Thickened endometrium

[Amireallyhere]

I am on hrt, I think I'm now post menopausal but have been having some bleeding/ spotting. My GP referred me for an ultrasound and hysteroscopy, which I had this week. They said I had a thickened endometrium and took a biopsy which I'm waiting for the results of.

I'm trying hard not to worry but finding it difficult. I'm currently on oestrgel and ultragestan and I'm hoping that it might be I just need a higher dose of the progesterone.

Has anyone else been through this?

Yes I have one too. I haven't done anything about it though. I was referred for a scan due to incredible pain even with no periods (and spotting which is unpredictable).

They did a smear which was clear and a scan which just revealed that I had thickened lining of the womb.

I am yet to go back to the GP

I'm sorry you are in a lot of pain. Did they not offer you a hysteroscopy to check the womb lining is OK?

No because they had no idea what was causing the pain so I had a general ultrasound (they checked womb/ovaries/liver/spleen/gallbladder/kidneys).

I'm not in pain now. It was v odd. Will speak to GP with results and see what they suggest. Even though ovaries looked ok, they recommended a CA125 blood test and a sample of my thickened endometrium. I have to go back to GP to start the process.

They also said it could be adenomyosis

When are your results due?

I will keep my fingers crossed for you

@Amireallyhere There is a lot more to this and it all 'depends'.

Are you post menopause? (at least 12 months with no period?) You say think so maybe not? That could well account for bleeding.

Are you on continuous combined HRT?

Or cyclical?

On combined HRT bleeding for the first 6 months is to be expected.

On cyclical, you can still get spotting if you are not post menopause (or- as you say- if you need a bit more progesterone.)

Also, the guidelines for a thick endometrium are very different when on cyclical HRT (they 'allow' up to 10mm, not the 'under 5mm' for women not on HRT.)

(I've been through all of this, and have regular private scans with consultant gynaes who talk it all through at the time.)

The likelihood is it's normal and just a blip with your HRT.

Thanks for your replies. The results could take up to 4 weeks.

I'm on continous hrt and have been for about 15 months. Prior to that I was on cyclical for a few years but struggled with anxiety. The trouble is before that I was on the pill for many years and didn't have periods, so I didn't really know when my periods stopped or whether the bleeding I'm getting now is still a period.

I had consultations with a private menopause specialist about my hrt as my gp was useless, and I trust her with my prescription. However my prescriptions come through my gp as I can't afford private ones. I'm now worried that if the results of the biopsy are clear my gp will try to mess around with my hrt. I realise I will probably need to up my ultragestan but don't want to lower my oestrgel as it allows me to function normally.

I would be careful with continuous oestrogen HRT. I had thickened endometrium- which I was told was ok a few years ago. It wasn’t followed up. I did have a Mirena coil.

Now I have primary peritoneal cancer.

I don’t have any other risk factors and whilst I don’t regret taking HRT, I do regret that I wasn’t followed up more closely.

What was thickened endometrium is now showing as adenomyosis on ultrasound. I think it’s been a progression over the years and now I have cancer deposits throughout my abdomen

Primary peritoneal cancer is rare, but has a poor prognosis.

Just to warn you not to assume HRT is always safe.

@RedRosesPinkLilies Really sorry to hear about your diagnosis.

No one is allowed in the UK to use estrogen only unless they have had a hysterectomy. So it's estrogen daily, but with progestogens, either on a cycle, or daily.

The Mirena coil is used as a progestogen by some women as part of HRT (it needs changing every 4 years as part of combined hrt.)

Adenomyosis is not cancer, it's similar to endometriosis, but in the muscle of the womb rather than elsewhere (like endo can be.)

I'm so sorry you have this diagnosis and wish you all the best with your treatment.

I know adenomyosis isn’t cancer, and I do know what adenomyosis is.

I think this may have been the stage before the cancer developed.

I was told the progesterone coil would provide the progesterone component, and that I therefore did not need combination therapy. Is that not true?

I've had the same problem and was told the endometrium is thicker because of the hrt. I also had a fibroid which has now been removed.

Sorry to sound a bit thick but what is cyclical HRT vs continuous? I'm on Evorel Sequi (or was until GP took me off)

jingling - you might know. I've tried this on a few threads so sorry to be repetitious! I am on Evorel Sequi - have been since March. Still have periods once a month. Prior to this was on HRT tablets since late Dec. Am 51 and definitely by your definition not post menopause.

My lining was 8mm and they want a hysteroscopy. I am finding that a bit confusing. One breakthrough bleed a few weeks go on the progesterone bit of the cycle . I have had two scans. The first one was prior to HRT (November) and all was fine. Recent one was last week.

Adenomyosis doesn't turn into cancer. It's when the lining of the womb has grown into the muscle of the womb. The same way that endometriosis is the womb lining in other parts of the body. Lots of women have it for all their lives and it doesn't change.

I'm so sorry you are going through this.

The condition you described is in your abdomen and not connected with your womb or HRT.

The information online on it (from websites/charities for ovarian cancer) says although it's not that, the symptoms are similar, which can include a very high C125 reading.

Yes, the Mirena is part of combined HRT- that's what you had- combination HRT with the coil giving you the progestogen. What you were told was that you didn't need any additional progestogen like tablets or a patch that included progestogen.

Hope you make a good recovery.

No, you're not being thick at all! I think people get confused as some of the terms used are a bit clunky!

All HRT is 'combined' (that means using 2 hormones - estrogen and progestogen.)

(I'm saying 'progestogen' as that is what they are. Being really accurate only Utrogestan is a progesterone.)

Combined HRT - is cyclical Estrogen daily +12 days progestogen/progesterone.

Combined continuous- both hormones (combined) continuously ( daily). The no-bleed sort.

Why have you been taken off HRT? It's not necessary to stop HRT before any investigation.

If you are using sequential, your lining will be thick. It's growing each month because of the estrogen.

To get an accurate reading of the lining, it should be done as soon as the bleed is over, so that's anything from Day 5-8 of a cycle (where the bleed is Day 1.)

If it wasn't done then, the reading is meaningless because the lining can grow much thicker over the cycle. There is guidance on this which states the cut-off points depending on HRT or no HRT.

I was told (personally) that they allow up to 10mm for women on cyclical HRT before getting concerned AND a good consultant can tell a lot from a scan (thickened area, irregular surfaces, etc.)

I

Thanks, that's really clear and helpful. I should have known that about progesterone vs progestogen from school biology!

The GP told me to stop taking HRT as soon as I reported this breakthrough bleed. Tbh, I kept taking it and was still using it when I had my scan. I then stopped it once I got those results. The scan was taken about 16 days after a bleed began I'd say.

Armed with this info, I may phone the clinic n Tuesday and see if I can speak to someone about all of this.

If you were using estrogen when you had your scan and halfway through a cycle the lining would be 8mm. Women who are fertile and have their own estrogen can have linings up to 18mm during their cycles.

There does seem to be a lack of joined up thinking sometimes around all of this on the NHS. So many threads over the years on exactly this topic.

Thanks jingling. This is very silly indeed and I will pursue it!

Just to update , thanks to info from @JinglingSpringbells , I contacted GP and the senior partner has replied. I queried why I might be put through an invasive and potentially very painful procedure on the evidence I had. I highlighted that I am not post menopausal and that 8mm seemed a normal reading.

She replied agreeing that my understanding was correct about the thickness being nothing abnormal. Her notes seem to suggest my periods/monthly bleeds stopped when I was put on HRT, though , and then restarted in May, and that the issue was probably the RT regime. Even that isn't correct!

She told me the letter says my lining is both thick 'and irregular' and urged me to keep the appointment as it 'might just be a rescan and a consultation'. I bloody well hope so! I can't see any point in doing a procedure like this on such a normal presentation!

What next? I think you need to contact whoever you are seeing next and make it clear that you consent to a scan but nothing else.
You should also try to arrange the scan for immediately after a bleed if this is possible.

A soon as I get my letter, I am going to do that exact thing.

Noted about the scan. Good tip.

You have been so helpful!

Hope it all works out well!