Waiting for hysteroscopy and Mirena coil insertion following a uterine biopsy and polypectomy

[AmeliaShepherd]

I have been reading relevant threads whilst waiting an appointment for a hysteroscopy and Mirena coil insertion and would welcome hearing recent experiences.

I am 2 years post menopause and had one episode of a few days of light bleeding/spotting at the end of last year and was referred by my GP. I have had no other concerns or episodes of bleeding. An ultrasound indicated a uterine lining thickness of 6.1mm. This was followed by a biopsy and removal of a large polyp which was discovered at the appointment. The biopsy came back clear but the polyp was found to have simple hyperplasia.

I am now awaiting an appointment for a hysteroscopy and insertion of a Mirena
coil. I have opted for local anaesthetic although a general was offered. I coped with the initial appointment without any pain relief so hopefully this will be similar.

I have never been on HRT and have been fairly lucky with regard to menopause symptoms. Lack of decent sleep and joint pain are the main ones. I am somewhat apprehensive of the Mirena coil at this stage and would welcome hearing others’ experiences post menopause.

There are a few different issues here.
I know that the Mirena is the standard treatment for a thickened lining, but they could also give you (tablets) Norethisterone for a few months.

Equally, many women have them inserted in their 50s and 60s as part of HRT (it's the progestogen element.)

I'm not sure I understand what the question is.
Are you worried about the pain of insertion?
How did they take the biopsy and remove the polyp?
Did you have a GA? (Many women have this done without a GA.)

Depending on your age, it's not unheard of to have a light period some time after the last period, if you were post meno under 50. I think you could have been given the option of 'watch and wait' for the thickened lining as it may regress naturally especially if it was caused by a late hormonal surge. They could scan you every 6 months.

What is the plan? Is it to leave the Mirena there long term or just for a few months then recheck the lining, remove it and then keep scanning in the future?

sorry- see you didn't have a GA for the polyp removal.

Thanks Jingling
I think it’s the relative permanence of the Mirena that is bothering me plus the getting to this point with no HRT and not having to weigh up risk factors. I’ve not had one before and not been on the pill for more than 20 years. I am 58. I did have a reset of my menopause date after 11 months of no periods but have been period free now for 2 years.

The oral form of progesterone is not something my consultant mentioned so that is possibly something to explore. I am just not sure at present what monitoring would be factored in.

Am I correct in thinking that the hyperplasia detected in the removed polyp is of more concern than a lining thickness of 6.1mm?

The RCOG has some guidance (for drs) on how to treat post meno bleeding hyperplasia.

The Mirena alone isn't HRT.
It's used by some women with estrogen as part of HRT.

Am I correct in thinking that the hyperplasia detected in the removed polyp is of more concern than a lining thickness of 6.1mm?

I'm not sure about this! I'd have assumed that all polyps show hyperplasia as by definition they are classed (in most cases I think) as an overgrowth of the womb lining. But again, this is a question for the gynaecologist who is treating you.

Whoever is treating you needs to explain in detail what the plan is. The Mirena has enough hormones in it to last 5 years. Is this the plan or would it be removed after a certain length of time? (I find it amazing that doctors don't tell women all of this at the time!)

The other option is to not do anything and check the lining in 6 months which is called 'watch and wait' (this is mentioned in the guidance.)

The Mirena is supposed to have fewer side effects compared to oral progestogens. However, it does say in the guidance that they are used for 6 months and the same for the Mirena.Treatment with oral progestogens or the LNG-IUS should be for a minimum of 6 months in order to induce histological regression of endometrial hyperplasia without atypia.

This is from the document[[https://www.rcog.org.uk/media/knmjbj5c/gtg_67_endometrial_hyperplasia.pdf

1. How should endometrial hyperplasia without atypia be managed?

7.1 What should the initial management of hyperplasia without atypia be?

Women should be informed that the risk of endometrial hyperplasia without atypia progressing to endometrial cancer is less than 5% over 20 years and that the majority of cases of endometrial hyperplasia without atypia will regress spontaneously during follow-up.

Reversible risk factors such as obesity and the use of HRT should be identified and addressed if possible.

Observation alone with follow-up endometrial biopsies to ensure disease regression can be considered, especially when identifiable risk factors can be reversed.

However, women should be informed that treatment with progestogens has a higher disease regression rate compared with observation alone. Progestogen treatment is indicated in women who fail to regress following observation alone and in symptomatic women with abnormal uterine bleeding.

Basically, you need to talk to the dr and ask some questions. You ought to be told of the options and be able to come to some agreement with your own wishes considered if the options are similar in efficacy.

That is fantastic. Thank you so much Jingling So much good information there. I will definitely be prepared with a list of questions to ask at my appointment and make sure I know what plans are for future monitoring.