8 months on hrt and now an urgent referral for thickened uterus

[stirling]

Can anyone please let me know their thoughts on this?
I started hrt in March primarily for bladder symptoms, atrophy. I had a history of mild adenamyosis and I small fibroid. Was always told in past five years I had a bulky uterus. I'm 50.

In my 40s very heavy periods flooding. At one point my lining went up to 12mm.

Then in 2020 after covid my periods stopped for a while, around six months, had a couple of random spotting type bleeds, and in March this year started sandrena and uterogestan. Plus estring as vagifem and ovestin caused reactions.

My bladder symptoms were a lot better.

By the time I put in my third estring, I was in agony, felt I'd blown up like a balloon. Couldn't wee, constant pressure (of uterus) on bladder. Had it removed last week thr day before my TV scan.

GP called this morning to say it was 9mm and required urgent referral.

So now I'm all worried.

Any advice appreciated!
Thank you

Anyone?

I'm no expert but as your lining has previously been up to 12mm I wouldn't be unduly worried. Of course this needs investigating but it may well not be hrt related and just part of your existing condition.

Good luck. I know waiting for tests and results is a worrying time .

@stirling We need a bit more info:)

If you are using sequential HRT ( sort where you have a bleed) then it's normal for the lining to grow and shed each cycle.

If you are using Utrogestan daily, then after 6 months any odd spotting ought to settle down.

On sequential HRT they allow up to around 8-10mm of lining if the scan is done mid -late cycle. The best thing to do with scans is to have them just after the bleed, when the lining will be thinnest.

If you are using continuous Utrogestan (1 capsule daily) then the lining should be around 5mm max.

If it's not, then it looks as if you might need another dose to keep it thinner.

Thank you both for your reassuring replies which certainly help during the waiting period. JinglingHellsBells I'm on continuous Utrogestan one a night.
Originally I started on two for twelve days
but my GP felt I should be on continous. Its my eighth month now.
Last heavy bleed I had was in July. Between March and July, just a few odd light bleeds. Between July and now, two very light bleeds - just spotting really.
I was feeling my uterus balloon up with the third estring. It was like a baby pressing on my bladder constantly for a whole month.

My scan last week was done following one of these strange 'spotting' type bleeds.

Thank you both for taking the time to reply!

You may not yet be post menopausal @stirling

The continuous type is for women 12 months after their final period.

From what you say, you had some spotting (could be a very light period) and others not that long ago? Just based on what you say, it doesn't sound as if you have gone for a full year with no bleeding at all (?)

You could still be in peri and if that happens, the lining can get quite thick, even on HRT as you are adding estrogen to your own levels.

Thanks jingling that's a very clear explanation. Wish my GP would explain it like that, she's got me into a "oh just play around with it a bit 'regime. (the sandrena) she's a gynae specialist but I feel like I ought to seek out a proper menopause clinic. The newson clinic has a very long wait list.

It sounds plausible because prior to starting HRT, the longest I had gone without a period was about 7 months. And that was very light too. The post meno diagnosis came about in November of last year when two scans, a TV and a contrast mri both concluded "this patient is post menopausal" as my ovaries had significantly shrunk. Bloods revealed low estrogen too.

Unless you have gone for 12 months with no bleeding, it's likely you are not post meno.

Small ovaries and low estrogen does not alwaysequal post meno.
I was 'diagnosed' with post meno hormones 18 months before a final period :)
My gynae said it proved that tests are not accurate.

Thank you for your insight jinglinghellsbells

You are most likely going to be fine :)

if all is ok, I'd suggest - with your GP consent- that you use Utrogestan on a cycle of 12 days per month.
This will control the lining and reduce any odd bleeds.

You might like to know that after 12 years and more on HRT my meno consultant is fine for me to use it on a cycle still .

Jingling thanks for the encouragement and that's really interesting re uterogestan. I'm booked in to see a gynae on Monday who specialises in female reproductive cancers and menopause, hrt. I'll certainly ask her about this as I felt my symptoms were better when I started off on the 12 day drill, two tablets a night. It knocked me out too. I've been so utterly sleep deprived with the ongoing bladder hell.

I must say I find it quite comforting to know you've been on it 12 years.

@stirling how did this pan out for you? I've just been urgently referred this afternoon. I'm so worried x

DWMoosmum try not to worry, easy to say I know. But I needn't have worried. It was fine. Had a hysteroscopy and all looked normal. I was told that it was a gp being unnecessarily alarmist. Hopefully you'll be fine. A hysteroscopy is straight forward too if you need one.

@stirling thank you. They have requested that I have the Hysteroscopy. The alarming thing was that the letter today was from the Gynaecological Oncology nurse. That set me on edge today. Ill know more on Thursday xx

@JinglingHellsBells I was told by Newson that after over 12 months on Utrogestan sequential you could move to continuous? I’ve done this because my periods were far apart and ended up being at the same time as the higher dose of Utrogestan and I felt awful when I would stop it and get panic attacks for a few days. I’ve been on HRT 16 months or so. I barely get a bleed if I do. I’ve been in peri 8 years. This is all so confusing!