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[laszla]

I had a uterine TV scan in August as ordered by my meno clinic on a yearly basis. A few days later the sonographer's results notes noted quite a thickened endometrium (no doubt because of my scanty intake of progesterone on my sequential regime) and she wrote that a 2 week urgent referral should be made.

3 months elapsed and I heard nothing from the hospital so I wrote to complain (about that and other failings) and received a copy of the letter they've just sent to my GP which implies that I've just had the scan and that they are 'immediately' taking action which is dreadfully misleading.

But what I really need clarification about is this: the letter writer says that I had "PMB following which a scan was done". I see that PMB stands for postmenopausal bleeding but I haven't had any bleeding other than the withdrawal bleed that starts a couple of days after I finish the utrogestan.
Surely that does not count as PMB or am I wrong?
If as I believe my bleeds are just withdrawal bleeds, surely it is incorrect to say I had PMB in the letter?
I really need to clarify this as I need to respond knowing what I'm talking about.
 

[Hurdity]

Yes you are correct. Post-menopausal bleeding is abnormal or unscheduled bleeding. A withdrawal bleed on sequential HRT is normal and is not classed as PMB. Having said that if it is suddenly very heavy or clotty etc then there could be cause for concern - so it may be abnormal, but not PMB as such

PMB is normally reserved for post-menopausal women not on HRT who suddenly bleed, or women stable on conti HRT for some while and then suddenly bleed, or possibly also women on sequi HRT who bleed at completely the wrong time.

The other important point is that the endometrial thickness will of course vary throughout the cycle, on sequential HRT and therefore the best time to have a routine scan that you are having, is immediately following the withdrawal bleed (even if in the very last stages of light spotting at the end), when it is at its thinnest. Only then can you tell if it is thickened or not.

So the most important thing to note is when you had the scan in relation to your bleed and how thick the lining was. Whoever wrote that you had PMB is wrong and has not understood what regime you are on. Any menopausal clinic should know this and take full notes on what your regime is.

In the circumstances and if you don't know at what point in the cycle the scan was done, nor the thickness (or even if you do know the thickness) I would get back to the clinic or GP and ask for it to be redone but make sure it is timed as above - and explain this to them if they don't know!

All the best

Hurdity x

[CLKD]

I suspect that the sonographer had a) no idea about the various HRT methods of delivery and b) was going on 'guidelines'? 

Do U need another scan considering that there was no timing for the last relating to your regime?  Copy and paste the explanation from Hurdity and take with you to a Nurse Practitioner or GP for discussion.

Let us know how you get on. 

[laszla]

Thanks so much to both of you.
Hurdity that is exactly what I thought but sometimes you start doubting everything you think you know so thanks for your voice of reason.
Re what you say about doing the scan at the right time of the cycle, this was precisely one of the things that I addressed in my complaint letter to the hospital: knowing that you need to do it right at the end of the bleed, I tried to schedule it accordingly and kept being told by the hospital "there's nothing in your notes about having it done at any particular time".
I insisted and had the appointment slightly earlier than they'd wanted but still several days after the end of the bleed which no doubt accounts for the thickened lining. It was 10mm but I've had that thickness before - albeit slightly later in the cycle just prior to the bleed.
So now they're ordering a hysteroscopy which seems totally OTT (as well as terrifying to me) considering it's based on the incorrect info that I had PMB.

Anyway I can now write and try to explain all of this rationally, though rather alarmed that I need to...
CLKD it's actually not the sonographer who's at fault but a consultant in response to my letter of complaint - albeit a consultant I've never had any dealings with and who clearly hasn't read a jot of my notes.

[CLKD]

Let us know how you get on!  Years ago specialists would liaise with patients that were being assessed in various clinical situations.  Now no one seems to communicate 

[laszla]

Years ago specialists would liaise with patients that were being assessed in various clinical situations.  Now no one seems to communicate 

Exactly! With easily avoidable and potentially serious consequences...

[CLKD]

As well as taking less time, patients at hospital appts would be seen on the same day by all the Consultants necessary.