Post menopause bleeding - 2 week wait - really anxious

[HelenHywater]

I started HRT in the summer and have had bleeding on and off throughout. I assumed the bleeding was just my body getting used to the HRT but the doctor was less relaxed and referred me. Scan on Thursday. I also had a smear test this week and the nurse could see blood. So now I'm terrified!

If you've gone through this what was your experience?

In my simple understanding oestrogen causes a build up of the lining of the womb. If you're suddenly getting bleeding this could be the cause. I've read bleeding is common in the first 6 months of hrt. If you're post menopausal and have had no bleeding for a year they probably have to check it out as a matter of course.
Obviously the medical professionals are the best people to check things out with.
Many things trigger a 2 week wait but are usually nothing to worry about. They just have to follow certain guidelines.

What exactly has happened @HelenHywater

If you're using HRT on a cycle, odd bleeding is common. It can also be your own cycle breaking through if you're not post meno and usually over 54.

If you're using combined continuous (both hormones daily) bleeding for up to 6 months is normal and on the patient info leaflet. To use continuous combined HRT you should be 54 or over, or no period for at least 12 months if you're under 54.

If you start continuous too soon, odd bleeding can happen which is your own hormones overriding HRT.

Your GP should know this and if it's not yet 6 months medical guidance is no scan.

If it's over 6 months on continuous HRT the guidance is to adjust the HRT as the first step but dr's are to use their own judgement- ie if you're younger and not post meno then it's likely to be HRT related.

Be assured that anything serious when on HRT especially for such a short time is very very rare. A tiny number.

It sounds more like to be your body adjusting or an incorrect protocol.

I started a month or 2 after my 55th birthday (I think it was June or July this year) (that's the HRT not my birthday - I know when that is!) around 16 months after my last period. So am on the continuous regime. I did increase the oestrogen but not the progesterone (which I take vaginally because I'm traditionally pretty intolerant of it), so I was hopeful it was that causing the bleeding (which is really light and only when I wipe really).

I'm probably not 6 months into HRT yet - or only just.

Thank you everyone. I'll try to stop worrying about it (too much)

It’s normal to go on the two week wait for this type of thing. It’s understandable that you are worried but chances are you are fine. They are just ruling out the small chance of cancer.

Your GP has jumped the gun a little bit because the medical advice states that odd bleeding is usual for up to 6 months. There is advice on this online by consultants like here.

However, a scan is straightforward and should put your mind at rest. Try not to worry.

https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved.

When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin.

Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations.

Always exceptions to this. I'm 53, not at menopause but a consultant has recommended continuous HRT for me due to severe pain and difficult periods. And i have fibroids - which is another reason against me being on HRT..but again - all looked at by a consultant and decided upon. Seems there are no strict rules but general guidelines which always have exceptions

Yes, you're right, there are always exceptions.
You are 53 so likely to be post meno pretty soon - average age is 51.

There's a link to medical guidance earlier in the thread mainly for anyone who might need it.

The issue is that quite a lot GPs seem to put women onto continuous early (lots and lots of examples here) and that sometimes causes problems because HRT doesn't control their cycles and they end up having the stress of investigations.

I'm on the 2ww. I had a transvaginal scan yesterday it showed a small fibroid and my womb lining was 8mm so they took a biopsy in the clinic after. It was uncomfortable but quick. I feel a bit sore this morning. I should get the results within two weeks. They have advised I stop taking the HRT whilst under investigation. I dont feel anxious but a bit spaced out. Can't really focus on work so I've taken the day off. Hope your appointment goes as smoothly as mine I'll be thinking of you on Thursday.

I was on the 2 week wait pathway in the summer due to a PMB, not on HRT though. I would be reassured that the NHS are extremely on the ball in my experience with this. As others have said 90% of those on a 2 week wait don’t have cancer and I would say that the HRT would also make it more likely that it is a fluctuation of hormones.

It's actually a matter of discretion to stop HRT or not when waiting for an investigation. Not all consultants say women need to stop.

They didn't say I needed to, it was advised.

It's good they do that as many women are in a really bad way if they have to stop immediately.

I know this is a concern for me. I should have the results in two weeks so I'm in two minds what to do.

Me too... Wanted to go back on HRT after a year's break. Had an ultrasound to check all ok, as I am 59. Womb is 6.8 mm and fibroids. No symptoms or bleeds, in fact one of the reasons I came off was no bleeds, so wanted to check if in proper Menopause. I was a very late starter, late period, and still regular when I first went in at 55. I have been referred to Gynaecologist. Sigh.

Hopefully we'll all be OK x

@HelenHywater How was your appointment?

Well the process was fine I suppose (as much as these things can be! ). I don't get the results for a week though. (He did tell me he thought the womb lining wasn't thick so maybe I can draw some comfort from that, but no idea what else he found in there. )

My smear test result came today and that was ok.

Did you stop the HRT in the end @Dippedbiscuits ?

That does sound reassuring with regards to your womb lining. It's just that wait for results I didn't sleep a wink last night I wasn't consciously worrying but it's obviously playing on my mind.
I have decided to stop the HRT until I get my results in a week or so.

So really weird experience - I had another appointment in a different hospital today - I thought for another one of my ailments. I got there and it was gynae ward. They told me I'd come to wrong place for the first appointment, and they were expecting to scan my uterus. So given I was there, and I didn't know the outcome of yesterday scan, I decided to go ahead - this time with a doctor not a sonographer. So I had the scan, and got the results in the same appointment - all fine - and they also fitted me with a mirena coil and took my old (probably very rusty) copper coil out.

It was just a different experience today - how the NHS should be (let's ignore the fact I got 2 appointments, in two different hospitals, for the same thing).

@HelenHywater how bizarre. Well at least you've got the results quickly and you'll probably get feedback from your other appointment too.

Got my referral through for a hysteroscopy with biopsy next week at the gynea clinic. One stop shop effort. Reading up it looks as though it could be fine or horrendous ..... Feeling a bit anxious now.

@HostaCentral its understandable to feel anxious. I did find it uncomfortable and I was achy and sore the day after. I didn't take any pain killers before hand but if was to have another I would do.

Sounds like it all worked out ok.
I had similar issues. Went for an ultrasound which was inconclusive so sent for an MRI as well.
Then I waited for the results but never heard back so assumed it was fine (it was. I eventually found the report in my pt records online!).🙄

I've still not got my biopsy results, the waiting is really starting to get me down. I've stopped my HRT on the advice of the Dr and I can feel my mood slipping and I'm aching again . I've not had anymore bleeding I thought I may get a withdrawal bleed after stopping HRT. I've had this terrible cold so that's not helped being in bed for three days. Feeling a bit better from the cold so I'm going to go for a walk today to blow the cobwebs off.