Heterogeneous endometrium 0.7cm

[MegCleary]

So I am balding and hairy and was asking my gp if I have PCOS. I am 48 and on POP stay on it all the time, no bleeds at all. Bloods seem to indicate not menopausal scan shows heterogeneous endometrium, abdominal and refer to gyne.
obviously I have looked at this on a Sunday and can’t speak to go.
how freaked should I be?

bump

Anyone at all?

Tumbleweed

Was it a trans abdominal/transvaginal scan? Did they say anything else
about the scan? Anything over 5mms think for the endometrium is a concern if postmenopausal, but not sure about pre. Would have thought that they would have commented on the ovaries if it’s PCOS.

Oh thanks for replying had trans vaginal and abdominal

report below
Anteverted uterus measuring 3.1 cm in AP diameter. No obvious fibroid
seen. Noted at the anterior lower uterine segment, likely at the site
of a previous caesarean section, is a hypoechoic triangular area
measuring 0.4 cm in depth and 0.7 cm at the base. The resultant
myometrial thickness over the caesarean scar measures 0.3 cm.
Heterogeneous endometrium measuring 0.7 cm in AP diameter.
Both ovaries were seen only on TA and appear sonographically normal
measuring 1.9 ml on the right and 3.1 ml on the left.
No obvious solid or cystic adnexal masses seen.
No fluid noted in the pouch of Douglas.
Conclusion:

1. Ultrasound features consistent with a caesarean scar niche.
2. Heterogeneous endometrium. Gynaecological referral is advised.
3. No sonographic evidence of PCO.

@fluffythecat1 did a huge needy reply without tagging you! See above

Heterogeneous means that it’s not smooth and even which is more normal, which makes it potentially worth investigating, however this can indicate lots of non-suspicious issues. Mine is heterogenous too, but that’s because of a fibroid and a polyp I had. I wouldn’t worry too much because the scan doesn’t sound too bad, they just want to look into why it’s not smooth and varying in thickness.

@fluffythecat1 i am trying to not freak, thanks for the reply. It says no fibroids.

Well no gp apt until 8/1, not sure whether to push for sooner. Any advice?

any advice on booking a holiday while waiting for apt with GP. We have annual travel insurance.

@MegCleary Hi just saw your post, heterogeneous means it doesn't look uniform, and the texture is patchy or irregular. It could be something like the uterine lining going into the muscle and so the uterus is uneven.

It could suggest some different things but since they didn't see fibroids it could be something like adenomyosis where the lining of the womb (endometrium) grows into the muscle of it (myometrium).

How did your appointment go, you said it was on the 8th? Did they make a plan for further investigations? Do you have any particular symptoms, if so what are they? Happy to help where I can.

@LivelyViper thanks so much for the response. GP felt it was not sinister more likely adenomyosis as you suggested. Helpful for me as I have a background in oncology and can catastrophise as an Olympic sport.
Referred to gynae and may have to wait until march to hear when apt is.
My main issue is lower abdo pain, started after the scan. Went a bit and now back. Did urinalysis and had blood in urine but MSU was normal.
I know I can have two unrelated things at once! But not sure the gynae issue causing the pain. Microscopic blood in urine a concern. Stumped.

So your GP does think it's likely adenomyosis. When you see gyne ask for an MRI as its pretty good at detecting adenomyosis. Plus the ultrasound has already given a clue with the heterogeneous uterus.

In terms of management, I'd probably look at the blood in urine as seperate to the gyne stuff and make sure your GP investigates that throughly. Something like an ultrasound of the bladder area could help, an abdominal one to check kidneys etc. Did you get other urine tests done?

I would look into getting a mirena/IUS (ideally before the appointment as it is 1st line for good reason for this and gyne will suggest, so its good to get adhead of it and discuss all other things to help alognisde it). The mirena is more effective at thinning the uterus lining, preventing growth of lesions and the lining, and can stop or make your period much lighter, so there's less cramps as well.

For the insertion, I would ask the GP surgery prior to your mirena to make sure you have pain control. That can be all of or some of the following: numbing gel, an injection into your cervix, lube etc to make the insertion the most comfortable. Also take paracetamol and ibuprofen 1h before the procedure to help.

For the pain talk to your GP about them prescribing you NSAIDs such as naproxen or mefenamic acid, they can prescribe some for like the 3/4 days leading up to your periods and then during it as well (they work better if you start taking them before the pain/period starts). They are anti-inflammatories so help to reduce pain, etc. It's very worth looking into getting that prescribed.

You can also use and I'd recommend using tranexamic acid, it helps with the bleeding during your period and can massively reduce any heavy bleeding and again start it 1-2 days before your period as well.

https://www.nhs.uk/conditions/adenomyosis

The link has good info you might want to read.

My goodness @LivelyViper thank you so much for the comprehensive and thoughtful support.
I am on the POP and have been without a break for up too ten years so no periods or pain. Bliss. They were awful and I had a ferritin of 2 at one point.
Do you think I will have to have a coil? Dread the thought.
As for the blood in urine will do another dip tomorrow and see if still there and get back onto GP.

Hey, I just went through this. My endometrium was at 8mm and uterus was bulky I was referred in case of cancer. I’m 46 and premenopause. Specialist was not worried, did a biopsy for reassurance and it was benign, I have a bulky uterus due to adenmyosis. I had an ablation with another more thorough biopsy and it all looks good so far just waiting on final biopsy result.

@Gingybread glad to hear yours was ok. Did you get referred on a two week cancer wait? Just curious. My GP did not refer as urgent.

Im in Australia so no 2 week path way as such here. My GP just said it should be investigated and referred me to a Gyno who he sent the ultrasound reports too. They rang me and offered me an appointment within 2-3 weeks. He was very reassuring that nothing in the ultrasound was concerning as at my age that thickness could be normal he was more concerned with dealing with the bulkiness and heavy bleeding caused by the adenomyois. Getting the biopsy done was what I wanted though as I needed to be sure. The Ablation was easy and so far seems to have done the job

@Gingybread good to hear, and happy for you

Please let us know how you go, I will be hoping your problem is similar to mine.

You definitely don't have to have a coil but it can be very helpful, on a whole from the stats of the effectiveness and my personal experience I would . Th e other options are also an endometrial ablation which should get rid of heavy bleeding and periods but as it only getor get rids of the lining doesn't get rid of pain etc. But if you aren't having a period, which is normally painful then it can be great for some. The other option which would be a cure is a hysterectomy as well.

But especially since you have good management on your POP I'd just continue with that and add in any meds I recommend above including the coil if changes happen, and periods or a lot of pain comes but hoping that doesn't happen for you.

@LivelyViper thanks so much for the reply, I will wait and see what the gynae team say, when ever that will be…..!

@LivelyViper I have my gynae apt next week. Went private in the end. Would the next investigation be an MRI or will they just biopsy do you think.

@Gingybread @LivelyViper been to see gynae privately and he said he recommended no action. I have no symptoms. Am premenopausal so lining can be differing thickness.
the haematuria was investigated separately. So first result was abnormal, next msu borderline and third one normal.
am beginning to relax