Perimenopause and endometrium biopsy

[TreesWelliesKnees]

I'm looking for help as I'm not sure what to do. I was put on continuous HRT a year or so ago by my gynaecologist even though I'm still very much in peri. This was with the aim of stopping heavy bleeding due to adenomyosis. It hasn't stopped my cycle but it has reduced bleeding by at least 50%. My last scan showed endometrial thickness of 6mm and, surprisingly, also showed that I was about to ovulate.

Gynae has ordered an endometrial biopsy as he thinks the lining is too thick. Google disagrees, since I am not post-menopausal and was at a point in my cycle when the endometrium would naturally be at its thickest. I really don't want to have a painful, invasive procedure if it's not necessary. I have no unusual symptoms, much reduced pain and bleeding and feel very stable on my hrt. Does anyone here know anything about this?

I imagine the gynaecologist is the best qualified person tbh.
I was given a ‘surprise’ biopsy during an examination by a female gynaecologist. NGL I’m glad I wasn’t forewarned because Google would have probably terrified me, although it would have been nice to have been able to have taken painkillers before hand. However, It was better than having an injection & filling at the dentist tbh. It was very quick, a sharp pinch and over in seconds. Of course you don’t have to have any procedure you don’t want, but if it gives you answers/options it may be worth considering.

Thank you. My fear is that he's 'trigger happy' - he initially wanted to give me a hysterectomy for the adenomyosis rather than take a watchful waiting approach. Based on my symptoms now that would have been completely unnecessary.

Briefly, OP, the 6mm measurement does not apply to women on HRT who are in peri. The slight issue with you is that you are on combined continuous HRT so normally the lining would be under 5mm. For women on sequential HRT they allow up to 10mm in the proliferative phase.

Have you had bleeding when it's not expected? That would be a reason for a biopsy.

If someone doing the scan is an experienced, they look beyond the simple measurement for signs of anything being amiss. I've had numerous scans (privately) with a specialised gynae. The measurements are only a guide and it's what they can see (as well) that's important.

If you do need a biopsy, on its own, it's actually very simple and over in 5 mins. It's not the same as a hysteroscopy and takes less time (and isn't especially painful.) I had one just in the consultant's room and was back out again in 5 mins.

I'm in peri and have a mirena coil. I had a D&C biopsy as my lining was 6mm.

The consultant took photos too so I could see the areas of concern when I woke up.

All came back clear.

Thank you. I will have it. It just feels a bit overly cautious, but I guess it's better to be sure.