Post menopausal bleeding

[Northernmumxx79]

I have had PM bleeding before. I had a scan and a biopsy as my endometrium was slightly above normal range. All good.
It has happened again and I have been told the ultra sound could take 12 weeks. Do you think this is unacceptable please?
Thank you.

You should be put on the 2 week pathway. I had to quote the NICE guidelines to my GP.

I had excessive bleeding and went to doctors in March. She was sure as it was the first bout of excessive bleeding (at the point I went to doctors had been bleeding for a number of weeks) that it was ok and I only borderline met the guidelines to be investigated but she wanted me referred to be safe. I had my scan on Monday past.

and I need further investigation as the nurse couldn't get a clear internal scan. The nurse was fantastic though and thinks it's only due to a fibroid that she couldn't get a clear scan.

was given an appointment when I was there, next one is 4 September

It depends on so many factors @Northernmumxx79

Are you on HRT? If so, they don't consider a scan so urgent because the risk of it being cancer is tiny.

If your scan was 6 months ago or less than that, they don't rush to do another scan.

It also depends on your age. It's possible for some women to believe they are post meno but if they are on the younger side (under 50) there can be some new ovarian activity even after a year.

12 weeks does seem a long time so I'd query it with your GP.

Thank you all. Yes I am on HRT so having researched I feel less annoyed about the 12 week wait. My last episode was over a year ago. At thst time my endometrium was slightly thickened but the biopsy was clear.

@Northernmumxx79 There is a very clear 'flow chart' for GPs written by the BMS on what to do with PM bleeds on HRT.https://thebms.org.uk/wp-content/uploads/2024/12/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-NOVEMBER2024-A.pdf

See page 4. There is a statement there about 12 weeks but as it's over a year since your last scan you should be seen in 6 weeks.

Your GP should adjust your HRT- less estrogen or more progesterone (or both.)

That might mean a lower dose patch or fewer pumps of gel.

If you're using micronised progesterone, the guidance is to try 200mgs every day for conti, or 300mgs x 12 days on sequential.

Have you been offered these changes?

Many women on conti do have thickening and it's usually because they have started conti too soon and are not actually post menopausal.

GP are now being encouraged to get women onto conti after 1 year on sequential, often regardless if they are post meno. This often results in unexpected bleeds.

Could this be you?

Thank you. That is very informative. I am on evorel conti and and topical oestrogen .I haven't been given any advice at all. When I saw the gynaecologist last time I stopped HRT completely but went back on it last November. I will have a read.

I am definitely posy menopausal. My kady period was about 10 years ago. I muddled through with just the vaginal tablets for too long.

Hi @Northernmumxx79

If you’re on Evorel conti & additional oestrogen (without any additional progesterone) then it seems logical that your thickening/bleeding is because the progesterone isn’t high enough to oppose the oestrogen dose you’re on.

Evorel Conti has norethisterone (a synthetic progestogen) which opposes the 50mcg of oestrogen that’s in the patch.
But if you’re on additional topical oestrogen you also might need additional progesterone (body identical or synthetic) to oppose this & keep the womb lining thin.

By topical I think OP means vaginal estrogen. She mentioned earlier she uses it .
No need for more progesterone with that.

I am not saying this to scare you and I am completely recovered now but given my own journey I believe you should be put on the two week pathway. I was put on it twice.

The first time they discovered thickening and removed a polyp during a hysteroscopy. Fourteen months later bleeding happened again, I had a biopsy where they found atypical hyperplasia and suspected early stage endometrial cancer. One total hysterectomy later and they were right but it was all removed with the procedure.

I believe this happened because my HRT was not properly balanced.

Thank you for sharing your story. I think I will contact the surgery again. When I was discharged by gynaecology they said if it happened again it should be 2 week pathway but here we are. Last time the wait for an ultrasound was about 6 weeks.

Yes sorry it's a vvaginal tablet.