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[kateJ]

Hi everyone,

i am really appreciative of all the information on here and I am looking for some advice and reassurance please.

I am 55 and have just had my second internal scan in a year to check the thickness of my endometrium. The first result was 6mm and the second, done about a week ago, was 6.4mm, taken 7 days post bleed. The radiographer said that all looked fine and was within the range for a woman on HRT that is, below 8mm.( I have been on HRT for about ten years and changed to the Estrogel/Utro regime in January of this year. However, my 'consultant/specialist registrar at the C & Westminster has advised that I need a hysteroscopy if my lining is above 5mm.

i am confused as i was told that i was in the normal range my the radiographer and research supports her assertion:

https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12150

In this study, it clearly states:

A 10‐year study of endometrial appearance in women on sequential or combined HRT compared with no treatment concluded that women on HRT had a thicker endometrium and a higher incidence of bleeding. No difference in the incidence of endometrial cancer was identified between the two groups, however it concluded that women with unscheduled bleeding on HRT require further investigation by hysteroscopy and biopsy if the endometrial thickness was greater than 8 mm.50.

I am symptom free and I had a colposcopy to rule out anything sinister late last year for post intimate bleeding. I would like to avoid this incredibly invasive and painful procedure if possible, but really don't know what do now.

I would be very grateful for any clarity or advice.

Many thanks

[Jari]

Hi Katej, welcome to the forum.

I would ask your specialist why you need a hysterocopy if all the info you have says you are in the normal range. Definitely get a full explanation and do ask all the questions, before going forward with it, so you are confident that it is actually needed, if that's the case.

It's true that hrt does cause extra thickness, bleeding etc and in my case it caused a fibroid to grow. I believe the added estrogen hormone encourages the lining to thicken and the progesterone encourages the shedding of the lining. So it's important to have the right dosage of both..

You will feel better if you make sure you have all the info explained. Maybe you can email him/her?

I think there are a few ladies who have had to have hysterocopy's so they will be able to give you more info. X

[Foxylady]

Hi KateJ, this is interesting for me as I am coming up to 3 months on my current HRT regime (Everol 75mcg patches & Provera 5mg daily) since starting I have been having fortnightly bleeding (at time of period fresh blood, much lighter than normal period, mainly during the day little if any at night, the other two weeks its old blood for around 4 days) the cramps are getting really annoying, more often at night & bloating also. Was planning on making a GP appointment when I got to collect my prescription tomorrow as it has been going on for so long. I'm assuming it's the Provera that's causing the issues. I've never had any scans, investigations re endometrial lining etc but assume that will be the suggestion from GP. It's such a rollercoster this menopause what helps with some symptoms then causes others, hope you find a solution that you are happy with kate. x

[Jari]

Also Kate, if you go back to the home page and then enter hysteroscopy in the search area, then you will see a number of other threads with posts about hysteroscopy. There might be some good info there, you could make some notes and email the specialist to find out?! X

[Wrensong]

Hi KateJ  I agree with Jari about querying this with the C&W.  I had similar differences in opinion from relevant professionals - Gynae said my lining was too thick on HRT, but menopause clinic said it was fine & well within range.  I did not have another hysteroscopy at that point as I was stopping HRT for other reasons & the lining reduced of its own accord within weeks. 

However, I had had a hysteroscopy for persistent bleeding on a conti regime, 6 months or so after starting systemic HRT & though it's over in minutes it's not something I would want to repeat unless absolutely necessary.  If it turns out it is recommended for you I would insist on local anaesthetic.  I had one in fertile years under general together with a D&C, one in fertile years under local (which was fine & not at all painful) & one without any anaesthetic or sedation well postmenopause & with poorly managed VA, simply because no anaesthetic was the hospital's policy at the time.  I would not recommend that to anyone!

Foxy - I'm on MPA too, but currently only 2.5mg & find it has a greater tendency to cause cramps than norethisterone or Utrogestan.

[kateJ]

Thank you so much everyone for your replies.

I intend to query the recommendation from the meno clinic at C & W like you say. i would prefer to wait a few months and have another scan to see if there's a 'trend' in the thickness. i only changed HRT recently and suffered during the transition ( back to terrible night sweats, anxiety and depression mainly). I realised that I was probably not having enough pumps of estrogel - 2 pumps daily - as well as the effects of the daily utrogestan, so I didn't take the utrogestan for a month and felt much better, but still very low mood. then started following Prof Studds regime as i put everything down to the utrogestan.

Then at my first consultation at the meno clinic, blood tests revealed that my estrogen was low ( 135) and i was told to up it to 3 pumps and to try to increase my utrogestan as they don't approve of Studd's advice. So for the last two months I took
( vaginally) 200mg for 7 days and the following month 200mg for ten days. ( yucky moods!). This month I will now increase this to 12 days as per NHS guidelines.

Sorry for so much detail - this is in case anyone else has a similar issue. And the bottom line is is that I really don't want to subject myself to a hysteroscopy if it is unnecessary.

I will call the hospital tomorrow and ask for advice.

Thank you all again. Enjoy the bank holiday sunshine

[Wrensong]

KateJ please don't apologise for giving detail - this is what helps us all understand another's situation.    With any luck, increasing your progesterone will have the desired effect.  Good luck in your dealings with C&W!

[Foxylady]

Thanks wrensong, I assumed it was the provera rather than Everol. x

[suzysunday]

Hi katej.  I had to have hysteroscopy last year for post meno bleeding and I was terrified.  After internet research I decided to ask for it under a general anaesthetic.   I got one no problem, but I did have to ask.  I was home the same day and so glad I did it that way. Some women have no problem with hysteroscopy and some do so it's worth considering.

[kateJ]

Hi katej.  I had to have hysteroscopy last year for post meno bleeding and I was terrified.  After internet research I decided to ask for it under a general anaesthetic.   I got one no problem, but I did have to ask.  I was home the same day and so glad I did it that way. Some women have no problem with hysteroscopy and some do so it's worth considering.

Thank you Suzysunday and everyone again.

I have called the C & W today and on a lovely lady's advice I am going to email my concerns for clarification.

The more I think about this, the more i worry:( - but thank you for the recommendation to ask for a general anaesthetic.

[suzysunday]

Regarding hysteroscopy, I found a freedom of information site called What do they know" run by Katherine Tylko and Elaine Falkner.  They campaign for informed consent so that women know what's available regarding the procedure in hospitals across the country.  They have a Facebook page "Campaign against painful hysteroscopy".  I found their help invaluable at a time when I was SO stressed. 

[Nairn]

Hi Katej

I can really understand your concerns.  I'm 52, been on HRT for 7/8 years.  My lining was thick due to use of sequential HRT (view from the consultant), and I was changed to conti HRT to try and reduce it, when 1st measured it was 6mm and then increased to 10mm within 6 months - don't know what it is now.  However the view after a biopsy (negative) was that the original type of HRT was causing build up.  The gyno was clear with me that as the biopsy was negative I did not need to worry, especially as HRT was being changed so you are right to check out your concerns and really think this through.  I have to say since changing HRT I have lost lots of strange stuff in periods so they may well be right that the lining is reducing.  I would also add that the biopsy without anesthetic was v.painful for me (I have a super sensitive cervix), so if going for something more intense I would definitely go for a general, not just for the pain but its awful having the sensation as well - however i think my pain threshold down there is pretty low now!   Hope you get the answers x

[kateJ]

Regarding hysteroscopy, I found a freedom of information site called What do they know" run by Katherine Tylko and Elaine Falkner.  They campaign for informed consent so that women know what's available regarding the procedure in hospitals across the country.  They have a Facebook page "Campaign against painful hysteroscopy".  I found their help invaluable at a time when I was SO stressed.

Thank you for this. I've had a look and there seems to be a lot of concern out there regarding how we are treated as women re pain relief. This is an incredibly invasive and painful procedure, yet it is only now being considered important to offer adequate advice about what to expect.There is even now an online petition demanding that women are offered more pain relief.

Thought people might find this interesting to listen to  https://www.bbc.co.uk/sounds/play/m000612b. About 33 mins in there's a discussion about hystersoscopy and how women are not given enough information.

I have now emailed C & W for advice and will update the forum when I hear back. But it is a stressful time, as you say.

[kateJ]

And thank you, Nairn for your advice. I think I will have to have a GA too especially after my research!

[Wrensong]

Suzysunday - that sounds very interesting - had no idea it existed.  In retrospect, I did feel my last hysteroscopy & biopsy, without the option of either pain relief (other than the recommended paracetamol beforehand) or sedation, was a bit much to expect a 5 years postmenopausal woman with inadequately controlled VA to endure.  The nursing staff were clearly uncomfortable that I had to have it done that way too, but I think it was hospital policy.  The biopsy was OK but the cramps were intense.  They apologised for the discomfort & the shock of it, combined with their kindness, made me cry, which was embarrassing!  I was not especially anxious about it beforehand, so hadn't been terribly tense to cause access to be more difficult.

KateJ - with any luck it won't be necessary for you to have the investigation, but if so, do push for either local or if you're happier with the idea - general anaesthetic.  I prefer to avoid the latter if I can, as it usually doesn't agree with me, so feels like overkill for a short day case procedure.  This is a quick procedure & I know some women find it OK without any medication, but I think better to be cautious & get whatever help is on offer & that way you go in feeling less anxious.  Good luck, whatever happens.

Sorry - our posts crossed!