Post menopausal bleeding & 2 week referral pathway - anyone want to join me for a handhold while we’re waiting?

[Wobblestitch]

Saw my GP today following 3 days of light bleeding & spotting and now on the 2 week referral pathway.

Trying not to PANIC 😱& wondering if anyone else is in the same situation and wants a virtual handhold, or anyone who’s been there and done that and wants to share their experience.

In case it rings bells with anyone else - I’m 52, not sure exactly when my last period was but over 12 months ago, not on HRT (have prescription but not started yet) & have had red / pink bleeding & spotting.

Thanks so much @Trampauline. I really appreciate your reply!

Hopefully that's is but it feels different but maybe that's me overthinking!

Thank you for sharing your experiences. It's been reassuring to read and I'm so glad things have worked out. I have not been on here for many years but came looking for this.
I'm 52, nearly two years since last period and on Sunday started bleeding like a very light period. Still coming but very light. Just wearing a panty liner.
Rang GP Monday morning and got seen. She examined me and said she couldn't see any polyps (presumably just around cervix). Confirmed bleeding definitely coming from uterus. Not on HRT. I have a tranvaginal scan booked for Thursday. Trying not to worry but have read up on worst case scenarios like you do. Anxiety much!
Hoping it's just an ancient egg, polyps or decaying endomitrium!
One thing to mention though is I started taking Rheal Bionic Tonic about a month ago which is meant to stimulate your hormones including the body's natural oestrogen. It's meant to be ideal for fertility and menopause. Wondering if it could have had an effect on my hormones.
I had a transvag and bladder scan last Dec because of pelvic pains with urine infection. All was normal at that scan. Had full bloods in Feb and all normal. Had the ovarian cancer marker blood test in last Oct and all fine. Had all these because of the ongoing urine infection pains. Thankfully urine infection finally got beaten down in Feb with a longer course of antibiotics.
It's great to be a woman innit!!

I’ve had the occasional dark brown spot recently. So little if I’d been wearing dark coloured pants I wouldn’t have noticed anything at all. I suppose I should go get checked. I have a mirena which needs to be removed and am on HRT though I seem to have hit a wall with that and my mood’s very low currently.

So sorry your are feeling low. I would call GP just let them know. See what they say.

Just thought I'd update in case anyone comes here in the future looking for reassurance like I did. Scan showed a 'beautifully thin lining' and no problems with ovaries. She agreed that it might have been down to the Rheal Balance Tonic superfood ingredients. Causing a hormone surge. I bled very lightly until today it's just about stopped. So like a very light end of the line period.

Are they really seeing you within 2 weeks?! I've had this twice, and in Scotland you have to wait 2 or 3 months. I think that only about 1 in 10 cases is cancer.

I had a 'period' after fourteen months without and was referred for an ultrasound. They said that my uterine lining was thick and took a biopsy there and then. That was two weeks ago - when I called on Monday, they said it can take up to 28 days to get the biopsy results back 😢

@2userspast3, I was seen for a scan and biopsy within 2weeks of seeing my GP about post menopausal bleeding, and have just had the hysteroscopy done within 2 weeks from the scan. I was amazed at the speed and efficiency! I am in London.

Is it only me that finds this number scary? I can't get that out of my head!

Sorry, Flounder. That may not even be the right number - just a memory. Personally, I find it a reassuring number. The waiting period is a killer in Scotland, and the first time I had to wait again to have the hysteroscopy (due to a thick lining). I was told that at that stage it was more like fifty / fifty. But the most likely cancer is cancer of the womb, and that's relatively treatable. This time round I thought I'd go private to avoid the waiting time, but the private waiting time was as bad.

Try not to worry and hopefully you will get the all clear very soon.

I read the same number! Sorry, I didn't mean it to sound like I was having a go at you for saying it!

It's a week since I have my examination at the GP and still no word on the ultrasound. Have another appt tomorrow on another issue so I'll follow up

Hi thanks everyone for your messages. I’m 56 and haven’t had a period for 10 yrs since ablation procedure. Been on HRT ever since. Noticed spotting and clots over past 3 days. Had a horrible pulling pain sensation on left side of pelvic area the first day I saw the bleeding. My tummy feels tender on that side too. Went to my gp yesterday and they examined me- struggled to find my cervix. Said it looked fine when they did locate it (head of practice came in to ‘have a go’!). They’ve put me on a 2 week pathway- feeling worried. They bluntly said they wanted to rule out cancer of the womb lining. Anyone out there had a similar situation? They’ve put me in for full bloods in 2 days time. I’ve decided to go private - I go this week to a one stop shop appointment for a transvaginal scan and I’ll get my results that day. X

@Lynetteceltic13 I have been on HRT for over two years, with no period, and then suddenly had bleeding last Wednesday - like my periods used to be, though lighter. I called the Dr and they put me on the 2 week pathway, and was scanned today. They've found a fibroid at the back of the uterus but weren't worried about that. My uterine lining is thickened though which will need further investigation. I am speaking to the GP tomorrow to get the proper results, and am also having a fasting blood test to check hormone levels. I am feeling terrified but it sounds like in most cases it's not cancer (my GP thinks it is down to an increase in oestrogen that I was given in July). I hope all goes well for you. I know how hard it is not to worry - I've been in a real state all day. :-(

@dunant173 I've replied to you on your other thread.

You are not having a post menopausal bleed because you are using sequential HRT and the bleed was a withdrawal bleed (after the 12 days of Utrogestan.)

Post menopausal bleeds are unexpected bleeds in women usually not on HRT, and post menopause with no natural period for a year or more.

Yo said your GP recently increased your estrogen dose. This will have thickened the lining (normal, each cycle) and produced the bleed.

On your previous, lower dose of estrogen, the lining wasn't getting thick enough each month to bleed. Bleeds are usually directly linked to the amount of estrogen so more/higher dose means a heavier bleed.

I'm really sorry that you are feeling concerned when your GP should have understood the bleed was to be expected using sequential HRT. They are also wrong to think you need to go onto continuous HRT when it's a choice (because most women prefer not to bleed.)

hi there I had similar and they were polyps and consultant said they are really common try not to worry - good luck

@JinglingSpringbells thanks for the reply but I am really confused! I have not had any withdrawal bleeds all the time I have been on sequential HRT, which is what was worrying. Should I have been having them? I can understand that the increased oestrogen this time could have caused the bleed, but I am completely confused as to why I have never had a withdrawal bleed before. No one even told me, when they put me on the sequential HRT, that I should have a withdrawal bleed, or to expect one.

NHS guidelines state: "Your doctor will usually recommended continuous combined HRT if you are post-menopause (you have not had a period for 1 year or more)."

They also say HRT should be monitored by the GP once a year - I have never had monitoring at all - only had the increase because I was recommended to seek advice for fatigue from the Long Covid clinic.

I've had an ultrasound which has found the thickened lining but does this mean that this thickening is therefore normal? They didn't think it was and hence this is why they want me to see a gynaecologist.

You're confused because your GP sounds lacking in knowledge or unable to communicate with you.

It think it says on the Utrogestan Patient Leaflet that you should expect a withdrawal bleed each cycle. But that's not the point. Your GP ought to have told you.

NHS guidelines state: "Your doctor will usually recommended continuous combined HRT if you are post-menopause (you have not had a period for 1 year or more)."

But were you post menopause when you started HRT? Presumably not or you'd have started on continuous combined then.

https://www.menopausematters.co.uk/postmeno.php

And all the time you are on HRT now, you won't know if you are naturally post-menopause.

I am assuming you use gel - maybe 1 pump? - or low dose patch (25 is the lowest.)

Did your GP explain how HRT works?
Estrogen stimulates the womb lining. Progesterone stops the stimulation and when you stop the progesterone each month the lining breaks down.

If the dose of estrogen is low, or your uterus isn't stimulated by it (and all women respond differently) the lining will stay thin when using 2 weeks of Utrogestan and nothing will be shed (no bleed.)

If you increase the estrogen the lining will be thicker and you will bleed.

TBH if you can see another GP who is more knowledgeable (and knows something about HRT) that may be best.

Yes, you should have an annual review. This is a legal requirement for all prescribed drugs, including HRT.

If you are using sequential HRT then yes it's normal for the lining to be thicker.
The only time for an investigation would be if you were bleeding at odd times ,not at the end of each cycle.

@JinglingSpringbells thank you very much for this.

This recent bleed is the only one I have had after the 12 days of progesterone.

Ironically the GP I spoke to who upped my oestrogen and never reviewed me is the practice's HRT specialist who asked me in July if I'd had any bleeding. I hadn't then. I don't want to talk to her again as the current GP I am dealing with seems far more proactive and helpful. Whatever happens it sounds like I am being referred to a gynae.

I am on the oestrogen patches - highest dose possible. Then Utrogestan for 12 days.

My doctor has written 'Postmenopausal bleeding' as my current active problem, which is why I've said I am postmenopausal. She seems to be confirming that I am?

Hi I hope you’re ok. I had an nhs scan tonight but they didn’t give me any results. Did you get your results straight away x

I didn't get my results either, though they said that beside a fibroid there was nothing sinister. They said my lining was thicker than it should be and they'd recommend I see a gynaecologist and to call my GP today to get the results. My surgery booked me an appointment yesterday when they got the results through so it was very quick.

I hope you get your results back quickly and that all is well x

My doctor has written 'Postmenopausal bleeding' as my current active problem, which is why I've said I am postmenopausal. She seems to be confirming that I am?

@dunant173 But no doctor (or you) can know whether you are peri or post menopause! The only way to confirm that is if you stop HRT and wait 12 months to see if you have a period.

Lack of withdrawal bleeds when using sequential HRT does not equal being post menopause! HRT when sequential resets a false cycle with a withdrawal bleed.

Honestly, I feel sorry that NHS time is being wasted by these GPs who seem very confused and sending women for investigations. I am pretty sure that when you mention a bleed on sequential HRT, happening at the right time, the consultant will wonder why you have been referred.

Hi @JinglingSpringbells
Just a brief update - endometrial lining was 7.8mm and so the GP has referred me for a hysteroscopy but said it was likely the bleed was a fake bleed because they had messed up the hormones! But I had my hormone levels back today and my oestrogen is so low - lower than when the previous GP upped my levels to 100 patch! This time my levels were 37 - previously they were 81! So I have no clue what on earth what is happening for oestrogen to fall on a higher dose!

I have decided to stop HRT now because I just can't cope with the worry. I told the GP I might do that. She suggested gradually cutting down but then told me that the type I should use (gel instead of patch because she now thinks I am not absorbing the oestrogen through the patch) is out of stock and they cannot get it easily anywhere!

@dunant173 It's interesting that your GP calls it a 'fake bleed' rather than a withdrawal bleed, don't you think? It does look as if you have never been absorbing estrogen well, not enough to create a withdrawal bleed. And now you've upped your patch you've had one!

I'm a bit confused (without reading all your posts again) if you have in the past used 100mg Utrogestan daily, or 200mgs (2 capsules) for 12 days a month because somewhere you mentioned not having used enough utrogestan (?)

Anyway, I hope you get the all-clear. I'm sure what you have experienced is normal.

one thing you ought to clear up with your GP is that (unless you were already post menopause when you began HRT) she won't know if you are now. (And neither will you unless you stop HRT and have a period again within 12 months from now.)

I had the same 3 years post meno. Had all investigations and relieved that it was a benign uterine polyp which was removed under GA as a day case.
Not all post meno bleeding is sinister but you are wise to get it checked out.