Thickened lining - worried

[dunant173]

Hello
Last week, I had a 'period' after being postmenpausal for nearly 2 years. I've been on sequential HRT (they should have had me on continuous but no one picked it up and it was only when I asked last week that the Dr admitted I had been on the wrong sort of HRT). Back in July, the Dr raised my oestrogen levels because she said they were too low and that I needed to protect my bone health. It was after this increase that the bleeding happened, so I am hoping it is to do with that.

HOWEVER, today I had two ultrasounds and one of them showed that my endometrial lining was thicker than it should be. The radiographer said it was probably due to the oestrogen especially since I've not been having the correct amount of progesterone to balance it out. She said she was going to recommend I be referred to a gynaecologist now about this and that I should call my GP tomorrow to discuss the results of the scan.

At work, I received a text message saying that they had already booked a phone call with the GP tomorrow to discuss the results and this is scaring me because usually my practice is pretty useless and takes ages to do anything. I am freaking out about what all this might mean. From my own reading, it seems as though I have endometrial hyperplasia, which can either be benign or not-so-benign and it's going round my head. I've just been given the all-clear from Long Covid and now have this to worry about - just when I felt I was getting my life back together.

Sorry ... Has anyone here had this experience? What happened next? I am expecting to be told to have a biopsy of sorts which is also frightening me.

Thanks.

Do you have the measurements?
It's very hard to comment , without that information.

I'm a little confused about what you have been told.

If you are on sequential HRT then you will have a gradual thickening and thinning of the lining over the month. You should also have had a withdrawal bleed each cycle.

Was this happening? OR do you mean you were using only estrogen and not Utrogestan or another type of progesterone?

You don't actually need to be on continuous once you are post menopause (it's a choice, not a mandatory rule.) So nothing 'wrong' has actually happened in that sense. If you mean you were using only estrogen for 2 years then yes, that is not right.

The lining thickness on HRT can go up to 10mm during the 2nd half of the cycle, and then reduces to around 4-5mm after a bleed. But even these measurements are a guide.

If someone is on combined continuous HRT the lining should stay thin (below 5mm) once the regime has settled after 6 months.

@dunant173 Do you think that using Utrogestan for 12 days a month was 'not the right amount'? Is that your concern?

It's the prescribed regime and can be used by women for many years, right into their 60s and 70s if they can't tolerate daily Utrogestan.

If you had a bleed, was this out of the normal cycle when you'd expect it? (And if you have recently switched to combined continuous, bleeds are known to happen for at least 6 months.)

If your scan was not right at the end of a withdrawal bleed it's not an accurate measurement because the lining will have started to grow again.

If you have just moved onto combined continuous, then the lining can take 6 months to become very thin.

I hope this reassures you!

Thanks for the reply! I have been on sequential HRT for nearly two years. I stopped having any bleeding 20 months ago and I heard that once you are officially postmenopausal, then you should be taking progesterone every day with no break as there is no bleed?

I began bleeding spontaneously last Wednesday and my doctor referred me on the two week pathway. It was like a proper period, with cramps, so I was hoping it was as the result of another GP increasing my oestrogen in July without balancing the progesterone. The GP I spoke to said I should have been changed onto the continuous HRT but wanted to check my blood hormone levels first.

Anyway whatever happens with the hormones, I've decided that I want to stop the oestrogen (looks like I will have to take progesterone to try to decrease the endometrial lining - I don't have the measurements yet as the radiologist didn't give them to me). But I'm scared about what has caused the thickening. Especially as the radiologist thinks I should be referred to gynaecology. Hopefully it's benign but I can't help worry. I'm also frightened of having invasive procedures and biopsies.

Ps the bleed was after finishing the 12 days of utrogestan but this has never happened to me before.

I heard that once you are officially postmenopausal, then you should be taking progesterone every day with no break as there is no bleed?

No.

It's a choice. Some of us can't get on with the side effects of daily progesterone and I'm still on cyclical after almost 15 years, from a very expert menopause gynaecologist.

Bleeding on sequential- most women do bleed but something like 20% don't.
The fact you have now is not really relevant but might be because (if I've understood correctly) your GP suggested you increased the estrogen dose. (from what to what?)

Your GP appears not to really understand HRT and the fact you were referred for a scan was a waste of time and not necessary. It's quite shocking that they don't understand that more estrogen is likely to promote a withdrawal bleed.

Yes, the lining would/ will be thicker as you are on sequential HRT and that's what happens each month. The person who did the scan is not qualified either to make a decision and they will have assumed you were post menopausal and not on cyclical HRT (I assume.)

To be honest, your GP needs correcting because all your experience does is show they are confused.

I'm sorry you are worried but it's because you have been misinformed.

Also the bleed is a result of the sequential HRT regime. It will carry on as long as you are using that (except some women don't bleed. This is because some women are using a low dose, and not enough to build up the lining to be shed, or their lining responds less to estrogen stimulation.) It's not your own period.