Post Menopausal Bleeding

[HollyBerri]

Hi. I haven’t had a period for about 18 months. I am on Evoril patches (75) & Utrogestan 100. All good . I have had some very light spotting recently, been to the GP and have been referred to the hospital under a cancer pathway.
I am trying not to worry too much as i have no other issues and have have googled there can be several reasons. I am waiting for a call this week for an appointment.
Has anyone been through this and tell me how it turned out- positive or not just so I know what to expect?
i am trying not to fear the worse. My last all clear smear was 3 years ago. The bleeding is very recent and very light- not even enough to need a a pad.
i have been told to keep on the HRT for now as stopping suddenly can also potentially cause problems.

I had this and it was vaginal erosion. I now have oestrogen pessaries twice a week and no further issues. I am not on HRT otherwise. Don't worry until you need to and hope things aren't as dark as you presume.

I've been referred for this a few times, and everytime an ultrasound has shown it to be something else. HRT can cause this. Try not to worry 💐

I’m in the middle of this at the moment. They don’t seem overly worried. I’m 42 and went through menopause aged 37 due to autoimmune issues. As part of the investigations I had a scan and that was normal but they want to take a biopsy. They tried at the same time as they did the scan but I found it too painful so they’re booking me in for it under general anaesthetic so waiting for an appointment for that. I’m reassured by my scan being normal but they said they can’t completely rule out some sort of cancer without the biopsy, although they’ve told me the risk is low and it’s more likely to be either HRT dose not being quite right or a poly / fibroid. I’m not that worried to be honest. I’ve had so many other investigations etc (I have lupus and lots of other things) it just feels like another thing to tick off the list.

*polyp

Thankyou. Am trying not to worry too much. It does keep popping into my mind though. Usually in bed - hence the early post this morning. Have told Dh but no one else.

ive had this too, about 6 months ago. Turned out to be nothing, just one of those things. The majority of these aren't caused by cancer but they have to check to catch the ones that are, it's a scary, anxious time. 💐

I had this recently, though after only 10 months without a bleed. Because it was under a year (I think) my GP has insisted I stop my HRT for 6 weeks, to see if there is any bleeding, before referring me on. I'm very unhappy about that but am about 2 weeks in and feeling pretty grim 😑
Kind of wondering how it is helping things to wait an extra 6 weeks if it does turn out to be something serious? 🤷🏻‍♀️

OP I hope it turns out to be something very minor, chances are it will be. It's really great that your GP is proactive and referring you quickly though it feels scary.

Yes,I was sent for scans and it was a cyst which I'm about to have removed. It can just be a blip OP and nothing serious, take each appt as it comes and just see what they say otherwise you'll drive yourself mad.

Thankyou for the replies. I am trying not to think about it. I only saw the GP on Friday. She texted me after checking with a colleague about the HRT and also said to ring & chase the appointment if i haven’t heard by this Friday so at least the initial appointment will happen quickly.
I will keep you posted.

I am having this at the moment. I had a scan of my uterus and a biopsy and that was all fine, the spotting has been since then so I will have to go back to my gynae. I haven’t had a smear test in years so that is my only worry.

I'm going through this at the moment also. There's another thread on it with some other experiences also!

I'm not on hrt and it's been about 16m since I had a period. Have had the ultrasound which showed some thickening of the womb lining so awaiting follow up appointment (for a biopsy I'm thinking?)

Also trying to not overthink but it's really hard!

That’s interesting. I’m 56 and had my final period at 52. Started HRT 6 months ago and about 10 days ago had a period again. GP said current protocol was to stop HRT immediately for 6 weeks and resume if no further bleeding- referral only if there is bleeding. I double checked this and it is current NHS protocol for those on HRT. I wouldn’t worry - bleeding is v common on HRT.

This is current protocol and makes sense otherwise now that more people are taking HRT again there’ll be a lot of unnecessary referrals. This rules out the HRT related bleeds. I was dubious but have checked - online and with GP friends and it is the accepted pathway.

@HollyBerri I'd been following your posts. I wanted to try to reassure you. Statistically, very few women have cancer if they have odd bleeding on HRT. The women who are more at risk are women who are post-meno and not on HRT, then bleed.

You say you haven't had a period for 18 months. Did you mean before you started HRT or since using it?

On the continuous combined type of HRT you're using then you'd not have one anyway unless you were not post meno when you started it.

The first question is were you 100% post menopause when you started on continuous combined HRT?

Almost daily here there are women being given the incorrect HRT by GPs. Usually this is being given the type of post-meno women, when they are still not post meno! The symptoms of this are often irregular bleeding.

Also, with all combined HRT, as yours is, bleeding for up to 6 months (in post meno women) is normal.

Where are you in the meno 'journey'?

@GreenDressy I don't really understand what has happened to you. Have you had to stop HRT because you have had a bleed while using a combined continuous form of HRT? (estrogen and progestgen every day.)

(That is for women with no natural period for 12 months before using that sort of HRT.)

Your GP's request that you stop HRT doesn't make sense because if you are in peri still you could go many months before another natural period.

@Notellinganyone No, I don't think it is protocol.

The rule is that any woman (not on HRT) with bleeding, who has not had a natural period for 12 months, is referred for a scan.

If a woman is on combined continuous HRT, bleeding after 6 months on it may be investigated, or the dose may be tweaked (adding more progesterone.)

Yes @JinglingSpringbells that's exactly it. I was expecting a referral, not to be told to stop HRT for 6 weeks. I even went back and asked a different GP. I honestly can't see what it's achieving except for delaying any investigation and making me feel dreadful.

I genuinely don't understand.

Was this unexpected bleeding as you are using continuous combined no-bleed type HRT?

Were you post menopause when you were given it?

Or are you in peri and you have had bleeding outside of an HRT cycle, where there is a monthly withdrawal bleed?

I think your dr is very muddled.
If you are post menopausal, then you aren't going to have any more bleeds at all. So waiting 6 months or 6 years is not going to produce one!

If you are in peri and have been using a type of HRT meant for women post-menopause, then that's quite likely to be why you have bled.

@JinglingSpringbells
I've have been on continuous HRT fir at least 3 years but I wasn't in menopause then, it was because I was having huge mood swings and the GP thought that the continuous type would even that out, which it did, but I had lots of erratic bleeding, until about a year ago when I changed from taking Provera to Utrogestan, and the bleeding stopped - hurrah. All was well until a couple of months ago when I had a bleed.
Both GPs I saw assured me that it's now now protocol to stop HRT for 6 weeks.

I use Estrogel alongside the Utrogestan.

That's not so. Ask them to show you that protocol in writing, where it is online.

It's pretty clear to me that it's highly possible the reason for your bleeding is that you are still in peri and you are experiencing what many women do if on the wrong HRT.

How is stopping for 6 weeks going to prove anything?

Is your GP expecting another period to arrive in 4 weeks or something?

@JinglingSpringbells well exactly!

I haven't had even a spot in nearly 3 weeks, I might just start taking it again 🤷🏻‍♀️

The protocol unless it's changed is a referral for a scan within 2 weeks. There is nothing as far as I know saying stop HRT for 6 weeks either before this appt, or at all.

I think you need to challenge your GP on this and ask what is behind this. They need to explain.

The problem is that many women are being referred for scans when it's sometimes because they are on the wrong type of HRT.

The protocol is only immediately refer for a scan if patient is bleeding post menopausally and NOT on HRT. If on HRT and willing to take a break then HRT stops for 6 weeks to see. If no further bleeding then can restart HRT.

Also not the case- post menopausal bleeding can be a symptom of cancer amongst other things but can also be caused by HRT. If taking HRT then that is probably the most likely reason. If it continues then it suggests that further investigations are needed. In my case - despite being 4 years post menopause I had a bleed. It felt exactly like a period in terms of symptoms etc so I suspect it was as a direct result of the HRT.

@Notellinganyone Is it possible please to see the link please for that protocol? Could you post it? It's just your experience and advice on it is very different from my own under a consultant. (I'm thinking especially of stopping HRT for 6 weeks to see what happens. ) I've never heard of that.

Protocol may have changed recently of course.

Yes, HRT can cause bleeding even if it's the right type.
This happens if there is too little progesterone in the estrogen:progesterone ratio.

Or sometimes bleeding on HRT can occur if estrogen is not being absorbed and the level is reducing.