Menopausal bleeding worries - polyp, sore nipples, HRT, hysteroscopies, scans

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Really hoping others can pitch in with some experiences as I'm driving myself mad with worry.

I am 50 and started sequential HRT in spring 2022 aged 46. Always on the lowest dose. The withdrawal bleeds were a bit inconsistent - sometimes happening, sometimes not - and eventually they stopped. About a year ago they switched me to continuous HRT. I also switched to gel at the same time because I was having trouble with the patches - they kept falling off.

In April this year I had some bleeding - not loads. So I had an internal ultrasound. Womb lining 4mm. They thought they found a polyp. Referred for hysterscopy.

Had hysterscopy, found it very difficult (it was triggering as I had IVF in the past). They didn't get into the womb but did see a small cervical polyp. Consultant said to do the ultrasound scan again as she thought the polyp was very small.

Second scan, saw polyp, womb lining 3.6mm. Then I had another hysterscopy. Again they saw the polyp but could not get into the womb or remove the polyp.

I bled after the second ultrasound scan but not the first. Then 2 weeks after that had more bleeding, heavier this time (went through knickers onto shorts when out on a run).

Both scans said everything looked normal apart from the polyp. They have suggested a hysteroscopy to remove the polyp, with womb biopsy (consultant called it a "girly MOT"), but under general anaesthetic. This will be next month.

I'm bleeding again now, enough to wear a pad, and last week I had sore nipples. I'm so worried about it all, and looking for others who may have had similar experiences? I just can't stop thinking about it.

It's very common to experience bleeding on HRT. Mostly it's polyps or fibroids. Your womb lining is not massively thick- I was told 4.5 is considered high enough for a hysteroscopy.

I had all this, including sore nipples. A high dose of Starflower Oil will sort that out. I took it for a month, the highest dose you can buy.

I read that 98% of hysteroscopies show nothing sinister. It's the only diagnostic tool they have at the moment for bleeding like this.

The 'cure' for bleeding is to increase your progesterone or change it to another. I ended up with a coil. I read about so many women who go for investigations and then aren't offered this, so it keeps on happening.

The Menopause Support Network on Facebook is brilliant for advice.

When I read your post the first thought that came to me was that you are having periods.

The bleeding is very likely to be your own periods.

Has no one suggested this? The fact you have sore nipples is a big clue - you're ovulating and the bleeds are periods.

Just because you had no bleeding when using sequential does not mean you are post menopausal. Sometimes periods stop- for up to 11 months- then resume.

Sequential HRT doesn't always give a withdrawal bleed especially if the estrogen dose is low.

I'm suggesting this as a long-term HRT user (over 15 years).

My guess is you have two things going on- a small cervical polyp that can easily be removed, and a continuation of your own cycles. (mine didn't stop till almost 53 and I started on sequential HRT just before that.)

It seems incredibly common now for drs toput women onto continuous combined hrt too soon, often resulting in this worry and investigations.

The guidance used to be over 54 or no natural periods for a full year. There is now more flexibility on this - trying continuous after a year or so on sequential- but it comes with the downside for many women of irregular bleeds.

Thank you both for replying!

I did wonder if it was just periods. I've had 2 episodes of sore nipples this year, and 3 episodes of bleeding (April, July and now - 3 weeks after the July bleed).

But I don't think I have had any sort of bleed for over a year, so it's really confusing. When I was on sequential, I bled sometimes, and sometimes not - it was very inconsistent. Then I just stopped bleeding. I was 49 when they put me on continuous HRT and I did wonder if it was too soon.

No one has suggested anything about periods. They could not actually see my left ovary on either of the internal scans, and on the second scan they could not see either ovary, so I don't think there's anything sinister going on with the ovaries. I have always had (what I think is) ovulation pain (since I was about 14) and do still get it sometimes.

It's very worrying even though my womb lining is thin. Pretty sure I have never had HPV either, as I have only had one sexual partner and he was tested before we started having sex. I have never had an abnormal smear. I just can't stop thinking about the bleeding, though. The hysteroscopy is in a month's time and that seems ages away. They did it as an urgent referral but the consultant said it was not because she thought there was anything sinister (she explicitly said she did not think that), but because she could see I was incredibly anxious.

Stop worrying.🙂

It's pretty obvious (to me anyway) that these are periods.

But I don't think I have had any sort of bleed for over a year, so it's really confusing. When I was on sequential, I bled sometimes, and sometimes not - it was very inconsistent

You said yourself that you didn't know when your periods actually stopped as you weren't having regular withdrawal bleeds on sequential (and you can't tell when on HRT if you're having a real period or not.

No one has suggested anything about periods.
Have you told them about the 'ovary pain' and sore nipples? All sign of a natural cycle. And 3 periods in almost as many months.

Your womb lining will change depending when you have the scans. If it's after a bleed it will be thin, and as you're using progesterone every day that will keep it thin.

If I were you I'd go back to sequential at least for a year and see how that goes.

This is very frustrating as you have had 2 abandoned hysteroscopies.
After the first, why didn't they rearrange, either with a GA or local jab?
Also if the polyp is on your cervix, that's usually easily accessible (unless it's in the cervical canal in an awkward position.)

Sorry you are having to go through all of this when the chances are it's just your HRT.

Are the consultants trained in menopause and HRT because many aren't. It's 'extra' training and not all do it.

I had a hysteroscopy under general anaethetic for slight postmenopausal bleeding/thickened endometrial lining to investigate in case it was endometrial cancer. It all looked healthy.
Although I last had a period 3 years ago, the doctor told me the bleeding could be a result of activity from 'bits of' my ovaries.

I had a GA as the consultant I first saw said I wouldn't be able to tolerate it awake

Thank you, I really hope it is periods or something else that’s hormonal. It’s just so disconcerting after not having bled for a long time.

I should have said that the second hysteroscopy was as a result of the second ultrasound, as they decided to remove the polyp. The consultant (who was very nice) said it would be better to do it under GA. So I went onto a waiting list, told that the procedure would happen in November. But I was very anxious about the cause of the bleeding and waiting so long, and was offered a last-minute cancellation to try again in outpatients in July. They did offer a local but I was again unable to continue, and it did make me feel like a failure. But it brought back memories of some very uncomfortable procedures I had done pre-IVF (turns out none of those investigations were needed as my husband has a zero sperm count and they didn’t think to check that first - but that’s a whole other story).

I don’t think the consultants are trained in HRT though. And I’ve never had a face-to-face chat with anyone about HRT either. All I’ve had is SMS conversations and one 10-minute phone call.

That’s interesting, I hope my bleeding is some sort of last hurrah. It does feel like a light period with very slight periody cramps/fullness feeling.

I’m a healthy weight, not diabetic and no concerns were identified when I had a full blood count a couple of weeks ago as part of the pre op checks. I was told I’d only hear from them if there was a problem and that if I did hear back, it would be the same day. Can’t get the worry out of my head though and the whole thing had massively impacted my stress levels and mental health since April!

What I suggest is that after you have had the investigation - or before- you make an appt to see a menopause specialist, paying if you need to for one privately (there are dozens around now and most also work online.)

It doesn't sound as if the drs you are seeing know anything about menopause/HRT and are simply checking for uterine cancer, which presumably it isn't as you have had 2 scans already showing a thin lining.

Largely similar experience actually.

I'm older, 58, and had my (I thought) final coil removed May last year, and bled from then on. I was on HRT including daily progesterone. It was quite heavy at times and not cyclical.

Eventually went to GP who sent me for scan, which showed 6.5mm womb lining, so then sent for hysteroscopy on the 2w thing. I refused to have it without anaesthetic (you should definitely insist on this!).

So, in that they found polyps and a fibroid, removed them, shaved the womb lining (🤢), took biopsies, inserted a new Merina (I didn't really want it but not much choice at this point).

That was March. No cancer.

But I am STILL BLEEDING!. So annoying. Mostly not much, but never so little that I can risk no pad. And I do now seem to be having a cycle 🙄 and it gets heavier then, plus sore boobs.

I'm leaving it a few more months then I'll go back to the GP, but I don't want them to put my oestrogen down because that gives me anxiety/other meno symptoms I don't want. Not that it fully resolved them all anyway, but it's better than without.

Anyway, upshot is - yes, it's worrying, but it's lost likely benign and just hormone changes with peri menopause.

@JinglingSpringbells thank you, that’s a good suggestion. I’ve never been 100% sure about HRT anyway so it would be good to check in with someone properly.

@Negroany sorry to hear that something similar is also happening to you. I hope you get to the bottom of it too.

Well - I asked for a face to face with the GP, saying it was not 'urgent' but I would like to speak to someone, and was basically just told no!

And to tweak HRT myself and/or return to sequential.

Good advice here from others - this all sounds so unnecessarily worrying. It's all so non-joined-up isn't it? Gynaes who don't know about HRT...

And I really sympathise about the trauma of all these investigations after your experiences. I had two difficult births and every time I had a new Mirena inserted (for contraception) I found it increasingly painful, and increasingly distressing. Also a difficult hysteroscopy that I think was done for no reason - I just had a period after my last Mirena was removed! You are not a failure.

I don't know how you took it but 'girly MOT' sets my teeth on edge.

I can recommend the private specialists I have seen at My Menopause Centre. You should get a Zoom appt pretty quickly, or I'm sure others have recommendations.

"But it brought back memories of some very uncomfortable procedures I had done pre-IVF (turns out none of those investigations were needed as my husband has a zero sperm count and they didn’t think to check that first - but that’s a whole other story)"

For fucks sake. Medical misogyny is real

@SodThisHeadache thanks for the recommendation. I’ll take a look. I just want to have a conversation really.

Sorry you had difficult births and procedures. I can empathise.

And absolutely on medical misogyny. Turned out I had no fertility issues myself, and we wasted a year of investigations when actually we could have been fast tracked for IVF if they’d just done a simple sperm test first. Still, the amazing miracle of it all is that we do have a 13 year old who is my husband’s biological daughter thanks to surgical sperm retrieval. Incredible when I think about it.

Thanks for replying anyway. And no, I don’t like the phrase “girly MOT” either (have never been a girly girl …)