Best choice for thickened womb lining

[feelinggeriatric]

I'm having investigations / biopsy for a thickened womb lining. I'm mid 40s with previous history of breast cancer. The consultant merrily said he'd pop the mirena in while taking the biopsy and was surprised when I said no thanks.

Thinking positively- if biopsy is negative- presumably I can't just carry on with a thick womb lining ? I can't take hrt. So I want to be prepared for my next consultation- I've read about ablation but also read a paper which compared outcome of that to a laparoscopic hysterectomy and the latter had a better outcome in terms of patient satisfaction (97pc to something like 86pc from memory). Also read that 20pc of EA cases end up having a hysterectomy anyway.

I was wondering if I should ask if I can go straight to the hysterectomy option? Then it's all done - no more hellish periods and it takes away the risk? Or am I oversimplifying. I realise it's a big op.

@feelinggeriatric Would like to offfer you some help and info, but unsure where the 'menopause' part of your question is. Any more info from you?

Hi, the consultant said the thickening could be a normal part of the menopause rather than anything sinister, I understand it's a common occurrence in peri menopause and was wondering how other people had dealt with it.

Why are you not keen on the Mirena?

Could you tell us a bit more?
ie how did you come to have investigations- what were your symptoms?
Have your periods stopped?
Investigations usually only happen if women are post menopause and have spotting or very heavy bleeding during peri meno.

A thickened lining during peri is usually nothing to worry about as it often happens as a result of missed periods, so there is a build up of more than one month.

Is this connected in any way to your treatment for breast cancer? Some drugs- maybe Tamoxifen (???) - have a higher risk of endometrial problems.

There is no simple answer to your question :)
Some women who have had BC do use HRT so it's not black and white.
Some experts think it's synthetic progestogen that is the culprit in HRT that can trigger BC (so giving you a Mirena coil may not be the best advice.)

It's quite complicated ! BUT as yet you have no idea if the thickening needs treatment. There are 4 types of hyperplasia and only one type - atypical- is one that causes a lot of concern.

Because although the consultant said it's fine with having had bc before, that's definitely not my understanding.

But mainly because I don't want anything inserted ! And I don't want hormones. I actually feel very calm and balanced and have for many months and I'm not risking that changing. I also have an implant in my chest from my bc surgery which I hugely regret as it has been uncomfortable since I had it put in over a decade ago- but i am not keen on more surgery to take it out. At the time it was presented as an obvious thing to do but I wish I had thought about it more and just gone flat. So I don't want anything else added that would require surgery to remove and I definitely don't want something that could mess with my current state of well-being !

why were you referred in the first place?
What symptoms did you have?

I had a 6 month gap in periods then a long heavy period. It actually stopped about 2 days before the scan. They are doing the investigation because of my previous bc. I didn't take tamoxifen, I was hormone negative.

I think the thick lining may be new as I had 6 months of hot flushes then they stopped and I got this insane period. So presumably the balance of hormones has changed ?

IMO there was no need to refer you.
The rules for referrals are if the women has not had a period for 12 months or more.
(Disregading the BC.)

The reason for the heavy period is it was 6 months' worth!
You weren't ovulating then and that's also why you had flushes.
So after 6 months (or 5) you did and the result was a heavy bleed.

I wouldn't worry- it sounds as if it will all be normal.

Hi my journey started out pretty much like yours! I had breast cancer 5 years ago and was on Tamoxifen. I started getting random bleeding (just spotting really) last year. Ultrasound showed thickened womb lining. Long story short a few weeks ago I had my ovaries and Fallopian tubes out by keyhole surgery. Gynae surgeon didn’t take my womb as she said it’s a bigger op and she wanted to save it (mistake!!) but she did take biopsies. Results of biopsies show pre cancer changes and I’m now booked for hysterectomy 25th May. I’m 52 though.

Look if I was you I would push for the whole lot to come out, ovaries and womb. Previous breast cancer puts us at higher risk of ovarian cancer and Tamoxifen can cause changes in the womb. They don’t tell you all this stuff

Feel free to pm me if you want.

@MissyB1 The OP says her BC was hormone negative.

Removing ovaries etc is a big op and it's not one that's recommended in someone under 50 as there is the increased risk of osteoporosis and heart disease.

Missyb1 sorry to hear that. I agree , if any changes / atypical cellsI think I will get everything removed. I hope you recover well from your surgery.

I didn't take tamoxifen, was hormone negative.

Presumably there is a chance that cells could be normal and I don't need anything ?

@JinglingHellsBells thank you that's reassuring. And I agree actually that this is Uber cautious ! Feel a bit conflicted as I don't want a GA but I feel that I should have the biopsy and definitely cannot have it any other way as can no longer even tolerate a smear test pain wise.

Have read a lot in last 24 hours and feel a bit calmer. Trying to liken it to my yearly mammograms which I never get anxious about

Aaaah sorry misread OP 🤦‍♀️ yes if you were hormone negative that’s different.

@feelinggeriatric I have had both a biopsy (twice) and a hysteroscopy with no GA. The first biopsy was in the dr's room and pretty straightforward- no worse or even better than a smear to be honest. A tiny nip and that was all. The hysteroscopy was okay too. A lot depends on the patience and skill of the person doing it. Mine took longer as my cervix was tight but in all honesty it was not painful. You don't have to have a GA- they can put a local jab in your cervix as the other option.