Perimenopausal, mirena and endometrium too thick

[HalfasleepChrisintheMorning]

I’m 48, with a big gynae history- endometriosis, polycystic ovaries, lots of gynae ops and one child but 3 pregnancies.
I had a mirena fitted under GA in November 2022. I think I still have my own cycle in the background but am on 1mg Sandrena for HRT peri symptoms.
I have light spotting most of the time. I mentioned this to the GP at my HRT review and she sent me for a scan. Scan has showed endometrial thickness 5.1mm, fibroids and an ovarian cyst. GP has fast track 2ww referred me to gynaecology.
Trying not to panic. Any experience?
I think I’ll need a hysteroscopy but I will only have it under GA. Are NHS ok with this? I’m in Bupa but GP said stay nhs due to it being a fast track referral?

I had similar (but without the history), mirena and post menopausal, I thought. Spotting turned to heavy bleeds. Referred under 2ww.

Scan showed thickened lining and cysts.
Did have hysteroscopy and that showed polyps, which were removed. Biopsy clear. Been fine since (3 yrs).

I didn't get offered GA. (Didnt get offered anything, just told to take paracetamol). If you want one, you might need to be insistent. I have seen here plenty have managed to get GA under NHS. I think it just doesn't get "advertised".

I hope it all goes well x

I’m having one next week under GA, first time I had one without GA and they didn’t get very, has them with GA since.

That measurement of your lining is pretty much normal.
For post menopausal women the cut-off is 5mm.
In terms of accuracy of the scan 0.1mm is neither here nor there and that depends on the experience of the person scanning as well.

You probably aren't post menopausal and being blunt, anyone scanning should be able to see your ovaries and see ovarian activity. Ovarian cysts are often the result of ovulation.

The issue is the NHS uses technicians (often nurses) to scan, not consultant gynaecologists or radiologists, so anything that is a teeny bit unusual gets fast tracked for another look.

I'd be surprised if you do need a hysteroscopy but wait and see.

The wait is more likely to be 6 weeks (the 2 weeks is optimistic in some areas) so you have plenty of time to see a gynae of your own choice through your private health cover.

Just to reiterate the measurement of over 5mm applies only to women post meno.

In peri it can be much higher- up to 16mm at the end of a cycle- and although the Mirena will control this to an extent, it's not always going to be under 5mm.

This is so reassuring thank you.
I’ve booked in with a Consultant gynaecologist a week on Saturday via Bupa. If the NHS come through before that I will go, but if not I am happy that I will be seen.