Bleeding after menopause

[BarrelOfOtters]

I had a Mirena put in a year ago. I’m 54 and been peri for 10 years. I’m spotting so gynae wants me to have a endometrial biopsy or come off HRT. It seems that if I carry on spotting I’ll have to come off anywy or have another biopsy in x months…?

im thinking just come off it.

I was spotting because my coil had slipped down. Have you had a scan ?

The chances of anything seriously wrong when you have a Mirena are minute.
Gynae sounds as if they are overreacting.
The first step would be to have a scan.
You are only 54 and it's not sure you are post menopause anyway .

I'd see another specialist to be honest. Ask your GP for another referral.

No need to stop HRT!

I’ve had a scan and all fine. But that can’t tell you how thick the endometrium is. I really don’t want a biopsy as the coil insertion was fairly horrific and he said this would be similar.

I’ve had a scan and all fine. But that can’t tell you how thick the endometrium is.

A TVS (transvaginal scan) can tell how thick the endometrium is.

(I've had a lot of these scans and the readings always show the thickness.)

Did you just have an abdominal scan?

As PP said the transvaginal scan will tell you. Mine was 16mm

Sounds like they want to do a hysteroscopy. If you know you can't cope with it while awake, insist on having it done under general anaesthetic. Don't allow them to persuade you otherwise, if it needs doing then that's your line in the sand. Have been there myself and there's no way I could ever have that done while awake.

As others have said a transvaginal scan can measure the thickness. I had it done recently and was ok.

The attempt to do a biopsy was not! I should have known better than to even start a procedure when the gynaecologist asked what my pain threshold was like.

Before Vaginal atrophy I may have been able to tolerate it but definitely not now. The procedure was abandoned and I have it on my notes that a general anaesthetic will be required if they ever want a biopsy.

i had the scan with the probe inside and that said 7 mm (I think) but said because of Mirena I needed the biopsy done.

I had a hysteroscopy and biopsy very recently. Everyone is different, but the hysteroscopy was in no way painful, the biopsy made me jump and was a bit painful, but that pain had gone by the time I had my knickers back on.
I would not have a general anaesthetic for that personally.

Has anyone measured your hormone levels, or looked at your ovaries to see if you are still ovulating? You say you are post menopause, but with a Mirena, you won't know.

They can do a biopsy without a hysteroscopy. The procedure is minimal and shouldn't be painful.

I had a biopsy and it was just like a smear test, bit uncomfortable but quick - I didn’t have a hysteroscopy for it (although that came later). I would always suggest that any post meno bleeding should be thoroughly checked though, much better to be on the safe side.

I didn't think with a mirena/HRT there was any way of telling if I was actually menopausal -without coming off it all.

His view was that if I stay on the HRT and carry on bleeding I'll just have to have the biopsy at some point. Or come off HRT and see what's what. I'm summarising.

didn't think with a mirena/HRT there was any way of telling if I was actually menopausal -without coming off it all.

That's right.

Which is why an investigation for 'post meno bleeding' doesn't really apply.

The Mirena coil is a treatment for a thickened lining.
It's far more likely you have had a hormonal surge, perhaps one last ovulation, and this is the result of that.

How long have you been spotting?

Spotting on and off since Mirena put in a year ago.