Scan showed thickened uterus lining ... what now?

[GlomOfNit]

I'm on HRT (have been for about 3 years, am 51, perimenopausal and think if I wasn't on HRT I would probably still be having the odd cycle) - currently 3x 0.5mg sachets of Sandrena and 2x Utrogestan capsules for first 12-14 days of my cycle, and I'm also trialing testosterone (Testogel, one sachet spread over 8 days). I've been on testosterone for about 4 weeks.

I was referred for a non-urgent scan last summer and for various reasons missed the appointment. I had been getting weird 'smelly' periods (can't really describe it but it smelled like off meat!) and a GP thought it was worth checking out. They stopped of their own accord and having missed the scan, I didn't rebook the appointment, but in recent months I've experienced some urinary incontinence (not massive, but a bit more than a stray drop at times) so another GP suggested I get rebooked for a scan, 'just in case'. In the interim, I finally got round to downloading the NHS 'Squeeze' app for pelvic floor exercises, and I'm using Oevestin cream. The annoying occasional dribble has almost stopped, hurrah!

However, I had the rebooked pelvic/internal scan a few days ago. Today (2 days after the scan) my GP rang me to discuss the results. She says I've got a thickened lining over what they'd like to see (7mm) and while it's not thick enough to send me off for a 2 week wait hysteroscopy, she's referring me to a gynaecologist who will assess whether that's what I need, or how to go from here.

I asked whether 7mm was significantly thickened, she said it was below 10mm so not too bad, but they wanted to see 3 or below. (I have no idea if the point in my cycle at which I was scanned makes any difference - scan was on 23rd and I would have had my 14 days of Utrogestan from the 1st, then started my withdrawal bleed maybe a couple of days after that course ended ... so I guess I was pretty much mid-cycle.)

She asked if I've had any recent odd bleeding or mid-cycle bleeding. I do get a pinky-red discharge at point of ovulation (which I think still happens) but have had that for years - she wasn't bothered by that. I also get a sort of 'false start' period about 4 days before it starts properly - sort of starts then stops. She wasn't worried about that either, and I haven't had any bleeding that starts up mid-cycle. (of course this is now getting me worried and doubting my memory of what happens...)

Anyway, she said the referral is non-urgent, I'm not to worry, but in the interim I should either reduce my oestrogen or stop HRT altogether. I'm happy to drop a sachet of the Sandrena which would take me to 1mg daily. But now I'm dithering about whether I should just stop.

This is pretty common, right? I'm trying not to freak out but I do have health anxiety.

I’m the same. Waiting for gynae appointment next week. I’ve stopped the hrt but not sure whether that was right thing to do or not. I’ve got an under active thyroid and apparently that can cause hyperplasia.

@GlomOfNit
Dont stop the hrt
if anything slightly reduce the estrogen . That’s what builds up the uterine wall. But I’d give yourself a few months reduction before going back and at start of cycle.
I was on 4 pumps of estrogel and had same concerns from dr had ultrasound and hysteroscopy. First I was 7mm a year later having gone to 3 pumps of estrogel it had gone to 3.4 mm and all healthy .
i suppose we should be thankful that they are proactive about it but it was very alarmist and made me worry unnecessarily

How long have you been waiting, Thelma? Was it a 2 week referral or a non-urgent one? Hope it all goes well next week.

How did you find it, coming off - was it a sudden stop or did you ease off it? I'm no longer sure what HRT is doing for me - it feels a long time ago I started, though only 3 years, and I had a whole bundle of symptoms and complaints, some of which I think went away, or changed ... These days I feel exhausted, achey, foggy ... might have to accept that this is just ME!

ys, reducing the oestrogen is what she suggested and I'll definitely do that, down from 3 to 2 sachets... GP kept saying that 'we want to give patients the lowest dose that still works, with the lowest dose being zero HRT' I know what she means but I went on it for a reason. This is the same GP who used to wag her finger and tell me I wasn't perimenopausal because I wasn't ticking her three boxes of missed periods, dry vagina and daily hot flushes though, so ... and she also tends to say 'you are only allowed to be on HRT for 5 years so we don't want to start you off too early' (not all the GPs at that practice are like this!).

Literally just got my all clear from similar. I was only 5.6mm but they put me on the two week path. I don’t take HRT, I had a Hysterscopy where they took a biopsy, during the procedure they found a massive polyp which they said at the time was the probable cause of the bleeding. I’m now waiting for the polyp removing. It took five weeks to get my official all clear, the nurses told me at the time it all looked ok, but they couldn’t guarantee it until I got the results. They also said that they get women in with as much as 18mm thickness and they turn out to be fine, so my 5.6 and your 7 isn’t much.

If I've understood this correctly @GlomOfNit you're using sequential HRT? On a cycle?

The womb lining is thicker on sequential HRT and the only reliable measurement has to be done immediately after a withdrawal bleed. So that's usually Day 6 to 7 (counting the first day of the bleed as Day 1.)

If you didn't have yours done at the point, the lining is of course going to be thicker. And assuming you normally have a withdrawal bleed each month.

The measurements you've been told aren't applicable to women having a scan using sequential HRT. The lining can be much thicker towards the end of a cycle when the bleed is due to start. Just like a normal cycle, without HRT.

The limit of under 5mm apply to women who aren't on HRT or who are on continuous HRT.

Good luck with it
sometimes I do wonder if it’s all worth it the constant juggling and side effects
I can’t tolerate progesterone well at all but that’s another story.
You may notice a change in how you feel when you first drop the estrogen amount but I levelled out .

Hi -thanks for your comment. Yes, I take the progesterone sequentially, starting on the first of the month and take it for 12-14 days, 2 caps.

I don't really keep records of my cycles (I'm starting now, though!) so it's hard to pinpoint exactly where I was on the 23rd. At the moment I've been starting my withdrawal bleed a day or two after I stop taking the utrogestan (in the past I've sometimes started bleeding while still taking it). I think my bleed started around the 14th and if that's Day1 of my cycle, then I had the scan on day 10?? It was a pretty light bleed this month though. So - not sure what implications that has for the thickness observed. They certainly didn't schedule the scan for a particular point in my cycle, I got the date I was booked in for.

The scan result for a sequential regime doesn't seem abnormal.
I can't PM you as I think PMs are disabled, at the moment, and I don't want to share too much here.

The lining on sequential is never as low as for other types of HRT (or for women post meno and not on HRT) and goes through the same stages of proliferation and shedding as on a natural cycle.

So unless your scan is immediately after a bleed, the lining will already have started growing again with the estrogen you use.

I don't know why your GP thinks 7mm is an issue when it's some way into a cycle.

The other issue here @GlomOfNit is who did the scan and what information did your GP put on the form?

If your GP just put 'post-meno bleeding', or nothing at all about HRT, without saying you're on sequential HRT, then whoever did the scan may have not understood what they were assessing.

And your GP must make this known to a consultant before your appt.

I am in similar position but don't take hrt. 7.5mm and urgent referral for biopsy under GA but sadly in Scotland that means a 3 month waiting list rather than 2 week referral.

From speaking to colleagues, this is really common, but it's still stressful. Good luck

The scan was done in the outpatients ultrasound department of our local hospital (the JR) by a sonographer who didn't share any of his observations with me - that tends to be standard, they rarely say anything if asked, just that the data needs to be looked at and then sent to GP.

The sonographer knew roughly what part of my cycle I was at, and asked if I was on HRT. I'm assuming the fact I was on HRT was part of my referral. Scan wasn't referred for bleeding irregularities , it was because of slight urinary incontinence, BUT initially the scan I should have had late last summer and missed, was because of slightly odd smelling bleeds (I think! I've had a couple of scans the last few years) and niggling pains on my right, which I think are just normal for me, have had them several years.

Having said I almost always get a slight bloody discharge around point of ovulation in my cycle, last night (which was about day 14) I got a bit more bright red spotting than perhaps usual, but now I'm second-thinking and doubting myself - is this in fact what I usually get, and I'm now just hyper-aware about it and anxious because of the scan?? (yes I have health anxiety) I spent a horrible night freaking out about this in a half-awake state and convinced myself I'd been lying to myself about what the mid-cycle spotting looks like. It really IS just spotting though, I think (as in, it's what comes off on the loo paper if I wipe slightly internally when I go to the loo, as opposed to something I'd want to use sanitary protection for).

So now I'm a bloody basket case and wondering if I should call the GP and tell her this and ask if she thinks I need to be bumped onto the more urgent pathway ...

Sorry to hear about your long wait, Sunset88, that would drive me into a horrible anxious place. I do think it IS pretty common though, I've also spoken to a lot of my friends of a similar age or a bit older and most of them have had this. Hope your spot comes up soon!

I have a trans vaginal scan on Wednesday for post menopausal bleeding I had an ultrasound a couple of years ago which showed thickening but on the cusp. I have been referred under the suspected cancer route although my provera was increased to 10mg a few weeks ago and I'm hoping it's due to that. I wasn't told to stop my hrt (100mcg patch) but I have dropped back to 5mg provera because the extra was making me feel ragey and off.

good luck op and let's keep each other updated

And you also @Sunset88 and anyone else as well 😊

Why would your GP think a scan would show anything to do with your slight incontinence. You should have been referred to a women's physio for an assessment and treatment with exercises and biofeedback devices.

The only reason usually for a scan is bleeding outside the regular pattern on HRT, not 'smelly' bleeds.

I'm sorry but i think your GP is putting you through the wringer and possibly wasting NHS time, for no sound reason.

You aren't having post meno bleeding, your lining wasn't thick for sequential HRT (it can go up to 10mm mid cycle and not be an issue based on what I've been told by consultants).

I expect when you do see a consultant they will tell you that there's nothing wrong.

I was put on the 2 week pathway, I’m perimenopausal and on HRT. I was out on it due to extreme heavy periods and continuously passing large clots during my periods. I had a scan which showed a thickened lining of 15.8 and a couple of weeks ago had a hysteroscopy to asses. They didn’t find anything alarming and I’m waiting for the results of the scrape they took. Should have them over the next week or so. The doctor said he doesn’t have any concerns and this is quite common. He fitted the coil whilst I was there which will hopefully help my periods immensely.

Is there a reason you take the Utrogestan for the first 14 days of your cycle? In sequential HRT it's more usual to take it during the second half of your cycle, so days 15-26 (or two weeks) then have a withdrawal bleed (although not everyone gets one).

@Fayrazzled Are you asking for yourself or just generally?
It's not always possible to time it to the 2nd half of a cycle in peri meno because cycles become longer (with gaps lasting months between periods) or shorter (less than 4 weeks.)

Most women in peri aren't having natural 4 week cycles. Even if someone starts it mid cycle for the first month, they won't continue to ovulate regularly, or at all.

HRT overrides a fertile cycle and creates an HRT cycle. Many drs now suggest starting the progesterone on the first day of a month and sticking with that.

Update:
Well, I was called by the community gynae today to do a telephone triage, as she wanted to clear up some of my timeline and get more details. (It seems she thought I might have been on continuous progesterone, based on suggestions from the menopause clinic IF my bleeds were very scanty or not there for more than 3 consecutive cycles. I didn't get that for 3 in a row so continued on sequential. Which my GP knew but maybe that didn't filter through...)

Basically I told her everything I've outlined in my initial post, plus that, following my GP's suggestion to cut down (or stop!!) my HRT I dropped it to one SAndrena sachet, so 0.5mg daily (I KNOW I didn't need to drop that much but I was curious to see what it would be like on a lower dose. Some side breast pain and a couple of night sweats, if that's linked).

So the community gynae was very nice and took a lot of notice of what I was saying - BUT because I'm over the parameters they have for thickness on sequential, plus I have 'erratic bleeding' (which she defined as more than once a cycle, because of that pesky 'false start' to my period that I've experienced as normal-for-me for years, in fact before starting HRT) that ticks the boxes for a urgent 2 week referral for a hysteroscopy.

I did go back and forth with her on why this pattern that I've had for ages was suddenly of concern but it's because they have the new data on thickness, plus she did point out that although it's to be expected that my natural hormones are breaking though from time to time (I'm fairly sure I'm still perimenopausal and not passed menopause yet) sh said the HRT should be controlling the bleeds. I don't think I misrepresented things, I just hope she really did get what I was saying about some mid-cycle spotting around the time I'd ovulate, plus this 'false start' where I bleed a bit for 2/3 days then it packs up for another 3-5 days and then my period starts. But it's a really regular thing, not erratic.

Oh well. I'm going to opt to have this under a GA. I get cervical shock, as I found out after 2 MCs and an ERPC op. She thinks it's extremely unlikely to be down to anything sinister but they want to rule everything out. Thinks it's more likely down to my HRT, but I am ticking their protocol so ...

In the meantime, she said I should up my progesterone to 300mg a day during the 14 days I take it. And said I was free to bring my Sandrena sachets back up to 1mg or even 1.5mg if my symptoms were coming back.

Good luck with it GlomOfNit and please update as you'll get yours before me i imagine (2 weeks down, 10 to go...) My symptoms and bleeding are all predictable too but best to be checked fully I guess.

I will. We both need to be chill and remember that it's extremely unlikely to be anything bad. Hope your date comes around soon so you can get it done and over with.

I'm trying not to over-think this but ... I hate cannulas, I hate hospitals, but I know about my cervix and what's happened on previous occasions when it's been dilated without its consent (MC, ERPC that took ages and a consultant stepping in because they couldn't dilate it, the odd very painful gory period in my youth - all resulted in a lot of pain, greying out or fainting, and feeling like I was dying - no joke, I get this 'presentiment of DOOOOM' feeling which I've since learned is possibly vasovagal in origin). I'm also a bit worried I might actually have something awry in there but I do know the chances are slim and that they're being very cautious.

So no - I don't really want a GA, but I also don't at all want a rummage in there without being unconscious, and I don't at all fancy the idea of several local anaesthetic injections into my cervix either! Feels like a shit sandwich, but hey, at least we do have the NHS and I don't have to dig deep into the empty coffers to fund this.

Keep Chilling both of you xx - it seems like all roads lead to hysteroscopy.

tiny update: was rung by the gynae dept while I was out and unusually hadn't got my phone on me! This felt quite 'lucky' though as I could control when to call back, collect myself a bit, get my notes in order and bring up my TV scan result on my patient record. The woman booking in wasn't remotely phased by my saying that I felt very strongly I would prefer to have this under a general.

But - of course! - since I wasn't taking the outpatient appointment offered within 3 weeks of referral, I would have to wait to be phoned by a consultant who would talk to me about the GA procedure. I'm not sure why this has to happen, rather than me just being put onto the waiting list for GA hysteroscopy. And she didn't know how long that would be! So now I feel quite conflicted, but I think it's probably too late now to change my mind and grab that outpatient appointment.

Hopefully not for ever. https://www.ucl.ac.uk/news/2025/mar/new-womb-cancer-test-available-women-uk#:~:text=The%20test%20looks%20at%20'tags,cancer%20is%20present%2C%20or%20not.