Thickened Endometrium

[Swissroll12]

Hi , I’ve been on HRT for 6 years which hasn’t been easy trying to find the correct dose which is still ongoing reducing my patch from 75 to cutting to 62.5 and 200 Utrogestan with the advice of my menopause Dr
Each time I’ve had slight spotting which has only lasted a couple of days Ive had to have pelvic scans

Last year I had spotting and my lining was 5.3 I spoke to a Gynaecologist after the scan and she said it was ok although it should be 4mm.

Then about 6 weeks ago odd spotting again I had a pelvic scan today and the lining is 5 but the lady said she’s sending a referral to Gynaecology.
I know that it’s going to be suggested that I have a hysteroscopy which I’m petrified about .

Has anyone been through this? Any advice please

Are you post menopausal? Or peri? Are you taking HRT continuous or cyclical?

I’m having a hysteroscopy this week as my lining is 5mm. I am having a spinal though.

I declined a hysterscopy. My lining was 8mm. I asked for my progesterone to be increased. Had a follow up scan and the lining reduced to 5mm.

I wouldn't have a hysterscopy due to a 5mm lining but ultimately the only way to rule out endometrial cancer is a hysterscopy and biopsy.

Not sure if you mean you are using continuous progesterone or on a cycle.
If it's on a cycle your scan result is not high- they allow up to 9mm at certain times of the cycle.

The reading is not that high. Unfortunately, if the person who did the scan was not a gynaecologist, they can't make a call on what they see - and your GP will just go by the rule book.

I have scans privately and the consultant who does them is an expert in scans. They say it's not simply the thickness but everything else the scan shows- they can see suspicious areas or whether it's all normal.

Many women having further investigations don't need them but GPs play safe.

The likelihood of you having cancer when using 200mgs daily are very remote. If you don't want a hysteroscopy tell the consultant and discuss what can be seen on the scan. They can also do a biopsy alone which is far less invasive and reasonably accurate.

Hi , thankyou for your replies , I’m post menopausal and on continuous HRT
as mentioned last year my lining was 5.3 and the Gynaecologist wanted to do a hysteroscopy but I declined . The break throughs are not all the time and so slight I would hardly notice it but it is on the tissue paper . Last year the gynaecologist wasn’t concerned and signed me off , however around 6 weeks ago I had spotting again and while it’s reduced to 5mm the sonography lady has done a referral , I also have a tiny fibroid which I’m aware of .

I really don’t want a Hystereoscopy probably due to the painful experiences that I have read about i realise that everyone’s pain threshold is different and I can ask for sedation etc , the gynaecologist will phone me to discuss this matter and I feel like asking if we can monitor it as it’s not as thick as last year when I had a pelvic scan .

What is this type of biopsy please?

When they do a hysteroscopy they take a biopsy at the same time.

But you can have a biopsy on its own without having the scope/camera inserted.
(I've had both.)

The biopsy alone is very simple and needs no pain relief etc. It's a very thin tube that is used and it simply takes a sample of the lining. (I had it done in the doctor's room and went about my day normally afterwards.) It takes a small amount of tissue. (It's probably all online etc is you want to see more detail.)

I don’t have any words of wisdom OP, but I am in the same boat as you. I am 8 years post menopause and been on HRT for 3 years. Started spotting 4 weeks ago and am now bleeding. Had a scan on Saturday and have been told my endometrium is 13.8mm, so I have been referred to gynae at the hospital. I think I will also need a hysteroscopy and was wondering if I could ask for gas and air to help.

Thankyou JinglingSpringbells sorry for this question but isn’t the biopsy a Hysterosopy anyway even without the camera ?
What makes a Hysteroscopy painful I thought it was the biopsy itself .i need to do some reading on it so I’m prepared when the hospital phones me

@Swissroll12 No, a hysteroscopy is (a 'womb camera'). The instrument is a tiny camera and also another small instrument within the same scope to take a sample.

A biopsy is done using a small instrument (thinner than a drinking straw) inserted through the cervix.It takes a small sample of cells from the womb lining.

I've had both. The biopsy was done in a normal room - pretty much like a smear in terms of time taken- and more or less painless ( for me.)

I had a hysteroscopy with no pain relief (my choice- it was done privately with a local jab on hand if needed) but everyone is different. It was decided to do that after another episode of spotting, some time later.

The disadvantage of the biopsy is that the womb can't be seen but scans can be so good now (but that needs a consultant) that sometimes a scan and biopsy are enough.

It's something that needs discussion and obviously all consultants work in a different way. My treatment was covered with private insurance.

Thankyou , How was you with the hysteroscopy and no pain relief , I know that the Dr who calls me will be advising one as my lining was thick last year .

See if there’s availability for a WID test in your area as an alternative to a hysteroscopy. It’s more like a smear.
I wouldn’t have a hysteroscopy without a GA or equivalent.

Thankyou , I will ask when they phone me as I really don’t want a hysteroscopy unless they say it’s strongly advised

It was fine to be honest.It took a little while as my cervix was tight but I think a lot depends on the skill of the doctor doing the procedure.
I knew that at any time I could ask for it to be stopped and given a local jab. I had been offered a GA but refused it, because it was so much more complicated in practical terms (after care etc.)
You will get all kinds of responses about this and to be honest it's very individual.

I had a hysteroscopy, biopsy and Mirena fitted earlier this year, after an endometrium reading of 14.3. I’m post-menopausal and the Mirena was recommended as the best option for progesterone.

The procedure was painful but I was given the local anaesthetic during it and it was ok then. I honestly don’t know why they don’t give it at the beginning. I think I’d have been fine, if they had.

There’s a bit of medical gas-lighting going on, because most women do find it painful. I don’t think a couple of paracetamol in advance would help. But, afterwards, there was very little pain and the paracetamol did the trick.

OP, don’t compromise your health due to fear. You can have the procedure but you have the information to make sure that you get pain relief in advance.

The RCOG has a detailed report on this (it's online.) They took evidence from women. The main point of the report is to offer guidance on pain relief and best practice.

The upshot of the report is that making the procedure comfortable is paramount. However, their research did show that 75% of women find the procedure tolerable without pain relief or just a local. They also comment on how sedation can be dangerous (not a GA , but sedation) unless carried out where counter-measures are available (same as for a GA.)

What may happen is that different NHS trusts may have different ways of doing the procedure simply on a cost basis. There is a huge difference between the cost and number of doctors needed for a GA compared to a quick 10-15 minute out patient procedure.

@JinglingSpringbells I’ve seen a lot of people saying that they have had bad experiences. I found the local anaesthetic did the trick but I was nearly hitting the ceiling by that point. If the local anaesthetic at the outset was the default option, then I wouldn’t have had a bad experience.

The pain during a hysteroscopy is caused by the camera/probe going through your cervix into your uterus. I don't think you'd feel the actual biopsy.

I wasn't really warned a hysteroscopy could be painful, and I found it horrendous. Gas & air didn't help much.

From my point of view, I'm glad I went through with the procedure, because it revealed early-stage cancer, and I had a hysterectomy two weeks later. I only had a small amount of bleeding but they took it seriously.

What’s the difference between a hysteroscopy and a biopsy?

Post meno here (not on HRT) and bleeding spotting last year. I refused a hysteroscopy unless GA and that wasn't available for months, but Gynae said my case was urgent. I went privately to a gynae who understood my fears and did the whole job in one for me. I had a transcervical resection (lining removal) polyp removal and biopsies all in one. I'm not in UK though and have PHI so don't shoot me! The recovery was a bit grim but it had to be done, and in the end the biopsies were clear thank god.

The bleeding came from vaginal atrophy and a polyp. I am using vaginal estrogen cream now, and all is well. That stuff helps night time weeing aswell. To my surprise!

Wishing you well OP. You are right to refuse hysteroscopy - unless you are sedated, get a spinal block or a GA. Some gynaes are very trigger happy with their medieval instruments!

https://www.ncic.nhs.uk/patients-visitors/patient-information-leaflets/Gynaecology-Endometrial-Pipelle-Biopsy

The biopsy described above can be done during outpatient hysteroscopy.

Hysteroscopy is using a thin tube with a camera inside to look inside the uterus
https://www.nhs.uk/tests-and-treatments/hysteroscopy

Hysteroscopy is just the procedure of going inside your uterus with a camera. They can do various things while they are in there - remove polyps/small fibroids, take biopsies, or just examine.

A biopsy is removing a tissue sample with a needle to test later. You can have a biopsy on any part of your body.

The link describes a biopsy, on its own. It is describing a separate procedure to a hysteroscopy. No camera is inserted for the biopsy alone.

I’ve just had a call from my Drs surgery to book a phone appointment as a Dr would like to speak to me . The only appointment is next Monday my nerves are through the roof
I had a look at my nhs app and it says my Endometrium is 6.5 the lady that done the scan said it was 5mm .
Anyway the report is sending me down the cancer pathway and I’m shaking , I know that it doesn’t mean I have cancer but the notes also say new critical findings . I phoned the Dr back as I can’t wait until next Monday I’m just waiting for a call back

I don't think they will know much more without further investigations. Which is probably what the doc is going to arrange. I reckon hysteroscopy and biopsy at a minimum. So make sure to insist on a GA if that's what you want for it.

The stats say that around 10% of thickened linings and post meno bleeding are cancerous. So you will more than likely be in the 90% that isn't. Try to think about it that way, which is what I did, and it proved true. We have to go through the investigations first though, which is not a pleasant journey TBH.

I hope all works out well for you. It is ok to be nervous and worried, that's normal, and anyone who tells you otherwise is lying.