Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[Pandora]

Hi all

I have last year had womb thickening and treated at my local hospital, they have a womens healthcare unit.  I had provera which did sort it out and the lining returned to 5mm.  The lining was 7mm and it should be 5mm. I am 57 and on hrt patches 50 at the moment. 

The consultant wanted me off hrt, but as I still have symptoms I don't want to come off it.  I tried the mirena coil but it didn't suit me so I had it removed. 

They wont discharge me from the unit and say I now have to have a biopsy every three months, which I think is over the top.  Just wondered what anyones thoughts on this was.

Pandora

[Taz2]

Although it is a nuisance I would say that they are being rightly cautious and you should have it done every three months. They know what they are doing and their advice was to stop HRT, which you obviously don't want to do, so this is the next best thing. It's far better to have the biopsy than risk endometrial cancer.

What progesterone are you using?

Taz 

[Pandora]

Hi Taz

Thanks for your reply. I am using Noristerone for the prog part.

Pandora

[Taz2]

So had the womb lining built up despite you using the norethisterone? If so then I can see why they need to check every three months just to be on the safe side.

Taz

[Pandora]

Well at that time I was on another progesterone, which is now discontinued, something called duphastan I think.

Pandora

[Taz2]

Yes that was discontinued around five years ago due to commercial reasons. Apparently it was mainly used to help maintain pregnancies where there was a risk of miscarriage and there was no proof that it actually worked. There was not enough HRT use to warrant it's manufacture after that.

Taz x

[andius]

 

I don't understand why they wouldn't want to know what thickness it is on the new med before they do the biopsy. Couldn't you just have an ultrasound to measure it instead? Maybe you wouldn't need a biopsy if the thickness was normal on the new med? At least they are being cautious.

[honeybun]

It makes you wonder if a scan should not be routinely offered to all women on HRT on a yearly basis.
It's non invasive and quick and would probably save many women from endometrial cancer.

Mind you I probably know why they don't.....money !

Can't see it happening any time soon on the NHS. If private consultants think it's a worth while procedure then it does make you think though.


Honeyb
X

[Hurdity]

I agree with andius. Personally I think this is over the top and I am surprised this is being offered on the NHS (is this in England?). The usual procedure is to scan first - abdominal and then trans-vaginal. A biopsy is often taken if there is post-menopausal bleeding as well as thickening, but not sure if for thickness alone. In any case - to do a biopsy once is good to be on the safe side. However if they have excluded any abnormality and then treated the thickened lining with a progestogen then all that is needed is to scan the lining to chekc it is still thin. Personally I wouldn't want to have a biopsy every three months.

I had the same as you - post-meno bleeding ( even though on HRT).  Two scans. Thickened lining found - 7.4 mm I think, and an abnormality. They did a biopsy because of the abnormality. Small fibroid found. No treatment given for the lining (which is odd) - but I am on cyclical HRT so the thickening could well have been due to that. My consultant ( who did the biopsy) was happy for me to continue to be on HRT even though I am 60.

I would suggest 6 monthly scans in the first instance would be fine - but I'm not a gynae! Maybe they found hyperplasia in your thickened lining? It is a complex condition and I understand you can have a thickened lining which is not endometrial hyperplasia ie similar to that which occurs in the normal menstrual cycle. Endometrial hyperplasia can lead to one type of endometrial cancer. I don't know a great deal about it though.

I agree with honeybun re annual scans on NHS - and I think I mentioned this elsewhere recently too. We are all coming to the same conclusion. I'm not sure why not - yes cost - maybe the stats don't justify the expense ie there are very few cases of endo cancer compared to cervical and breast?

Personally I would ask a few more questions, I donlt think anyone else on here has had this (ie biopsy every 3 months) over the past few years, not that I remember - others have been around longer and may remember

Hurdity x

[Pandora]

What is the difference between a thickened lining and hyperplasia. Im not sure.

[andius]

Thick lining means just the measurement is thicker than should be???

Hyperplasia is a pathological (meaning LAB term not necessarily bad although could be) term that the doctor sees when he looks at the slide of the biopsy cells.

[Hurdity]

Yes partly true.

The endometrium (womb lining) thickens in response to oestrogen stimulation - as in the normal menstrual cycle. This is called the proliferative phase - and I presume still takes place during the peri-menopause and with cyclical HRT post-menopause.

Endometrial hyperplasia is a specific condition related to the structural changes that may take place in the lining when overthickening occurs for whatever reason (this is my understanding). It sounds quite complex and you can read about it here:

http://www.uptodate.com/contents/classification-and-diagnosis-of-endometrial-hyperplasia

"Normal proliferative endometrium exhibits no crowding of glands within the stroma". The stroma is the base layer of cells from what I've read.

There are then various stages of hyperplasia starting with simple through to complex and depending on whether the cells are typical or not - complex hyperplasia with atypia is the one most likely to lead to cancer.

So - not all thickened linings become hyperplasic - but it is one stage on the road to it, which is why docs are cautious. Also it is particularly releant to post-menopausal women who (unless on cuclical HRT) do not have a cycle, and those on conti HRT need to have sufficient progesterone to prevent thickening.

andius - many doctors are female ... 

Hurdity  x

[andius]

YES....and thank goodness too!  I just made an appt. today with a female gastrointestinal doctor to do my colonoscopy!!

Thanks, Hurdity 

A