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[purpleflower78]

Hello all, wonder if I could have some thoughts/advice please?

So I had an ultrasound last week, transabdominal and transvaginal.  I'm 53, no HRT and regular periods until July of this year.

The results have now been uploaded to my patient records with the Doctor's surgery which I can view online.

Both reports read the same, although the transvaginal report is marked as "borderline" and the transabdominal as "satisfactory".   Under the section "What you need to do" both reports say "No further action".

Both reports read "The uterus is retroverted and enlarged. The endometrium contains multiple tiny cystic structures with loss of definition of the posterior myo-endometrial interface. The total endometrial thickness is approximately 24 mm. Appearances may represent endometrial hyperplasia however other pathology can not be excluded. Both ovaries appear within normal limits."

Does anyone have any idea what will happen now please?  The "No further action" option seems strange as I have been bleeding continuously for 8 weeks now and in my option this is not an option!  The doctor hasn't rung me to discuss results but I had already booked an appointment for this Friday in the hope that I would have had my scan by then - but any thoughts would be very much appreciated please.

[CLKD]

'no further action' - I wonder who makes that decision?  DH had this when he went for an X-ray ? possible gout.  But he was in pain for months both B4 and after the X-ray  .

Take a list of queries when you go to your appt. and let us know?

[purpleflower78]

That was my thoughts too - report gives an idea of what it might be and then says 'no further action' doesn't make a lot of sense.  I will certainly take a list of questions.  Hope you DH has got some answers/treatment. 

[sheila99]

I don't know much about this but as the lining is so thick perhaps the bleeding is a good thing. Perhaps your production of progesterone has been less than it should have been. Perhaps a mirena would help? I wonder what 'other pathology' they had in mind? I agree that 'no further action' doesn't seem appropriate.

[jaypo]

I think the no further action is from the specialists point,he/she is happy that THEY don't need to do further investigation but I'd definitely be making an appointment to talk it through with your GP

[purpleflower78]

Ah yes that makes sense about the no further action!

[Hurdity]

Hi purpleflower78

When you say you had regular periods until July this year - do you mean every 28 days and not irregular or variable cycles? Also how long since the first day of your July period until you started bleeding this time? If they were regular up until then and now you've started bleeding heavily eg after a couple of months it could  be due to a couple of what is known as anovulatory cycles - which is what you get in early peri-menpause as the ovaries start to fail. This means that several eggs start to develop so you produce lots of oestrogen but then ovulation doesn't occur so the lining has built up but it's not shed.

Do read this article about the peri-menopause to help understand what's going on:
https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

Having said that it does seem strange for the lining to have built up to that thickness in that short time.

Isn't it good to be able to read the reports online ( same at my surgery) - and you are right to question these results.

I would be asking about this:

"The total endometrial thickness is approximately 24 mm. Appearances may represent endometrial hyperplasia however other pathology can not be excluded. "

From my limited knowledge that is a much thicker lining than usual ie 24 mm (but presumably maybe normal during peri-menopause?) even at the maximum thickness just before menstruation in a normal cycle. Secondly the fact that the report says that endometrial hyperplasia maybe be present and that "other pathology can not be excluded" - says to me that further investigations are warranted notably hysteroscopy and biopsy - just to rule out anything other than a thick lining due to peri-menopause.

I would say it's not good enough just to assume that it's all OK without further investigation and I would go back and ask for these - unless there is a particular reason for them to say no further action. Yes agree with jaypo there - perhaps it was just the sonographer writing that - although still a bit odd....

In addition - even if there is no abnormal reason for the excess thickness, the doc should surely suggest a way of treating the thick lining eg through a course of progestogen, a Mirena or HRT to ensure you reduce it to within normal limits and don't have to wait until your next ovulation  - and in the meantime just bleed!

It may well be that the doc will see these and call you back but if not presumably the doc who ordered the scans said to make an appt after the scans to discuss the results? Even if not - I would do this if you can as jaypo said.

Hurdity x

[CLKD]

no further action is that - it doesn't take into account who made that decision  nor is it explanatory  .  DH eventually got sorted, in fact the condition settled itself.

[purpleflower78]

My periods were regular every 22/23 days until the beginning of July; I then did not have a period for 6 weeks until the middle of August and 8 week's later I still have that period! The Dr said my cycles were very short, but it had been normal for me for many years.

I have seen the Dr again today and she is referring me to gynae for a biopsy, I have no idea what the "no further action" comment was about!  She is sure it's nothing to worry about but because it mentions cystic structures this needs to be checked out.  If all ok she recommends Mirena and possible HRT.

It's a 6-8 week wait for the appointment which in the grand scheme of things is not very long, but seems forever to me when I've already been bleeding for 8 weeks.