I've had no more bleeding since.

Don't panic, 2 week referral for anything that might possibly have a connection to cancer is the required action. I was on 2 week fast track for a small lump in my throat that we all knew would turn out to be a blocked saliva gland, but the referral still needed to be done. Better safe than sorry approach.

Same happened to me during covid lockdown. I was seen in two weeks, biopsies taken (precancerous cells found along with a couple of small polyps), medications given. just under two years later and another two biopsies all was good and I was discharged.

Not denying anyone else's experiences but I don't have children and I had a hysteroscopy without general anaesthetic. I have always had problems with them opening my cervix for routine smears, although through gritted teeth, I've managed it.

I was told to take ibuprofen and paracetamol beforehand. I had biopsies taken from both the womb lining and a polyp removed. Neither were big surgical procedures. I watched on the screen while they did it. The worst part is they push in water to enlarge the space. It feels like uncomfortable period pain.

When it was all finished, I went in to town shopping.

I'm not saying that some people can't cope with the pain but not having children doesnt mean that you can't have a hysteroscopy.

I had a bit of bleeding after sex (post menopause) and GP saw me same day, and referred me on 2 week pathway. In 8 days I was seen and scanned by consultant gynaecologist, and booked for polyp removal. Was all very reassuring.

Did GP use the phrase "fast track"?

2 week wait pathway = symptoms that could be consistent with cancer but more often than not aren’t. If I remember rightly it’s something like 3% of 2WW referrals are found to be due to a sinister cause.

Referrals come in 3 forms

1. routine = months-years to be seen
2. urgent = weeks-months
3. 2WW = need to have contact with hospital team regarding symptoms within 2 weeks. Tests and diagnosis will not necessarily be within this 2 week period. If you haven’t heard anything by day 10, chase it up.

Hopefully it’s nothing serious OP. Good luck.

Post-menopausal bleeding is treated as suspicious for cancer until proven otherwise, which is why you have been put on the fast track pathway.

Fibroids or thickening of the endometrial lining (hyperplasia) can both cause post-menopausal bleeding, as can an endometrial polyp.

DH is on this for swollen glands in his neck- I read as a PP mentioned 90% of these turn out to be fine.

I guess it is good to know they do these tests quickly just in case. That is what I am trying to think anyway. Saying that we haven't had a date through for the scan yet.

Totally normal. What wasn't normal was being sent for a scan before a fast track referral

I'm having some perimenopausal symptoms, including irregular periods, the GP wanted to rule out fibroids/cysts before starting HRT (because I'm young at 44 to be having symptoms apparently). She pre warned me that it would fall under the two week referral pathway and not to be concerned by this so, yes, I think it's usual

Totally normal. I had exactly the same with sudden continuous bleeding. The GP did tell me that they didn't think it was likely to be cancer, but because it was possible I was on the 2 week fast track.
It wasn't.

Yep, 2WW is normal for post-menopausal bleeding.

Mine happened in Dec 2021 so my 2 weeks stretched slightly due to covid and Christmas, but by mid-Jan my thickened endometrium had been assessed and scanned and I was diagnosed with early - stage endometrial cancer.

I had a hysterectomy in early April (just 1 night in hospital) which removed all traces of cancer and I am now fully recovered with no further treatment required.

It's a daunting thing to go through and your mind will race in all kinds of directions but even if it is cancer it's one of the most treatable with the best outcomes.

Good luck, and feel free to DM me if you need a detailed chat about any of it

@RuthW Interesting. This is my second ultrasound plus transvaginal scan for post menopausal bleeding in the last 18 months...no fast track first time, not so lucky this time.