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[Sarai]

So today I went to the Post Menopausal Bleeding Clinic under the 2 week rule.
I've been on Evorel conti 50 for 7.5 months and have tiny old blood spotting probably every month for a couple of days.
Well my damn womb lining measured 6.6mm and the cut off is 6mm so I ended up with a mini procedure taking just a tiny bit.
Me being me, I passed out, as I do when I get pain, staff were lovely throughout.
Fingers crossed it's ok, then we see what to do.
Assuming all is well the dr says I can carry on on the hrt, but I wonder if it's not quite right for me. I know it's made me so anxious and tearful but I'd accept it if I have to as it's for my bones. And a small price to pay if it can help my bones.
But I'm really unsure if it's the right HRT.

[Wrensong]

Hi Sarai.  So sorry to hear you had to have the painful hysteroscopy today, but pleased it's behind you.  Like you, I found it pretty painful without anaesthetic, but as you say it does help that staff are so kind.  I think they should always offer post-menopausal women at least local anaesthetic for a hysteroscopy, though I know not everyone finds it problematic.  I had 2 in fertile years, 1 under general & one local anaesthetic which was perfectly adequate & this made all the difference to the ease of the procedure.  I was not given the option of even local last time & imagine this may be to keep it short & perhaps essentially, to keep costs down. 

Have to say I'm very surprised your lining was a little thicker than they would have liked on the Evorel Conti.  Like you I had bleeding & spotting on that regime but my lining was thin when scanned & the uterus found to be atrophic when they later did a hysteroscopy.  However, that's why its essential to have post menopausal bleeding checked out if it persists after the 6-month initial adjustment phase, so you absolutely did the right thing.  With any luck there will be no abnormality & they will advise how best to proceed to reduce the thickness & keep the lining nice & thin for the future.  Hopefully members who've been in this situation will be along soon to help reassure & advise you.  I do hope you get good news soon & can put the whole episode behind you.  Wx

[Sarai]

Wrensong I was shocked too frankly, I thought there would be nothing.
The dr thinks hrt, but obviously there's always the chance it could be bad news. Seriously 0.6mm sealed my fate.
I'm guessing this hrt is not right for me, though the dr said if all was ok I could carry on, on it. My feeling is oestrogen might be too high. But I really don't understand these things and my GP has no clue at all.

[Cassie]

Oh how awful was it very painful I cannot imagine going through this with no pain killer, I can barely handle a papsmear, you are very brave and am sure that the results will show that all is fine.

[Sarai]

Cassie I did get a local anaesthetic but that hurt going in, but he had no choice because he actually couldn't get the thing inhe needed to.
It makes me so mad because I didn't even want hrt it's only for my damn bones.

[dahliagirl]

Goodness - how do they even measure 0.6 mm!  I am trying to envisage it on my ruler 

[Sarai]

dahliagirl, goodness only knows. It was hard for them to get a good image as I've fractured vertebrae and couldn't lie quite how she wanted me to.

[Taz2]

Isn't it 6mm not 0.6mm?

Taz x

[LoriPA]

Oh how awful was it very painful I cannot imagine going through this with no pain killer, I can barely handle a papsmear, you are very brave and am sure that the results will show that all is fine.

Same here, but at least they used a local on me when I had both biopsies done.

Everything will turn out fine. Keep the faith!

[Sarai]

Taz2 what I meant was their cut off for those on hrt is 6mm, which the ultrasound girl said mine was. So I said to the dr great, I'm ok then, and he says well yours is 6.6mm.
That's what I meant by 0.6mm sinking me.

[Sarai]

This whole thing is doing my head in, I've had so many tests lately for this and that and my health anxiety is going nuts right now.
So damn annoyed because I never wanted or back in April needed hrt only went on it for bones.

[Wrensong]

Sarai, if your GP is clueless could you see another or ask for a Menopause Clinic referral?

[Hurdity]

Sorry to hear this Sarai. I can't remember where in menopause you were when you started HRT ie how long since last period? Also if your womb lining was measured before you started? The reason I ask is that sometimes in post-menopause women experience a natural thickening of the lining as oestrogen continues to stimulate some growth even though ovulation has ceased. I have read that this resolves in most women (in the absence so that treatment with HRT) so that the endometrium becomes atrophic and unresponsive to her own oestrogen. However if your lining was a bit thicker to start with ( eg on the limit or over it) then you would be more likely to experience some bleeding when starting the conti regime. It could be therefore that if you were given a treatment of progestogen to shed any excess lining properly, and then re-started with Eovrle conti immediately after the bleed - it could well work. However if the balance is wrong for you then separate oestrogen and progestogen might be necessary, or else a cyclical HRT of the same type (eg Evorel sequi) as some of us still have even into our 60's - which should enable monthly shedding of any uterus lining that has built up.

Another alternative is a Mirena coil and then you could just add back oestrogen at the dose required to protect against osteoporosis (minimum 50 mcg patch).

I had a hysteroscopy and biopsy but because it was planned I was advised to take 2 paracetamol and two ibuprofen an hour before my appointment - and that was fine - so didn't experience any pain - just a very minor twinge. The doc who carried out the procedure did say that a local anaesthetic could be more painful than the procedure itself and so advised against it.

Hopefully it will all be OK for you - do try not to worry in the meantime!

Hurdity x

[Sarai]

Hurdity I was just 13 months Post meno when I got the Evorel Conti and did read it should be 18 months Post meno but GP didn't note that.
It would make sense that I may have some lining build up before the hrt or even still some of my own oestrogen.
It would have been good to get a reading before starting but I knew nothing and neither does my GP.
I just wanted the lowest oestrogen due to clot risk, but I've learned that my hrt is in fact medium dose oestrogen.
I don't mind the tiny spots I get but obviously don't want my lining to continue to grow.

[dahliagirl]

Yes, it is probably a good chance that it is still your own hormones winding down and the hrt still settling in - hope the biopsy comes back with a good result and that they sort things for you.