Thickening of Endometrium

[raspberrymilkshake]

Hi , I’ve been on HRT for fours years and had a pelvic scan last week due to spotting I’m on 75mg Everol and 200mg Utrogestan.
Im so tired of it all , the Dr phoned today my Endometrrium is 4mm and he’d like me to have a Hysteroscopy, I’m just can’t find the correct balance with HRT all is good for a while then I start spotting . Does anyone know what thickness the Endometrium should be please ?

Hi Jennylamb, I’m so sorry to hear about what you went through , how on earth can Dr’s put women through this agonising pain , I think GA should be offered straight away
I totally agree about the cervix , you must have been in agony .
A Gynaecologist is phoning me next week so I’m going to ask the question and I’ll let you know
Thankyou for your honesty it’s greatly appreciated

I had a hysteroscopy today. My notes say ET 11. Anyone know if that's the thickness of the lining? They've recommended a coil and said the progesterone in the HRT I'm taking could have caused the thickening.

You’re welcome Milkshake, some women it seems get on OK with it, they did keep asking me if I wanted to continue and stopped immediately when I said no. Have a general anaesthetic arranged now. I did read that in 10% of cases a hysteroscopy can cause an involuntary vasovagal response which means that you may have a drop in blood pressure and pass out. Like I’ve said though some women are fine with it, I don’t know why people are different. The important thing is that you get things looked into and do this in a way that you are happy with.

I ve just had similar - thickness of 4.9 and I’ve been changed to continuous after having been put on sequential incorrectly it seems.

I had the hysteroscopy after the scan - I cried when they got all the kit out as I wasn’t expecting to have it done and it
s not pleasant but no worse than a smear for me and everyone was really nice. It was quite fascinating really seeing it all on camera. I did feel a bit faint after so had tea and biscuits with a lovely HCA. I know we are all different but hope my experience helps you worry a bit less.

Best get it all sorted but this hrt business is so confusing and contradictory advice. Pretty sick of it all to be honest.

I don’t know how true this is but it’ll be another question for the Gynaecologist but apparently it’s easier if a woman had a natural birth 🤷‍♀️
I have one child and that was a C section
I’m sick of it all too the benefits of HRT are good but the constant problems are getting me down

If think this was true because they used to say the same about inserting the coil

A Gynaecologist is phoning me next week so I’ll let you all know

I thought it’s the estrogen that causes the thickening of the uterus?

I‘m also struggling to get the correct balance between estrogen (Estrogel) and progesterone (Utrogestan) as I’ve had several episodes of spotting and scans. Maybe I need to take 2 Utrogestan’s daily?

I’m on 75 Everol & 200mg Utrogestan but still spot which I why I had to cut the patch to 62.5 which is a rough guide advised my meno Dr
I agree it’s the Estrogen that causes thickening my spotting has stopped since reducing the patch dose

@raspberrymilkshake May I ask how you take the 200mg Utrogestan? Do you have a prescription for the 200mg tablets or do you just take two of the 100mg tablets together?

Sounds like reducing is the correct thing to do. I had to have a hystercopy a couple of years ago when there was a shortage of ultrogestan and I was put on the combined patch which led to bleeding. It was recommended I was put back on my previous regime (duh…). But the doc did say that if I continued to have bleeding/spotting a coil would be recommended (which I don’t want), and to also keep as low a dose as possible on the patches.

@Sandmaennchen Just so you know- the 200mgs capsule is not for oral use. It's a pessary for vaginal use. It's actually only licensed now for fertility treatment but can be prescribed off-licence for vaginal use as part of HRT.

If you need to take 200mgs orally you just take 2 x 100mgs.

You can also use 2 x 100mgs vaginally.

Something to consider which I have never in over ten years is the coil. It has been great. No more bleeds or tablets. I just apply the gel in the morning.

Not an expert but would using utrogestan vaginally help with this issue as some believe that using it vaginally targets more of the hormone directly where it is needed?

I take two 100mg of Utrogestan orally not a 200mg capsule . What are the chances of me not needing a Hysteroscopy if the bleeding has stopped? I’m dreading the call with the Gynaecologist

I've done exactly this. Kept bleeding and the GP kept changing my dose. Been off it 2 months and apart from a few aches I'm fine.

In a post menopausal woman (whose had 12 months with no period) the endometrium should be no more than 4mm. Where I work all women with post menopausal bleeding whatever the thickness of the endometrium are offered a biopsy.
we frequently see patients with post menopausal bleeding or bleeding whilst on HRT, it's seems to be very rare that a good balance of HRT with no bleeding happens

The guidance is that it's 'watched' for 6 months after a reduction/change in HRT.
4mm is not considered thick. The criteria is 'more than 4mm.'
It's more the fact you were spotting.

You can't be forced to have a procedure. It should be a conversation over pros and cons. If you don't want one and it's suggested, discuss it.

Where I work all women with post menopausal bleeding whatever the thickness of the endometrium are offered a biopsy.

But not necessarily when on HRT.
That's the difference and it's an important one.

There are also biopsies without a hysteroscopy. The biopsy is done using a very thin instrument and can be done there and then in the surgery/clinic.

How do you know if you have thickening?

I had a pelvic scan