Period with cramps 3 years post menopause

[TreeBlindMice]

Im 53 and 3 years post menopause. I've just started a proper period with medium bleeding and ovarian cramps etc

Have been very happy on hrt for 3 years without problems

I know bleeding post menopause is a concern... but this is not just random bleeding, it actually feels cramp wise like a proper period.... so could it be just a period after a gap and therefore no need for concern? Or is it still worth getting checked with my gp?

Please advise anyone who has had this..

It would be absolutely insane not to get it checked out. I actually read an article this week about what incidents you should get checked out and one of them was post menopause bleeding. Better safe than sorry

so could it be just a period after a gap and therefore no need for concern?

A three year gap? Unlikely. Call your GP asap; do not ignore post menopausal bleeding. It's not at all normal and needs to be checked out (doesn't necessarily mean cancer, but that has to be ruled out).

This has just happened to me. 52, about 18-24 months post menopause, had a period-like bleed in May and again start of June. First time with bad backache that made me feel sick the day before and a really heavy bleed for 5 days, second time less so.
After the first bleed I made a GP appt and he referred me for ultrasound and internal scan under the urgent 2 week thing. I was seen last week and had both procedures plus a scrape of my womb lining as it was thicker than it should be. Now awaiting results.
Staff at the hospital were amazing - really kind and very reassuring. Internal ultrasound was a bit weird but not painful, and the scrape was a bit uncomfortable but nothing awful. They asked for consent to remove any polyps if they found any but it wasn't necessary.
Honestly, get checked out.

Thanks for the replies... bleeding a bit worse today... will be getting in touch with gp on Monday....

Similar position here except have had regular bleeding and cramps for about a year now. Had a hysteroscopy and ultrasound via GP which were ok but GP recommended I see an gynaecologist privately (nhs referral very long wait). Have seen one now and still took several months and am booked in to have an ovary removed as I have a growing cyst. As gynaecologist said, why wait until it is something serious when we can prevent that happening. I’m very grateful to have private medical cover.

Post menopausal bleeding should be investigated under the two week wait.

Thanks for the replies... quick update:

Saw my GP today who did an examination and recommended I temporarily stop HRT for 6 weeks to see if I have any more bleeds while off the HRT.

Will miss the HRT but have taken patch off for now.

I had very similar and had investigations under the two week wait, and it turned out that I had endometrial thickening due to too low a dose of progesterone. I had been taking 4 pumps of eostrogen and one 100mg capsule of Utrogestan and so my Utrogestan was doubled and this sorted out the problem in a couple of months.
However, I was lucky and postmenopausal bleeding should always be investigated just in case of a more sinister cause.

This doesn't actually help.

You could have a thickened lining that needs treatment regardless of stopping HRT for 6 weeks.

There was a thread identical to yours not long ago. It seems to be a new 'way' of dealing with this in some parts of the UK.

The bleeding will stop anyway whether you are still on HRT or not.

The correct protocol is usually a scan, followed by a review of the HRT (type and dose) is the scan shows all is normal.

This is not good enough and not really what they are supposed to do.

They are supposed to refer you to a gynaecologist under the two week pathway for an ultrasound scan and potentially also a hysteroscopy (to take a biopsy of your uterine lining) in order to check for cancer and hopefully rule it out.

What your GP has done is inadequate and will rule nothing out or in.

I don't want to scare you, but this has to be done properly. The risks are just too high if it isn't.

@JinglingSpringbells That's the protocol here in the US as well. Measure the uterine lining thickness for any episode of postmenopausal bleeding. They have guidelines for what is considered "too thick" for women who take HRT (and a lower threshold for those that don't).

Further testing is guided by those measurements.

Thanks ladies... interesting the doctor said that ideally I would go for a scan but that she had to wait to refer until I have done the 6 week break... I have to make another appointment for 6 weeks time. ( I'm in Worcestershire if that rings a bell as being one of the UK areas with this policy)

It's totally illogical .

There are 3 reasons for bleeding on HRT

1 Your own period (it CAN happen even if it seems impossible after 3 years. especially if your last period was under age 50.)

2 Your HRT not controlling the uterine lining, due to an imbalance in the ratio of estrogen to progesterone. But this would show as spotting rather than a full-on period.

3 A thickened lining where (as above) the progesterone has not been controlling the lining growth for some time (and this would be 'hyperplasia' and need treating.

Stopping HRT isn't going to prove it was your own period, or if the HRT is the cause.

Again, not to frighten you but purely speculation- if it didn't happen again for years, it could still be hyperplasia, when the situation could be developing and become more serious.

It's also completely unacceptable that you have to stop HRT for 6 weeks (or more) as your symptoms could return.

I'd go back and insist on a scan.

Not sure where the GP is getting this from. The NICE guidelines say something completely different!

• Unscheduled vaginal bleeding is a common adverse effect of HRT within the first 3 months of treatment.
• Monthly cyclical regimens should produce regular withdrawal bleeding towards the end of the progestogen phase.
• Continuous combined HRT commonly produces irregular breakthrough bleeding or spotting in the first 4–6 months of treatment. If bleeding persists beyond 6 months, becomes heavier, or occurs after a spell of amenorrhoea, endometrial pathology should be excluded. See the CKS topic on Gynaecological cancers - recognition and referral for more information.

https://cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/

Hi, I was on here looking for info then I spotted the points that you raised, in particular point 1. Where you say it could be you're own period . I was wondering if it's possible to be on continuous hrt and still have an underlying cycle. The reason I'm asking is because I started on femoston conti 0.5/5 mg when I was 50 ,I was only having a period about 3 times a year at that point,so not period free for a year, yet i was given continuous hrt. I'm 53 and still on the same dose ,it's not helping much ,I have cramps and pms ,awful sleep every month,feels like I'm having a period without the actual bleeding, it's as though my period is trying to breakthrough but can't because of the hrt , I stopped taking it to see what would happen and I bled for 10 days !! So I started taking it again ,been taking it continuous for 3 months since then I haven't had any more bleeds ,but today I'm cramping and have been awake all night,this happens every month.. Do you think this low dose hrt could be keeping my cycle going instead of stopping it,?? Sorry for the length of this question, my docs at gp surgery are useless and won't refer me to anyone even though they don't have the answers !! They just suggested increasing the dose to the 5/10 mg which I tried ,but stopped because they were making feel depressed and didn't improve my sleep. I'm not sure whether just to stop it altogether until my periods stop on their own ,but I can't face the prospect of hot flushes & uti returning! Thanks I would be so grateful for any advice that you can give me x

are you sure that Femoston conti is 0.5mgs estrogen? Most estrogen is 1mg apart from patches that are lower as an option.

Yes, a low dose of estrogen is not going to help much, as you're finding.

Can your GP increase it and maybe try sequential instead?

Hi thanks for you're help, I think I will go to the gp and ask her if I can try sequential hrt ,I think she will probably tell me that it's only for perimenopausal women ,she said that the last time, but I will try anyway,it's worth a shot ,I'm not bothered about the bleeding, as long as I feel better for at least 2 weeks of the month ,anything is better than the way I feel right now. Thanks again

Just don't expect to actually be seen or even sent an appointment within two weeks - week 4 here with no sign of an appt (it also took 3 weeks to get a GP appt to refer me in the first place). To be fair they did do bloods and my cancer markers were perfectly normal which was reassuring and has probably bumped me down the urgency list, but it's hard not to be panicking constantly while I wait!

I had a random bleed after only 5 months (also in hrt) and I was scanned within 3 weeks. Nothing was found luckily. I’d insist on a scan.

I have to say it varies wildly across the country. I had a 2 week wait to have a telephone appt with my GP (in hindsight, I could have pushed for an urgent appt). But from phone call to scan was 4 days, with a hysteroscopy carried out 3 days later (on a Sunday). The results were phoned through to me 4 days after that.
I was very impressed with the service I received.

Yes, that was me!

And I'm still not back on HRT after endless procrastination and pointless referrals by a GP...

Just found this thread while searching for info and reassurance. My situation is identical to the op's, called the surgery this morning and they gave me an urgent same day appointment. Had a basic examination, GP couldn't see any obvious problem so has referred me to gynaecologist under the 2 week referral thing. Have been for bloods today.

Meant to ask, TreeBlindMice, did you get a referral in the end?