Protocol - Post Menopausal Bleeding & others experiences

[SenoritaNaturista]

After being helped by someones similar post here last month, and the brilliantly helpful replies, I wanted to ask my own question:

Sudden onset debilitatingly painful post menopaulsal bleeding a month ago.
As though something “had burst on exertion” whilst window cleaning.
Felt like I had a large draught excluder lying across my abdomen (since disappeared)

Got a scan within 2 weeks, 7mm thickened lining in uterus (normal for my age would be 3) then a biopsy for histology very quickly after - results today thankfully normal.

Biopsy sample looked visually too small to be viable, both to the 3 consulting staff and to me, but on shaking the sample pot once the blood dispersed there was a tiny sample left.

The planned hysteroscopy was not attempted “as it was not tolerated” (I can only say that the pain from the biopsy alone was pretty shocking). They made a clinical decision not to attempt it.

I have been discharged from clinic unless bleeding recurs, which is great, I can get on with my life.

My questions for anyone who has undergone similar:

• I fully expected to be called back for hysteroscopy as a day-case - to investigate the thickened lining?
• Is it clinically acceptable to be discharged - without a hysteroscopy being carried out?
• GP advised initially stopping HRT for 6 weeks while being investigated - have other people been able to go back on HRT after their investigations? - I do really want to continue.
• I had been using Utrogestan vaginally rather than orally (after extensive research). My GP was initially alarmed that I had done this without seeking advice.
• For a short period of time I had followed the Dr Newson online advice to use only every other day/on alternate nights/ before later reading the BMS advice to use every day which I had then reverted to (could this alternate night use have allowed the thickening?)

I will of course see my GP for answers but it will be a while before I can be seen.
In the meantime would love to know of other peoples similar experiences please.

It would be usual to do the hysteroscopy under a GA and take another biopsy.

I assume they tried the first one with a local anaesthetic?

However, although you have written a long post here, there are some things missing!

How long have you been post menopause? How old are you?

If it's not at least a year or you are 54+, you should be on sequential, not continuous HRT. (That's how bleeding can occur.)

Is the bad bleeding possibly a normal period?

The other issue is that on HRT (used sequentially or in the first 6months of continuous), the 3mm lining does not apply. It's 4mm anyway, not 3mm for post menopausal women not on HRT.

For women on sequential HRT, the lining grows and thins each month. The cut-off point for women on sequential HRT is not 4mm- it can be as high as 10mm before they need to investigate.

Yes, using too little Utrogestan could have caused the bleed but such a heavy bleed sounds more like a period.

The other point is that if the scan is done by a very good consultant, they can tell a huge amount - whether the lining looks suspicious or not- and they don't just make the call on the thickness alone.

Was your scan done by a consultant radiologist/ gynae, or just a sonographer?

There can be a world of difference in what they see, depending on their experience and training.

Thanks so much for taking the time to reply Jingling - greatly appreciate.

No local anaesthetic when the biopsy was taken.

I was expecting the hysteroscopy first - so they got a visual on the area, then followed by a biopsy…(rather than biopsy first and then deciding against attempting hysteroscopy). The pain was unexpectedly incapacitating.

I’m 66, post menopausal for c 15 years

On continuous HRT for 12 months, started at my request. I know it’s considered late for commencing HRT, (but want to live as well as I can in my next stage of life and having done extensive reading)

The bleeding didn’t feel like a normal period, the pain that was abnormal, bleeding finished after around 10 days and all feels normal and resolved now.

Thanks for the reassurance about 4mm etc. Feel happier knowing that.

I believe the scan was done by a radiographer.

I feel way more positive now, thanks again for your reply.