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[Hurdity]

Hi AndieKC

Sorry - have only just seen this - have been busy over weekend - hope it went well today and you asked for the regime you wanted - do let us know how it went? I would have recommended patches because I get on so well with them but others swear by the gel and if the tablets suited you then fine to take them again! (That wasn't much help was it?!!!).

Hurdity x

[AndieKC]

Hi Hurdity and Cazikins
I completely folded at the appointment, I couldn't go through with it. I was up all night, nerves and all, tried to convince myself to go for it, that's it's the best option but I just broke down.

The doctor was very sympathetic, he did another internal scan at my request, measured endometrial thickness 8.7mm (it was 6mm a couple of months ago)   and located a small polyp that the other consultant had suspected before. So this good doctor says it's okay to wait with Mirena if I'm not ready and that anyway the polyp should be removed first and he is scheduling Hysteroscopy very soon, and Mireba could be fitted later, depending on the findings.

The nightmare continues, I am scared witless, I just want to hide and run away ...

So hyperplasia and polyp are caused by too much estrogen but at the same time my sudden severe menopause was caused by sudden drop in estrogen... I wish I could make sense of it all ...

Ladies sorry for my rant, and thank you for support xx

[Dancinggirl]

Andie - it is all very confusing and frightening at times but your symptoms, and even the hyperplasia/polyps, are very common when meno hits and really nothing to worry about.  Peri meno and early post meno result in fluctuating hormones and this is what is causing all you problems - this is very common - it's a shame we women are not educated better about what to expect at this time in our lives. Thank goodness for this site - we are here to support you. 
The polyps can be treated and the Mirena is now a standard favourite of many gynaecologists because it protects the womb lining so well and solves many of the problems women have with progesterone and erratic bleeding.
For the short term it may be worth discussing some sort of anti anxiety treatment with you doctor to get you through all this, as it has clearly frightened you so much. Thank goodness you had a better doctor at you last procedure.
You have done so well to get this far - you've had such a fight.
Have you every learned Mindfulness or other relaxation techniques - I rely on these heavily.
DG xxx

[AndieKC]

Hi Dancinggirl
Thank you for your post, you are right, it is such a shame we don't know more about it when menopause hits, but at least there are signs now that things are changing, thanks to Dr Currie's work, patients' pressure on doctors, accommodating menopause at workplace etc.

I do not dare to go to the doctor for any pills - I have never taken so much as a painkiller until I had that biopsy, and of course the HRT. It really seems that the moment you end up in the system, they want to monitor/test/check/invade every possible body part and prescribe something for it to 'treat it', and then take it away causing another problem, or prescribe something else to treat that, it's a vicious circle I want to avoid. They practically pushed the HRT on me at first, then 3 months later when I came in for repeat prescription, it all started because that doctor didn't know that Elleste Duet sequential is meant to cause monthly bleeds. So he ordered me to stop HRT immediately, to run a 6 week experiment to 'see if bleeds stop'. That's how it all started...

I am seeing my counsellor again (on and off most of my life) so that's been helpful, and I am trained in autogenic training (self-hypnosis/relaxation) but it doesn't seem to work for my anxiety - in fact, the HRT calmed me down like nothing ever did. It is the constant threat of doctors wanting to take it away that's been driving me demented for months. With anxiety, I find anything that encourages self- focus makes it worse, so meditation, self hypnosis, mindfulness seem to have the opposite effect, but I do write a journal to calm my nerves, deal with negative emotions, stop panicking - it helps but the past few months keeping calm has been a full time job!). Also, I will be working on the issue with the counsellor some more - you know, I have survived childhood abuse - physical, not sexual) by my own parents, I stopped it aged 19 when I finally left home, found a job and started building my own life. A lot of people like that end up on alcohol, drugs, I never did, so it is such an irony that I somehow managed to get through all that, build a life for myself, get married (no kids though, my own choice), but I fold at these gynaecologist exams/treatments. Normally I am a rational person, I understand science well ( studied it) but being a patient freaks me out completely. if it was my arm or my ear or something else, I would quite happily let them poke around/dissect/cut bits out, but women's things really take me to a bad place...definitely matter for the counsellor... Took me years to recover (mentally) form abnormal cervical cells op, (CIN3) 18 years ago, so it's like a bad dream repeating itself.

What scares me so much is that doctors seem to disagree with each other, won't look at the whole picture, stick rigidly to guidelines that were written for a typical menopause age, not early one at 44, so we have been dancing in this vicious circle for months now - something always crops up, one doctor says ET has to be 3-4 mm max, another says no, even 8.7 is okay if you are on HRT. One says must have Mirena, the other one says, no, it wouldn't help  and I would probably expell it anyway, polyps needs cutting off first. It is the wait that is so hard, now I'm 'catastrophising' what if the polyp is going to be cancerous or pre-cancerous (I know it's rare, but...), in which case it's still going to be a ban on HRT so my HRT future is nowhere near secure.

Before I went on HRT I suffered meno symptoms for 2 years, but at least that was my choice. Now that i've seen how HRT sorted all the symptoms and literally gave me my life back, the thought of having it taken away is driving me mad (and furious).

I will have to have this Hysteroscopy and polyp removed, and Mirena inserted at the same time, but the more i'm reading about it, the more it seems I should have GA, but that's scary too, so my head is like a washing machine hurling everything round, and of course I have a job to do, a business to run, and at least appear sane... I wish I could just laugh about it...

P.S. I thought I'd be dealing with something like this aged 60 maybe, not in my mid 40s, I am exhausted by the battle, the wait, not knowing... Can I please have a crystal ball?

Thank you for your support, hope I'm not a burden.
Andie xx

[Dancinggirl]

Andie - my menopause started in my mid 30s so I quite understand how you feel.  I have seen so many doctors and specialists over the years and opinion differs so much.  You are, quite rightly, asking for an holistic approach from the doctors and sadly this isn't what we get. I have had erratic bleeding, awful cramping and all kinds of problems with HRT as well but I am pleased I persevered as, at 62, and now 2 years without HRT, my joints are really going problems. I dread to think how bad things would be now if I hadn't used HRT til I was 60. The Mirena with Oestrogel was my best HRT regime and gave the fewest problems.
If HRT makes you feel better, then HRT is what you need.  You just have to get the polyps sorted (these are quite common) and decide whether you want the Mirena or not. Perhaps you can work with your counsellor over this so you can prepare yourself better when you have your polyp procedure.
I came close to a breakdown soon after my meno started in my 30s (so much stress going on in my life at that time as well) and had counselling for a year and it really helped me through.

You have had good advice and support from Dr C, you have fought hard to get this far and you are clearly a survivor.
Stay positive, decide what you want moving forward and go for it. Good luck. DG x

[Hurdity]

Hi AndieKC

Re endometrial thickness - if you are on cyclical HRT then your lining will vary depending on the stage of the cycle you are at. However if you are post-menopausal and on continuous combined HRT then it should stay uniformly thin (below  approx 4 - 5 mm i thought?) so 8.7 is generally thick. Bleeding is usually the sign that something is amiss and especially bleeding after 6 months on continuous combined hRT when the womb lining should have settled down to a standard - lower thickness.

"So hyperplasia and polyp are caused by too much estrogen but at the same time my sudden severe menopause was caused by sudden drop in estrogen... I wish I could make sense of it all ... "

It is the balance which is crucial not the amount per se - so if you have insufficient progesotgen in relation to the amount of oestrogen - that manifests itself as "too much oestrogen". It is best to have the (minimum usually - depending on age and your medical history) dose of oestrogen which most effectively deals with the symptoms you are trying to control. Then once you have got this right you need to take the correct amount of progesterone to keep th elining thin. Sometimes on the combi conti products it isn't right for some women hence the need to change and as discussed and as Dancinggirl's experience - the Mirena would do this.

Just to give my experience - I had some spotting and had hysteroscopy and biopsy to check womb lining. I opted to have this done under no anaesthetic but I had to sign a paper to give consent for removal of polyps at the same time if they found any - which they didn't. The gyane also said did I want a Mirena coil and he would have inserted one all at the same time - so it is possible to do everything at once.

Sounds like you are a really strong woman with all you have gone through so hope you manage to stay strong until you have your treatment sorted.

Take care
Hurdity x

[AndieKC]

Hi Hurdity, Dancinggirl and all the other kind ladies who have replied...thank you soooo much! New information has come up and I'm confused.

(Just completeda year on Elleste Duet 1mg sequential, today switched to Kliovance with Noriday (for extra progestin) as recommended by Dr Currie and prescribed by my Gp until Mirena can be fitted, and I'll have a low dose estrogen).

Initial scan 6mm thickness which started the whole merry dance of scans, biopsy etc. Now new scan was done and the dr says that my lining looks normal and thin !!! but in one place it's 8.7mm, but he is not worried about it as i was still on Sequential HRT but there is something that measures 10mm that could be a polyp, which could explain the odd spotting I had.

Hysteroscopy suggested with polyp removal, and Mirena insertion at the same time (I want it done underGA).

So how did the 6mm trigger all the hysteria, yet now consultant says he is not worried about 8.7mm... he said he would be if it was 30mm... By the way, never been measured after a monthly bleed, always before.

Biopsy showed  ‘simple hyperplasia without atypia so does anyone know :

if Endometrial thickening usually means all over the entire uterine lining or just in places?
 
Is endometrial thickening the same as hyperplasia? I know there is simple and complex hyperplasia, with or without atypia.

If 8.7mm is not of too much concern, does it mean the polyp is a big problem?
Could it be cancer?

I had a bit of spotting and some monthly bleeds were a little heavy compared to my real periods before menopause which were very mild but apparently on Sequential HRT erratic bleeds can be quite common?

As I was nearly 2 years after my periods stopped when I started sequential Elleste, could that have caused erratic bleeds? (continuous combined hrt would have been a better choice I understand)

P.S. I have been having a clear, watery discharge, it feels like excessive lubrication, but no hint of blood or any colour. It's been quite constant in the past couple of weeks, sometimes it makes me think ah, bleeding starting, but no, it's just a big of liquid I can feel. I've read somewhere that hyperplasia/uterine cancer can cause pink discharge but mine is just really clear, literally like lubrication, so getting worried now.

Did your polyps cause any symptoms?
Thank you, hope it's not too much information xx

, so I can understand

[Dotty]

Hi Andie

First let me say that I'm not an expert or a doctor , but I think the sequential hrt is possibly responsible for your bleeding. Hopefully your body will settle on the Kliovance and you won't get any bleeding.

I think HRT can cause more discharge too as it lubricates parts that have become dry.

I know it's hard but try not to overthink things. I'm terrible for needing to know all the ins and outs of everything and I have gone round and round in circles with all my problems caused by menopause . Now I'm settled on a hrt regime I am beginning to calm down and not think so much about the whys and wherefores of it all. But I know it's hard.

I'm not sure if I'm helping you! It's such a complicated and awful time of our lives, but there is light at the end of the tunnel. Xx

[Dotty]

I agree Jeaniewigs. We are here to support on this forum. And just someone giving you a few words of encouragement makes such a difference. Nothing is right or wrong on this journey. X

[Hurdity]

Hi AndieKC

I do agree with Dotty that it's best not to overthink but I do understand your desire to understand what is happening as I am the same!!!

Re the difference between endometrial hyperplasia ( ie simple without atypia which is nothing to worry about) - and the normal thickening of the womb lining that happens during the menstrual cycle ( and including the artificial cycle when on HRT) I have never really got a satisfactory answer from my research around the web.

When I had to have investigations that led to hysteroscopy and biopsy (due to spotting after sex) - I had a scan which showed thickened lining ( only to be expected as I was in the middle of long cycle HRT!), but the TVS showed an abnormality hence they sent me for investigations. In this case it would present on the scan as a thickening but they could see that it was a defined irregularity. It runed out to be a small fibroid which has since disappeared or is so small as not to be found on regular scan.

I don't know about irregular thickness otherwise.

Also I'm not sure why you think it might be cancer as I thought the biopsy showed simple hyperplasia without atypia? However if you have an area that could be a polyp then it is important to have it investigated and removed if necessary and that would put your mind at rest.

If you start sequential HRT 2 years after menopause then your bleeds should be more predictable - but on oral HRT there can be differences in absorption (it has to be digested before any of it gets into the system) leading to inconsistency in systemic levels which could possibly account for this.

I have no idea whether polyps cause any symptoms apart from bleeding - sorry, nor about the discharge!

I assume you are still having the polyp removed during the hysteroscopy?

Do try not to worry - you won't be able to find out what exactly is going on in your body until after the procedure so try to do something to take your mind off it all!

Hope this helps

Hurdity x