Thick womb lining despite Mirena

[Inapickle2]

Hi everyone,

on HRT for 3+ years, in perimenopause so have regular periods. Decided to get Mirena as both HRT and contraception. Spotting and bleeding for 3 months, which I was told is normal as the Mirena settles.

3 months on had a massive bleed so went to clinic where nurse said Mirena was on way out (second time body has expelled). So it was taken out and lo and behold a week after, bleeding, clots, cramps started.

visited GP who said it is expected but as there’s a possibility that Mirena was on way out, may not have been in right place to begin with. TV and pelvic scan has shown thick womb lining and now been referred to gynaecology via 2 week pathway.

i have an appt. in a couple of weeks. Still taking HRT including Utrogestan and have still had massive tissue clots being expelled.

anyone else had this? And if you were seen by gynae what was the outcome?

x

There is a standard series of investigations for this.
The first is what you've had- the scan.
The next step is likely to take a tiny biopsy of the lining, either with our without a hysteroscopy.

Bit confused as you say you've been on HRT for 3 years but the rest of your post says you've had the Mirena for 6 months.

So did the Mirena work for 2.5 years ?

And how long have you been on Utrogestan?

Depending on the timing of your scan, the lining could be as thick as 'expected' for someone with regular periods that are not being controlled enough by Utrogestan.

Are you using it in a cycle or daily? Are you bleeds a withdrawal bleed or happening at other times?

Sorry not to have any real answer but it you can get your head around the timing of bleeds, periods etc, it will help at your consultation.

The outcome is likely to be take a biopsy and then re-assess your type and dose of progesterone.

Thank you for replying @JinglingSpringbells I really appreciate it.

i was on Utrogestan (cyclical 12 days) for most of my HRT journey.

only recently switched over to Mirena and stopped the Utrogestan as a I thought I was getting the adequate amount of progesterone. Had the Mirena for 3 months in total.

after having it removed I’ve gone back to Utrogestan.

prior to switching to Mirena I was very regular with my bleeds and had only a few cycles where they may have been shorter or longer. Otherwise very predictable and uneventful.

I would’ve thought with the Mirena being in place for 3 months that my lining would not be so thick. So the only explanation must be that it wasn’t in the right place to begin with hence all the issues now.

As you say, until the appt. won’t know what is the probable cause and the what dose of progeserone I need. A waiting game until then!

I wouldn't worry too much.

I've had lots of scans over the years, some as an MOT.
I arrange them after a withdrawal bleed (am post meno) because otherwise it's not an accurate reading. (They are done privately.)

If you're peri and still having periods and were scanned mid-end of your natural cycle, or even an HRT cycle, the lining will be thick(er.) They allow it to be up to around 10mm on HRT if it's not straight after a bleed and maybe more if you're in peri.

I'm assuming as you're now waiting to see a gynae that whoever did the scan wasn't a consultant gynae, or aware of where you were in your cycle so wasn't able to make any diagnosis, other than taking a measurement?

You need to take as much info with you to your appt to discuss this unless your scan was done by a consultant who had all the info at the time.

I'd not worry- it is likely to be your own cycles and nothing too serious.

Thank you for reassuring me! The scan wasn’t done by a consultant or gynae specialist. And hopefully it isn’t anything to worry about.

thank you for taking time out to reply. Honestly, very much appreciated ☺️

Hi OP. I had a scan 8 months after mirena going in, mainly because I was under a gynae for something else so he suggested a scan when I told him how much I was bleeding.

My uterus was 7mm which as I am only in Peri he felt was OK, but he did a hysteroscopy d&c anyway to check. I had general anaesthetic which is just as well because I was on the ceiling with pain for about 4 days after the procedure.

I got some super photos of the inside of my uterus and the biopsy was fine. He said the mirena was controlling the lining OK and to carry on with it. I am on 100mg patch and very well oestrogenised.

If i were you I'd get the hysteroscopy done under GA and have another coil put in.

@Notsurewheretostarthere thank you. I’m also on 100mg patches and 3 Utrogestan tablets taken cyclically (now that the Mirena is out).

my body seems to reject the Mirena, has happened twice now. So not sure if I’ll be third time lucky if gynae suggest it again! I’m not averse to a Mirena in any way but just need it to stay put and do its job properly.

If I am offered a hysteroscopy, I would choose to have it under a GA. Struggled with the pain when the Mirena went in so imagine the hysteroscopy is worse.

@Inapickle2 mine was private so going without GA wasn't even an option! He does them all with a general, something the NHS could learn from.
. Good luck!