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[Tc]

I had an ultrasound today. Radiographer said lining is between 4.5 and 5.   I asked if he could proceed to a trans vaginal.as that might be more accurate but he said he didnt need to be more accurate. as I'm only a year post surgery and I wasnt post meno before ovary removal the lining wouldnt have changed that much yet anyway..so even if its 5 that's fine and it would have to be over 11 to cause any concern. .   He said, it would be different if i were 2 or 3 years post meno. 
That just doesnt sound quite right to me.  Maybe I'm wrong but Just thought I'd ask any opinions  as its playing on my mind a bit.

X

[pants46]

Tc, I found this ....

Postmenopausal
The thickness of the endometrium stabilizes after you reach menopause.
If you're close to reaching menopause but still have occasional vaginal bleeding, the average stripe is less than 5 mm thick.
If you no longer experience any vaginal bleeding, the average stripe is between 8 and 11 mm. An endometrial stripe of 11 mm or more is considered to be thick at the postmenopausal stage.

[Tc]

Hiya pants. Thank you for that. Much appreciated
Xxxx

[onion relish]

Thanks, Pants.

I'm not the original poster but I've been looking for information on what's normal. Sonographer told me mine was normal at 6mm. However, the gynae wants to send me for a hysteroscopy that I feel is unnecessary (but what do I know?).

[Hurdity]

Hi there boith - I think this paper will give you all the information you need about endometrial thickness:

"How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding" (Bindman et al 2004)

I will reproduce the abstract in full:

Abstract

OBJECTIVE:

Transvaginal sonography (TVS) is routinely performed as part of a pelvic sonogram in postmenopausal women, and images of the endometrium are frequently obtained. In women without vaginal bleeding, the threshold separating normal from abnormally thickened endometrium is not known. The aim of this study was to determine an endometrial thickness threshold that should prompt biopsy in a postmenopausal woman without vaginal bleeding.

METHODS:

This was a theoretical cohort of postmenopausal women aged 50 years and older who were not receiving hormone therapy. We determined the risk of cancer for a postmenopausal woman with vaginal bleeding when the endometrial thickness measures > 5 mm, and then determined the endometrial thickness in a woman without vaginal bleeding that would be associated with the same risk of cancer. We used published and unpublished data to determine the sensitivity and specificity of TVS, the incidence of endometrial cancer, the percentage of women symptomatic with vaginal bleeding, and the percentage of cancer that occurs in women without vaginal bleeding. Ranges for each estimate were included in a sensitivity analysis to determine the impact of each estimate on the overall results.

RESULTS:

In a postmenopausal woman with vaginal bleeding, the risk of cancer is approximately 7.3% if her endometrium is thick (> 5 mm) and < 0.07% if her endometrium is thin (< or = 5 mm). An 11-mm threshold yields a similar separation between those who are at high risk and those who are at low risk for endometrial cancer. In postmenopausal women without vaginal bleeding, the risk of cancer is approximately 6.7% if the endometrium is thick (> 11 mm) and 0.002% if the endometrium is thin (< or = 11 mm). The estimated risk of cancer was sensitive to the percentage of cancer cases that were estimated to occur in women without vaginal bleeding. For the base case we estimated that 15% of cancers occur in women without vaginal bleeding. When we changed the estimate to project that only 5% of cancers occur in women without vaginal bleeding, the projected risk of cancer with a thick measurement was only 2.2%, whereas when we estimated that 20% of endometrial cancers occur in women without bleeding, the projected risk of cancer with a thick measurement was 8.9%. As a woman's age increases, her risk of cancer increases at each endometrial thickness measurement. For example, using the 11 mm threshold, the risk of cancer associated with a thick endometrium increases from 4.1% at age 50 years to 9.3% at age 79 years. Varying the other estimates used in the decision analysis within plausible ranges had no substantial effect on the results.

CONCLUSIONS:

In a postmenopausal woman without vaginal bleeding, if the endometrium measures > 11 mm a biopsy should be considered as the risk of cancer is 6.7%, whereas if the endometrium measures < or = 11 mm a biopsy is not needed as the risk of cancer is extremely low.

You will see that the tolerance for thickness depends on whether or not bleeding has been experienced - and of course this does depend to some extent on what type of HRT is used. I was sent for hysteroscopy and biopsy following the finding of 7.4 mm even though I was on cyclical HRT (so would be expected to wax and wane depending on cycle) - but the scan did show an abnormaility they wanted to investigate which turned out to be a fibroid.

I would never turn down the offer of a scan (U/S then TVS at same visit preferably) - which should then determine whether a hysteroscopy and biopsy is appropriate.

Some gynaes and GPs will err on the side of caution and do a full investigation anyway with endometrial thickness much lower but it is reassuring that cancer risk is extremely low at low endometrial thicknesses and esepecially without concomitant bleeding.

Hope this helps

Hurdity x

[onion relish]

Thank you, Hurdity. Your posts are always helpful.

I really, really don't want to go for a hysteroscopy unless it's totally necessary. Long story but I can't bear the thought of anyone between my legs (sex abuse).

Do you think I could ask her to send me for U/S to keep an eye on it? No abnormality found at the last one.

I'm aware they're costly but I refused disease-modifying drugs when I was diagnosed with TM a few years ago and that's approx £4,700 every 6 months.

I know it's skewed thinking but I'm looking for any excuse here 

[Hurdity]

onion relish - what's TM? I haven;t come across that. Yes good idea to ask for a U/S scan regularly - after all there does need to be account taken of your justified phobia. It would be cruel not to. Are you able to go for counselling - but I presume you must have explored this avenue extensively.....?

At least U/S scans are relatively low-cost. You do need to monitor bleeding though. If you are experiencing abnormal bleeding then as you see , although you are at very low risk your gynae may be wanting to be ultra-cautious.

Not sure what HRT you are on and where in menopause you are - sorry I can't remember.

Hurdity x

[ElkWarning]

Hi TC

I work with radiographers and, with the best will in the world, they're not doctors.  They do the scans, not interpret the scans.  Some great info above, but if you're concerned ask a doctor, one of those medically trained people.

Best

EK

[joewillsmom]

After spotting post meno (one spot).. today I saw the consultant, he took biopsies and referred me for a scan, which I had a call for and went in this afternoon thanks to a cancellation.

Had an ultrasound and TVS, monographer said my lining was thickened, 8mm.
I rang the consultant in a panic, he said not to worry, he would expect it after the biopsies taken only hours earlier.
Has anyone ever experienced this please...
Am panicking xxx

[Hurdity]

Hi joewillsmom

Hvae just had a look to find your other thread - to see what's up and I see you were taking Tibolone. This is presumably what caused the thickened lining if you are post-meno - as it can have this effect?

That is not very thick though especially as you have been taking HRT, although a few mm over the recommended limit. The main thing is what treatment are they suggesting to thin it in relation to your hRT regime or maybe a new regime which won't cause thickening? I don't uinderstand the comment about biopsies and scan though? Maybe the act of taking them causes a localised reaction? Really don't know, sorry...

Try not to worry but find out if you can what the next step is - I imagine you will wait for the results and then decide what HRT regime you want to try next, if the Tibolone is off limits?

Hurdity x

[joewillsmom]

Hi Hurdity, I am so glad you replied.
I think he meant that he would have preferred a later scan, as today I'd already had a biopsy taken from the uterus and cervix so swelling could occur, localised as you said.
My health anxiety tends to spiral so I am grateful to have your reply. I was on Tibolone for a little while, stopping when the breakthrough bleeding started on the advice of the GP nurse. She said that as I was due for a smear, if all clear, maybe start it again after. Then this spot of blood, a few months after stopping Tibolone has sent me spiralling again and panicked the practice nurse, hence the urgent referrals.
I explained all this to the consultant today, he said to come back to talk to him in a few weeks regarding what to do next regarding HRT, as I really don't have much confidence in my GP surgery, the GP is always furious (stressed according to the nurse).. not as much as me I can tell you !!
I just have to wait for the biopsy results now. Then he can work out a plan for me. I'm open to HRT again as I felt so much better on Tibolone.
I am on anti anxiety meds for the HA, but can't seem to deal with this all the same. I appreciate your advice, as always.
xx