Shorter menstrual cycles at 47, ultrasound or MRI for reassurance?

[PeriStrange]

NC because I don't like broadcasting health things to people because I'm shy about it!!!!

My periods are occasionally getting closer together, 16 days, 19 days and now 20 days, with today being the third occasion out of 18 months or so.

I've met with a gynaecologist and she suggested an ultrasound or MRI, for peace of mind, but suspects the issue could be anything from my diet, stress, thyroid, perimenopause, polyps or fibroids. She says there is nothing suggesting anything scary, which was a relief.

But, she said she'd consider an ultrasounds to check for fibroids or polyps, at the very least.

My first question is: has anyone had this done and just continued on without hormone therapy, afterwards? Has anyone had this done and found anything and, if so, what happened next?

My second question is: should I do the utlrasound or MRI? The MRI sees more areas i.e. bladder, bowel, from my understanding, but is about £200 more. I don't know if it's overkill or just good investment for 'peace of mind'.

I'm 47 yo and started periods around 11.

Thanks so much for any advice or experiences. Navigating this is just strange and lonely.

Obviously there is a small chance there is something of concern going on, but I think your gynae really should have done a better job at reassuring you that your irregular cycles are most likely perimenopause. In the absence of other symptoms you really shouldn’t be so worried.

Saying this kindly, OP, but do you have anxiety?

What you're experiencing is normal and I agree with a PP that the consultant you saw should have reassured you. She has done her best to reassure you that shorter cycles are not a sign of anything seriously wrong.

There are no scare stories online about very short cycles in peri menopause. You've had 3 short cycles in 18 months.
That is completely normal for peri.
Presumably you were told this?

There is guidance about bleeding post menopause, or heavy bleeding in peri that can cause anaemia.

For what it's worth, for context, I've had private health care for years and that includes menopause. I know how the system works and the tests that are available. But I know that good doctors don't suggest unnecessary tests.

The Dr you saw picked up on your anxiety and suggested which tests there were- she didn't say you needed them. From what you say, it was more a case of 'Well, these tests exist but you don't need them.'

If you decide to pay for tests, what happens when you have more changes to your cycles for several years? Will you keep having tests, or will you accept they are part of peri?

It'll help you to read as much as you can about peri online so you get a full picture of what happens.

Thanks, and no, I don't have anxiety. I have no one to talk to who can help with experience apart from Reddit, MN and other SM outlets which tend to exaggerate every symptom and put them down to something sinister.

As mentioned before, there are very few people who come back to state that their fears were unfounded (or otherwise) so I'm left to sift through others comments, who may have anxiety, and try to determine my case via their experiences.

Additionally, all medical sites say to seek professionals when periods are less than 21 days for many reasons e.g. perimenopause, PCOS, fibroids, cancers etc. I have read about perimenopause for about 2 years knowing that it would be arriving shortly given my age.

Due to the above, I was very clear with the consultant about why I scheduled an appointment.

Yes, I agree she did try to reassure me but I'm trying to make sure I'm as comprehensive as possible within reason, given my lack of experience in medical expertise as I rarely visit doctors for any reason.

You may have missed that a pp stated that she had what she thought were perimenopausal symptoms but ended up being early stage womb cancer.

So, maybe many do have anxiety but I view what I'm doing to be pragmatic i.e. consultant appointment for a prudent, objective and educated opinion as well as seeking real life experience from women who have been through these things and can offer beginning to end experiences.

I have no issues going through perimenopause as long as I know that's what it is happening. The women in my life can be of no assistance to me so I draw information from where it is available.

Thanks for your update. I don't think there is anything wrong in seeking advice but there is a lot of misinformation online (Reddit is rubbish TBH!)

Its a mistake to put all the reasons for irregular periods or odd bleeding into the same basket and assume they all need investigations.

The most important is age and at 47 it's to be expected. (I'd like to see the link to the 21 days as it's something I've never heard about except in relation to menopause.)

PCOS has many other symptoms which are obvious usually ( excess body hair and weight gain.)
Endometrial cancer is incredibly rare in women who are still having periods (yes I saw the PP's post) and am pleased she got treated.
It tends to occur in women post menopausal, over 60 - smoking and being overweight are the main risks.
Fibroids or polyps can cause heavy periods and bleeding between periods.

You have only had 3 short cycles in 18 months. That's very different to 16 day cycles month after month, or bleeding between periods. Those are red flags and need a scan.

Best of luck anyway with whatever you decide.

That's what happens in perimenopause. It's a known symptom, as is heavy bleeding or light bleeding or all three in rotation. It's nothing to worry about at all. It's caused by fluctuations in your oestrogen levels. You can have a spike, then a crash, it's not even as it was before.

Google symptoms of menopause, there are well over 30, one being anxiety.

But I don't have anxiety and I've used Google and, as a result, saw a consultant for education. I've stated what the consultant said and now I'm simply asking if anyone has had an US or MRI to look at polyps/fibroids based on short cycles or decided to just leave it alone.

Sorry, but it's not helpful being told to use Google and being told I may have anxiety over and over for no reason at all.

I'm taken aback that women are suggesting anxiety and recommending Google. I thought only men dismissed women's concerns and curiosity as anxiety.

@PeriStrange what is happening to you is likely a natural life stage but if you want to pay for an MRI or scan then do that, it seems your consultant is pushing or offering a service that you clinically don't need. This happened to me at 46/7 and I had my last period at 50. I was on hrt for a few years to get me through.

I think you need to reread my original post which literally said I was relieved that she said nothing was sinister and that she'd suggest an US but I could have an MRI.

You are now starting to annoy me.

This is the downside of private medicine, you get unnecessary tests because they have to be seen to be doing something. This is just perimenopause and it's completely normal. Shame on the consultant for trying to pathologise it.

Thank you. She said she'd check for 'common reasons' via US or MRI but nothing suggested anything sinister for which I was relieved.

I'm not really sure what the difference between the 2 tests are, as far as what the pros/cons are, so I'm not sure which one (if either) is necessary.

Here is part of the letter:

1. Irregular Periods

During our discussion, we talked about your periods becoming more frequent over the last 18 months. Your cycle length has shortened from around 28 days to an average of 23 days. This change could be related to perimenopause, the fibroid you know about, or possibly a small growth in the lining of the womb called a polyp. The bleeding after straining might be a coincidence, but it could also be caused by a polyp or fibroid inside the womb being irritated.

1. Concerns about Serious Conditions

Another key point we covered was your concern about the possibility of bowel or endometrial cancer, based on things you have read. It is important to know that, based on our discussion and your history, there are no clinical features that suggest malignancy at this stage. The investigations we have planned are to look for more common causes for your symptoms and to provide you with reassurance.

3.Shortening menstrual cycles. Possible causes include perimenopause, the known pedunculated fibroid, or an endometrial polyp.

Plan
You have agreed to proceed with an MRI scan of your pelvis to look at your womb, ovaries, and the surrounding structures like your bowel and bladder. This will help us check for polyps, fibroids, or any other issues. The radiology department will contact you to arrange a date for this. We discussed checking your hormone levels (oestrogen and testosterone) to get an idea of your perimenopausal status. I would be grateful if your GP can arrange these
for you when your next thyroid blood tests are due next month. Alternatively, you can look for private options online.

If you had a scan will that stop you .reading about serious illness and cancer ?

I've already done that by going to the consultant. I'm asking about the scan she recommended. Why is this difficult?

It isn't difficult posters are responding to you appropriately, the women on your thread are telling you their experiences with peri menopause and cycles and how they don't think you need a scan, if you want a scan to help you feel better then have the scan, i don't think you are going to get the validation you are after though.

Not all posters are telling me to not get a scan, but many are, so I'm responding, to individual advice and perspectives out of courtesy.

One pp has told me she has a transvaginal scan planned, one has told me of an early cancer that was caught despite doctors not thinking it was there and many have told me that they would not proceed with scans because these symptoms are normal.

All of those things are extremely helpful to me.

Accusing me of having anxiety and suggesting I check Google is not helpful.

Asking me if a scan will help me not fear cancer etc, is not helpful, since I have already said that has been addressed and scans for polyps/fibroids have been suggested (by a CONSULTANT not Dr Google) as per the letter I posted.

So, now that's all clear, if only helpful perspectives and experiences could be provided (as most have done), that would be appreciated!

You are spending a lot of money on reassurance. Keep an eye on this as it could become worse. Unless you have endless £ to spend on private care I guess.

Id have just gone for the u/s first as will likely be quicker, at your age it a dead cert its peri related.

My periods went shorter, then i went months without one, then back to shorter, months without etc. All over the place. I had a u/s just to tick box before starting HRT. Been on it now for 8 months and its brill 😃 feel like me again. periods still a little skewy as GP said it doesnt give some women fully regular cycles as natural hormones will still be fluctuating, but theyre more predictable for sure and nowhere near as heavy or long.

Thank you. I've not spent anything yet. I came here to ask if anyone felt there was a need since I was leaning towards doing nothing at this time other than seeing the consultant which is already paid for.

Thank you so much!! This is exactly what the consultant suggested. An U/S to check for fibroids or polyps, MRI if wanted to check further (as per letter) and option to start HRT if further symptoms developed as not recommended for irregular periods in isolation.

Thank you so much! Glad you're feeling better!! The lack of predictability makes me feel so insecure about planning trips etc but I know that is all part of this journey.

To be fair, not all private consultants behave that way. I've had private meno care for many years and have had some investigations. They were necessary BUT my consultant was also very honest. They stressed that although there are dozens of tests available, which could total thousands of pounds, most were unnecessary.

I think what the OP's dr is saying is 'You can have these tests if you want but in my opinion they are not necessary.'

Sounds normal for perimenopause probably as progesterone is low.

What country are you in MRI or ultrasound sounds unnecessary unless say other risk factors for fibroids (eg very heavy periods, distended stomach). Would never be offered on NHS!

I’d also be very wary about her saying no need HRT but if no other symptoms may not be worth bothering. TBH I’d be finding another doctor.

This is exactly what the consultant suggested. An U/S to check for fibroids or polyps,

Some of what she has said is a little unusual. Fibroids tend to make periods heavier. Occasionally they may cause spotting in between cycles, as can polyps.

There are evidently 50% of women with a fibroid and unless they are huge and give other symptoms, they are left alone.

I know you seem reluctant to accept this but 3 short cycles in 18 months at age 47 does not usually warrant investigations.

If you want to put your mind at rest just make the appt for a scan.

I had to wear a pad every day at one point as had NO idea when id come on. Id have a 3 day period, a 10 day break, then another 3 day period, then nothing for months, then a 2 week period etc. Longest I went was about 6 months without, then back to 2 a month 😅

Its back to fairly regular now give or take a few days and varied heaviness, though i have a bleed during my 2nd week of progesterone which I was worried about but I read and was told thats not mega unusual, as long as its still one bleed every 4 weeks give or take its fine.

The progesterone was awful at first, I reacted the opposite to usual and was very hyper, like id had a whizz bomb 😂 didnt sleep more than 2 hours a night so I took it in the am and it was great for work 😂 then suddenly the normal reaction kicked in and felt drugged. It settled after a few cycles on it and my progesterone weeks are my fave time of the month now 😂

Good luck!!

Why do you keep suggesting I don't want to accept not having scans or further investigations? I have repeatedly stated that I'm open to just doing nothing if that's what most would do on here given their experience that I lack. That is the whole reason I came here, fgs!!

I'm not sure if you're trying to wind me up or help at this stage. If the former, many thanks. If the latter, I'm opting out.

Thank you so much! Glad you're feeling better!! The lack of predictability makes me feel so insecure about planning trips etc but I know that is all part of this journey.

If your periods are heavy your dr can prescribe Tranexamic acid to reduce the flow.

If not, you will be like all peri women- carrying sanpro in your handbag, or using it when you're out and about 'just in case'.