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[Blue Kingfisher]

Hi everyone,

Sorry I’m still clueing up on scans of the womb lining when on HRT. What is an OK thickness and when should we have the scan in terms of our HRT cycle? I.e. I’m on sequi….so X many days after withdrawal bleed for example?

[Hurdity]

Hi Blue Kingfisher

I answered someone else on another thread about TV scans about this and put a link. Here is another link "How thick is too thick" which gives the ins and outs and compares thresholds for those with and without bleeding and those on and not on HRT (if I recall correctly - don't have time to re-read it!)
https://pubmed.ncbi.nlm.nih.gov/15386607/

If getting a scan you should time it to immediately follow any scheduled bleed if on cyclical HRT. Don;t wait for the last trickle of spots/stains as the lining will have started building already. So time it depending on how long (the main part of) your withdrawal bleed normally is. If post-meno and on conti HRT then any time, though ideally after 6 months at least since starting the HRT I would say to give the lining a chance to settle and stabilise.

I waited what i thoiught was the right time recently but it was a light bleed and it turned out that my lining was 10 mm and I'm now at a loss to know what it really is, so asked doc to prescribe extra progestogen - but they haven't sent me for a scan!

Hurdity x

[Blue Kingfisher]

Thank you Hurdity, that’s so helpful 

Hope you mange to get to the bottom of your lining result….Will you be moving onto 200mg Utrogestan?

I’m going to re-try 200mg Utro on a long sequi cycle next (6 week cycle).

I’ll sort out when I bleed and then book a scan. I can only think I’ve never been referred for a scan before as my bleeds on 200mg Utro (7 days a month) were always like clockwork and not too heavy (easy to cope with). Needed a tampon for first couple of days but then very light. Still risky in hindsight not to have a scan by now though.

[Hurdity]

Hi BlueKingfisher

Somehwat belated response - sorry.

Just to say I alread take 200 mg Utrogestan vaginally whenever I am on the cycle - and for at least 12 days per cycle. Just that the cycle is longer so I am slightly worried at the lining being thicker and have no idea whether it has been shed.

Really I should do a proper consultation with doc as I should most certainly not have to pay for another private scan to find out...

How is your cycle going and let us know about your scan ( though maybe you have in another thread - I am on the forum sporadically these days...)


Hurdity x

[sheila99]

Hurdity you may be interested in my recent experience. I asked for a scan because more often than not I don't bleed now I rarely have a cycle of my own. I timed the scan to be just after the bleed but that cycle there was no bleed. Lining was 6.7mm 7 weeks after the last bleed - cue urgent referral for hysteroscopy. I asked for a phone appointment with the hospital as I thought it was unnecessary and the lining was surprisingly thin given the lack of bleed. They said chances of cancer are 10-15% given my age (61) and thickened lining and want me to have a biopsy but hysteroscopy not required if I don't want it. Not sure I believe the 10-15% but I'll go for the biopsy anyway. I queried the need for it given referral is usually due to unexpected bleeding rather than no bleed when it is expected. She said the people who bleed are the lucky ones as they catch it early. For those who don't bleed it's more advanced by the time they find it.

[Teresa]

Hi,

I am post menopausal, so I only know what the lining should be for my particular case ( I bled when I shouldn’t as I’m on continuous HRT).

 A couple of months ago and I started getting spotting suddenly after 7/8 months on HRT.  I had an ultrasound which showed the lining of my womb was 16mm and apparently it should be 4mm. I’m post menopausal.
I do take another med for another problem which I found out can break down progesterone too quickly and I’d already mentioned it to my GP back in October last year.  I asked her if I should take additional utrogestan at the time and she said no. This was well before the spotting.

So I had a hysteroscopy last month and they took a biopsy. The gynae wouldn’t answer my questions about progesterone at the time and said I needed to speak to my Gp…I found this so odd! Fortunately the results now show it’s ‘normal’ and they’ve discharged me and sent me back to my GP.

I’ve made an appointment for this Friday to discuss next steps, but I’m not holding out much hope as she is the only female GP there and has already made it clear that she is anti HRT. It is so frustrating, as I’ve always thought my progesterone was low as I do get classic symptoms.

Keep pushing your GP for answers is all I can suggest.  Good luck.

Teresa

[Hurdity]

Hurdity you may be interested in my recent experience. I asked for a scan because more often than not I don't bleed now I rarely have a cycle of my own. I timed the scan to be just after the bleed but that cycle there was no bleed. Lining was 6.7mm 7 weeks after the last bleed - cue urgent referral for hysteroscopy. I asked for a phone appointment with the hospital as I thought it was unnecessary and the lining was surprisingly thin given the lack of bleed. They said chances of cancer are 10-15% given my age (61) and thickened lining and want me to have a biopsy but hysteroscopy not required if I don't want it. Not sure I believe the 10-15% but I'll go for the biopsy anyway. I queried the need for it given referral is usually due to unexpected bleeding rather than no bleed when it is expected. She said the people who bleed are the lucky ones as they catch it early. For those who don't bleed it's more advanced by the time they find it.

Thanks sheila99

This is the summary quote from the paper I linked to in previous post to Blue Kingfisher:

" 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. "

This is for women NOT on HRT so I imagine is different on HRT but it does give some sort of guide that below 11 mm without bleeding the risk of cancer is extremely low. Adding oestrogen in the form of HRT does change things though but I did always understand tht lack of bleeding is of far less concern than abnormal bleeding - which is a sign of the endometrium spontneously shedding - so I am interested to read what you say about your specialist and the basis for that statement: "She said the people who bleed are the lucky ones as they catch it early. For those who don't bleed it's more advanced by the time they find it."

Teresa - I will be interested to hear the results of your appointment but you may have already posted ( will check after writing this!).

Hurdity x

[sheila99]

I wonder if they don't have enough information so have to err on the side of safety. Age seems to be a factor, if I was 51 instead of 61 I wouldn't have been called in but then v late peri would have been normal at 51 whereas at 61 it isn't and presumably the only statistics they have for my age are for menopausal women. They may see few menopausal women without bleeding as they normally wouldn't be referred. They seem to consider 4mm to be the safe cutoff point.

[Emm225]

That's all very interesting as I experience spotting at least once a month, and have been for both a vaginal scan followed by a (painful) hysteroscopy. My lining was I think 4.9 mm.  the consultant said I am now post meno.  I am on HRT, have been for 2 or 3 years with no bleeding until about last November.  I did increase oestrogen in September ...but the utrogeston remained the same.  I am (well was but dropped it until I knew the result on the advise of the consultantand wil increase it if safe as feel horrid on a lower dose) on 37.5 estrodot and 100 mg utrogestan.
Anyone else had this sort of thing happen?

[nigela]

Hi,

I am post menopausal, so I only know what the lining should be for my particular case ( I bled when I shouldn’t as I’m on continuous HRT).

 A couple of months ago and I started getting spotting suddenly after 7/8 months on HRT.  I had an ultrasound which showed the lining of my womb was 16mm and apparently it should be 4mm. I’m post menopausal.
I do take another med for another problem which I found out can break down progesterone too quickly and I’d already mentioned it to my GP back in October last year.  I asked her if I should take additional utrogestan at the time and she said no. This was well before the spotting.

So I had a hysteroscopy last month and they took a biopsy. The gynae wouldn’t answer my questions about progesterone at the time and said I needed to speak to my Gp…I found this so odd! Fortunately the results now show it’s ‘normal’ and they’ve discharged me and sent me back to my GP.

I’ve made an appointment for this Friday to discuss next steps, but I’m not holding out much hope as she is the only female GP there and has already made it clear that she is anti HRT. It is so frustrating, as I’ve always thought my progesterone was low as I do get classic symptoms.

Keep pushing your GP for answers is all I can suggest.  Good luck.

Teresa
Just wondering how you got on as I’m getting an ultrasound tomorrow , bleeding stopped for 2 weeks now but getting bad cramping again. So hope not about to start as I’m on continuous. I’m trying the utrogesten vaginally. Maybe it’s that making the cramps? My GP would t listen when I said maybe I’m not absorbing the utrogesten orally. I have coeliac and lactose intolerance and do have difficulty digesting things. I guess if the lining is found to be too thick then I’ll need an hysteroscopy.

[joziel]

I wonder what the health service is going to do, because there are massive amounts of women starting HRT now (which is great) - but it does lead to loads more incidences of unscheduled bleeding and referrals for tests than women not on HRT.

How is an already-crumbling health service going to deal with this? Are they going to have to do some more research pronto and come up with better guidelines about who really needs these tests... or train up a lot more staff... or what!?