Worrying about a hysteroscopy for endometrium thickness - reassurance please!

[Mouth]

I recently changed from sequential to continuous HRT and after a month or so, had a few days of bleeding. My bleeding had pretty much tapered out on sequential, that's why I went on to continuous. But because you're not supposed to get bleeding on continuous and it was my first bleed in a while, I went to the doctor.

Doc referred me to gynae for a transvaginal ultrasound - my endometrium was found to be 5.5mm which they said is a bit thicker than they'd want to see so I have been referred for a hysteroscopy (still waiting for appointment) to check for signs of cancer.

I'm a bit anxious about the procedure itself (no general anaesthetic) but I think I'll cope ok with that as usually don't find smears etc too much of a problem.

Mostly though, I'm worried about any possible findings. I know the thickness isn't that much more than the normal but it is really playing on my mind. Has anyone had experience of a thickened endometrium but had clear results from biopsy?

Thanks to anyone who can offer me a bit of reassurance!

The rule with changing to continuous from sequential is that you can expect odd bleeding for up to 6 months .

If you are not yet at the 6-month stage of continuous, then yes, the lining will be thicker than expected. Whoever did your scan didn't seem to appreciate it takes 6 months for the lining to be thin.

I'd go back and challenge this before going through a procedure. The info on this is very easy to find and your GP should know that this is perfectly normal to bleed when changing your HRT.

This is written by an NHS consultant gynaecologist, Dr Heather Currie (MBE for menopause services.)

You could take this to your GP.

https://www.menopausematters.co.uk/postmeno.php

"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy.

Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.

I disagree. Any abnormal findings should be followed up to exclude endometrial cancer. The investigation is to exclude and not to diagnose. It’s the same for any test. It is a standard approach in all areas of medicine.
As the PP has pointed out it is most likely to be the changes made to HRT but they have to exclude everything else to be certain.
We lost a member of the family during the early part of Covid because routine investigations and tests were put on hold. She had also stuck her head in the sand and failed to attend a couple of appointments was automatically discharged as a result and it was too late by the time she was diagnosed 6 months later.

The NHS still works for some of us so take advantage of the service if only to reassure yourself that all is fine. Having gone through breast cancer treatment I prefer the caution rather than the fear that they haven’t fully investigated the problem. I have a review mammogram yearly. It’s torture ( not physically but mentally) but when I get the all clear I can go back to living my life.

I had this procedure last week because mine was more than 10mm. Mine turned out perfectly fine...no issues. The only explanation they could offer was the increased thickness reading could have been because I had a coil in, which they have now removed. I have to admit I was worried and it spoiled my Christmas a bit. On speaking to friends it seems very common and I know 2 people who it turned out to be because of polyps and they whipped them out during the procedure.I was expecting this to be the case for me so was surprised when there were no issues. I know it is worrying, but there is every chance it will be nothing or just polyps.

But the point is this is not abnormal as the medical quotes show.

It's expected and patients should be told this happens.

The guidance on bleeding when changing to continuous is very clear. The BMS says the same thing. A lining of up to 7mm is acceptable for sequential HRT and some specialists say 9mm. After 1 month on combined continuous it's hardly possible to have a lining of 4mm which is the cut-off for long term combined continuous.

I was sorry to read about your sister @Angrymum22 .

Obviously the OP must do as she sees fit but the situation has occurred by her GP not advising her of what to expect.

I have had the procedure and they found nothing to be concerned about.

However a minority of people find the procedure incredibly painful (nothing to do with your pain tolerance). I would make sure you discuss pain relief before the procedure and agree on what will happen if you are one of the unlucky few. I had an incredibly considerate consultant and team and she gave me choices at each point of the procedure.

@@Mouth If you can, talk to your GP first. On the one hand no one wants to ignore symptoms, but on the other, when all the medical guidance is different to what your GP does, it's worth talking it over.

I understand that scans on the NHS are not usually done by consultants. If the consultant who read the scan is not fully aware of your HRT status, (first month on continuous) this could make a difference. It's worth asking for more info.

Wishing you all the best whichever route you go down.

I’ve had both procedures in the past few months.

The transvaginal scan is fine - like a medium-sized dildo, and they use plenty of lube 😅 my scan was done by a random nurse/technician, who was abrupt, rude and was in no way a consultant!

The hysteroscopy was absolutely horrendous, even done by the most senior gynaecologist in the county, just horribly horribly painful, even though I’d taken Valium and the max possible paracetamol and ibuprofen. Literally like sharp knitting needles being rammed up your cervix and wrangled around. Because that’s exactly what the procedure is. How it’s even legal to do this to women without proper pain management is a disgrace. Opt for the full general anaesthetic if you can.

I agree with @Angrymum22, it's best to get checked out, I was convinced by what other women said during Covid that my bleeding was nothing to worry about just normal effects of HRT changes and the perimenopause, ultrasound showed thickening that was borderline normal for someone on sequential HRT, but it turned out to be cancer and by the time I got it checked it had spread. Hopefully, I'm fine now, but treatment was much worse than it would've been if I'd gone when the irregular bleeding first started.

However, OP, there are lots of other things that it could be, and if it is endometrial cancer, it is usually caught and recurrence rates are very low. Good luck!

Thanks for all of your replies.

Jingling, I can appreciate what you are saying as it makes sense it's likely a transition with changing from one regime of HRT to another.

But I'll go through with it because, as angrymum said, better safe than sorry.

I'll mull over whether to go for GA or not. I just want to do whatever is quickest.

While waiting for the appointment, I seem to have developed some kind of UTI or overactive bladder issue, so that's playing on my mind too.

The joys of womanhood 😩

@Mouth

Do what you feel is best, obviously, to put your mind at rest. Be aware that you may carry on spotting for some time while changing to continuous.

FWIW I've had lots of scans and also a hysteroscopy. I didn't have pain relief although I had the option of a local jab (which you should be offered) or reschedule for a GA. I found the procedure almost painless even though I had to be dilated. I've a friend in her 70s who's had 2 or 3, and she's not found them painful. It's a very individual response.

Are you using vaginal estrogen? If not it's worth trying that too to get rid of the other bladder symptoms you've got.

All the best with it.

I had increased thickening which they said made me at risk of womb cancer. I had three options - hrt, regular hysteroscopies and hysterectomy. Couldn’t take the het due to breast cancer. Had a couple of hysteroscopies under general anaesthetic. Then went for hysterectomy to eliminate the risk altogether, and to eliminate regular ga.

I had this, vaginal bleeding post menopausal. I had a hysteroscopy, and biopsies taken. I didn't find it painful. I expected it to be, because what folk had told me about having coils inserted. It was a gynae consultant, older gentleman very kind. Results NAD and considered caused by continuous hrt.

@Nannyfannybanny Thanks. What does NAD mean?

And @Nannyfannybanny did you stay on the HRT, stop using it or tweak dosage?

I think she means No Active Disease

Bear in mind that you don't come into the category of post-menopausal bleeding in the same way as women not on HRT.

You're different to women not on HRT having PM bleeding, or bleeding after years on one type.

The Hysteroscopy itself isn’t too bad but if they have to take a biopsy that can be painful… they will give you some LA though and the biopsy process only lasts about 20 seconds.

My pain threshold is usually pretty good but I did find it tough and had a little cry to myself afterwards.

That being said I don’t think you need a GA for it.

Hello I have this procedure next week but I'm 44 not on HRT. My scan was done by a consultant and she told me then there were cystic spaces and some thickening.

I contacted my gynaecologist who saw me and said she'd like to perform a hysteroscopy and insert a mirena. This is all private and I'm booked in next week.

In the meantime I found a lump in my right breast! But the GP thinks it's a fibrous lump and wasn't concerned. Nevertheless it's a lump so she's referred me on the two week pathway.

I'm still having the mirena and hysteroscopy - I mean I guess if I have breast cancer the mirena will be removed? I'm not sure how it works.

I will have sedation for the hysteroscopy

agree
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A post menopausal Hysteroscopy story.

To reassure anyone who's up for this: a TV ultrasound - is absolutely fine if done gently. Tell them to be gentle and that you are nervous. Its much smaller than a d*ldo.... :-)

Hysteroscopy - This is a bit more involved. My advice: DO NOT HAVE ONE WITHOUT PAIN RELIEF unless you are 22 and have had kids. I had to have a spinal block and fentanyl (which was fine). Because I'd been neglected and not on HRT it was painful to have my cervix dilated; i'm a. old b. never had kids c. didn't have HRT as my GP may be a very vindictive man. After the Hysteroscopy (which was fine as the docs and the anaesthesiologist were gentle, skilled and understood pain relief) I was diagnosed with uterine atrophy which is why I had been bleeding and sent for the scans in the first place... So I was then given HRT..... which the GP had said 'was unecessary' but has cured a range of horrible symptoms.
all in all, just say you are nervous and need pain relief. xxx good luck.

mirena is progesterone only so you may be fine. good luck x

you can have an epidural anaesthetic (spinal block). it's a bit easier to recover than a general

There is a very detailed and up to date report on this procedure by the RCOG. If you google, you'll find it.

In brief, the report says that around 75% of women find it acceptable without any pain relief.

They do though say that women should be offered a local jab or a GA.
They do not recommend sedation and make it very clear why- higher risk of all sorts of things going wrong, some very serious.

FWIW GPs have recently been issued with new guidance for this investigation (again, all online to read.) The BMS suggests women on HRT are not 'fast tracked' any more as the likelihood of cancer is extremely low. The 2-week timeframe is for women not on HRT who are post menopause.

They suggest that HRT is stopped for a few weeks to see if the bleeding stops and to refer for investigations within 6 weeks if there are still concerns.

FWIW GPs have recently been issued with new guidance for this investigation (again, all online to read.) The BMS suggests women on HRT are not 'fast tracked' any more as the likelihood of cancer is extremely low. The 2-week timeframe is for women not on HRT who are post menopause.

Yet I look around at women who I met as a result of having endometrial cancer, and many of us were under 55, still having periods and on HRT. I wouldn't have met this guidance for a 2WW referral, yet I had endometrial cancer that had spread and no genetic or other risk factors, other than crappy periods all my life. The problem is just because something is a statistical generalisation, it doesn't mean it applies to you.

To answer,NAD is medical shorthand for NOTHING ABNORMAL DISCOVERED. lower dose, nope,we moved just after hysteroscopy,new gp here, refused to prescribe hrt. Cold turkey and symptoms back with a vengeance. Now at 72, vagifem vaginal tablets.. for vaginal atrophy and bladder prolapse.

To help anyone I had my hysteroscopy today. It was private so I had a consultant anaesthetist and a consultant gynaecologist.

Confirmed numerous polyps removed gone off for testing.

I was met individually by the two of them in my room. Anaesthetist first time of meeting - he said I'd be having a GA. Said sedation is not safe - he doesn't have control and I don't have control. He said with GA he can control everything while I'm under, it's a short operation. I'm not sure of timings how long it all took. I was in recovery for a while I believe. The gynaecologist came to see me after and confirmed the procedure went well, biopsies taken. She will see me in a few months time regarding the mirena. I'm not sure when I'll get the results of my biopsies. She indicated weight can cause these issues.

I came in at 730 and I'm leaving in about an hour