Post menopausal bleeding

[dexterslockedintheshedagain]

I have not had a period for 2yrs now, so am considered menopausal. However, over the last month-six weeks have had had two heavy bleeds, with light spotting in between. I have been on estradiol valerate since 2018.
Spoke to my GP, who asked if I still had a womb (I do). Turns out that when first prescribed, I had 2 lots of tablets to take, one to protect the womb. When I ran out, they only gave me the one lot and I didn't realise ( stupid, I know) so the upshot is I've been taking one hormone for nearly two years now, when it should've been two, the single dose is only suitable for wombless women.
I know I shouldn't but I've googled my symptoms, and they are very similar to those of womb cancer.
Has anyone else had anything similar, and what happened? Please tell me I'm being stupid. I'm scared.

Goodness- why didn't your GP tell you that you had to take progestins as well as estrogen?

So what's the plan now? What is your GP doing?

Have you had an appt?

You need to see your GP urgently and they must refer you for an ultrasound scan. You should also get the other part of HRT that you need.

I can't understand why they continued to prescribe estrogen-only when you need both hormones. Why didn't they repeat the original prescription?

You will have hyperplasia- that's a very thick womb lining as it's not been shed or kept thin by using progestins.

They may need to do a hysteroscopy and take a sample of the lining.

Used long term on its own, estrogen does cause womb cancer. Hopefully you won't have that , and it will all be ok, but you will probably be treated with a dose of progestins to sort out the hyperplasia.

Your GP sounds negligent. They should check your womb status before writing out repeat prescriptions. Hopefully you have caught this in time. You will need to be referred to a gynecologist. Be firm and push for this.

@dexterslockedintheshedagain

How long did you use estrogen- only? has it been most of the 2 years since you were prescribed HRT?

The licensing rules around HRT state women need a review at least annually ( and some drs prefer every 6 months.)

If a woman uses estrogen only for a year, 1:5 will develop hyperplasia - that's a thick lining which will eventually bleed. Hyperplasia can be 'simple' or 'complex' or 'atypical' when there are signs of cancerous changes.

You need to have this investigated quickly- the rule is you are seen within 2 weeks for any post meno bleeding, so even though it's near Xmas you still need to chase your GP.

Oh my.
Thank you for the reply! Yes, it's been for most of those two years.
I did have a review, but it was just 'Having any problems?' which I wasn't until now.
I spoke to the GP Thursday, have an ultrasound today, and a letter confirming they've referred me to the gynae dept at the hospital. Had bloods taken Friday. The speed of all this has also got me worried.
Phoned the gynae yesterday, they said it was with the consultants for review.
I shall keep on at them, thank you.

well your GP didn't review it very well, did they?

They ought to have confirmed what you were using and checked the prescription record on your notes- it's negligent and if necessary you could take legal action.

My review with my dr includes him asking me what I am using, how much, how much bleeding and when, any irregular bleeding, no bleeding when I should, etc etc.

Good luck with your appts.

Thank you.
I don't expect anything to happen until after Christmas now - I suppose the gynae will want the blood and ultrasound results before they decide the way forward.
It's going to be a very subdued Christmas on many levels for me 😔

Not sure why they are taking bloods.

You need a hysteroscopy most likely and definitely a biopsy of the lining.

I still cannot get my head round why your dr didn't explain when you first used hrt that you had to use 2 products not just estrogen.

That's pretty poor on your GP's part. I take oesrogel and a progesterone tablet. Also been having bleeding. I was referred for an ultrasound and they also carried out a scope and biopsy about 3 weeks ago. They tried to get me to have the coil fitted to stop the bleeding but I refused. I'm still waiting for results.

I am NOT having a coil fitted. Nope. No way.
Had a text from the GP - they have my blood results and they way me to make a routine appt to discuss. Not so bad, eh? At least they're not asking me to contact them urgently, right?

Fingers crossed for you. I got in from work and my results were in. Everything was fine, it's likely something to do with the oestrogen. The letter gave me the nurses number to get the coil fitted if I wanted - no thanks!

I'm pleased for you @hairypaws. It's a worry isn't it?

@dexterslockedintheshedagain I think you need to ask what the blood tests were for. If they were just to test your hormone levels that's pretty meaningless.

The biggest issue is the thickness of your uterine lining. If it's thick, which it is as it's been shedding itself, you will need treatment which is either a longish course of Norethisterone (that's probably what your pills were which you never got after your 1st prescription OR the Mirena.)

You need to know the results of your ultrasound, if they want to do a biopsy, and any treatment needed. I'd certainly push them on this because your GP presumably has had the scan results.

I've just phoned the docs, can't get a call back till 11 Jan. The receptionist could only say that everything just read 'normal' so I have no idea why they want to even speak to me. Ultrasound was only yesterday, they said to wait until after Christmas to phone for the result.
When I phoned the gynae, I got a message to say wait for 5 days before phoning.
Now, I'm not sure if my stomach issues (very bloated) is just stress!
My mind is going into overdrive and I may be catastrophizing.
And I'm worried my trousers aren't going to fit when I go back to work because I feel like I'm ballooning (have to wear a uniform). No matter how careful I've been with exercise and food, the scales will not shift.

Can't remember everything that was on the blood test form, but I do remember liver and thyroid function being there.

Being honest, given the crap service you have had from your GP-not even checking your prescription in 2 years - I can't see the point in a blood test when it's your womb lining that's the issue!

You need a biopsy- that's the standard for any bleeding when you have used only estrogen for as long as you have.

I don't really understand what the bloods were for either. I seem to have stopped bleeding for now. I'm sure I'm just panicking needlessly, but will keep on at the gynae anyway.
As my brother always tell me, it's the squeakiest wheel that gets the most oil.

I got a blood test also. Included was a marker for cancer of the uterus. A certain protein (i think CA something) is elevated but doesn't definitely mean cancer as other things could raise it. Its definitely reassuring though if it all comes back normal.

@hairypaws

I got a blood test also. Included was a marker for cancer of the uterus. A certain protein (i think CA something) is elevated but doesn't definitely mean cancer as other things could raise it. Its definitely reassuring though if it all comes back normal.

That would be the C125 marker and it's for ovarian cancer.

The test for endometrial cancer is a biopsy of the lining.

From a gynae nurse, the CA125 can be raised for many conditions not just for cancer.

@gelert5619

From a gynae nurse, the CA125 can be raised for many conditions not just for cancer.

The OP hasn't had that test as far as she knows. It was another poster saying she had. The C125 test is given to look for for ovarian cancer, BUT you can also have a high C125 for other reasons, as you say.

Thank you everyone for your help. I have a gynae appt Feb 17, so I guess they're not that concerned. And if they aren't, perhaps I shouldn't be either.
Have a lovely Christmas everyone.

I'd still do a couple of things @dexterslockedintheshedagain

Ask for the results of the scan from your GP (you have a right to see them.) You could have asked the person doing the scan at the time what they could see although some won't say :(

Presumably your GP has now put you on the right HRT and you aren't still using just estrogen? Have they apologised for what happened?

No apology - I expect if I go down that road, they'll put the blame on me saying I should've known. But should the worst happen, I'll try.
I've stopped HRT entirely on the GPs advice.
I was going to ask the woman doing the scan what she thought, but she had a face like a smacked arse so thought better of it