Post Menopausal Bleeding and HRT

10-26-2017, 05:56 PM

I was on birth control for years, having regular periods. At age 50, doc took me off, told me to wait 30 days then go have my hormone levels checked. During that 30 days, I began experiencing night sweats and other menopausal symptoms so I was not surprised when my blood results showed that I was for sure in the throws of menopause. My doctor put me on Activella which is an HRT. I wasn't crazy about taking it but it did relieve the night sweats. Also, he wanted me on it for osteopenia. So, I've been on it 5 months and have had spotting and twice a full bleed like a period although not as heavy. So, I tell him this at my regular check up and he says I should not be having post menopausal bleeding this long after starting the HRT. I mention that is a side effect of the HRT and he says I need to have a vaginal ultrasound to check the lining of my uterus and look for polyps. I had that today and the lining of my uterus is 6 mm and he says that is too much. So the next step is an endometrial biopsy. I feel like he is overreacting. If bleeding is a common side effect of HRT for at least 6 months, sometimes to a year, than are most women having to go through this? I'm scared of the procedure. He says don't worry, it isn't that big of a deal and we need to rule out cancer. Better to be safe than sorry later. I asked him if I could just get off the HRT to see what my body does and he said he didn't think that was the best choice. Does this sound like standard procedure or over caution?

10-26-2017, 07:37 PM

Standard procedure. I never had a bleed of any kind after I went on Activella though my doctor told me I might for the first 3-6 months. But they need to be sure so the procedure makes sense. Also, HRT is basically the same thing as birth control so you should not be worried there. Since I started having bone scans mine has improved from -1.6 to -1.0 and my doctor says it's strictly because of the estrogen. I'm 71 and have been on HRT for 14 - almost 15 - years.

10-27-2017, 04:03 AM

Your doctor checking your lining at 6mm seems extremely cautious. If you’re on any type of estrogen at all, you’re lining is going to be different than a woman in menopause not on HRT. 6 mm lining is pretty minimal. I had mine checked once during perimenopause (around age 49) when it was at 11mm, and still it was fine and it eventually shed.

I know a lot of women on HRT, many of whom have had spotting and bleeding issues. It’s very common. At 50, you are likely just starting into menopause. Since you have no idea when your “real“ last period was because of the birth control, you may not be fully in menopause. It’s not uncommon for our own bodies to kick up with hormone surges. Kind of like a last effort to turn the engine over! I’ve known women who’ve gone say 8, or 10 months without a period assuming they were going into menopause and then bam, they got bleeding and had to start the countdown all over again. Blood tests are not fully reliable in determining menopausal status. My sister-in-law is almost your age, she’s 49 1/2, and has been having hot flashes for two years now, and she still not in menopause. She still gets erratic periods once in a while. Honestly, it is really, really hard for you to know where you’re at where you’ve been on birth control for so long, and you don’t know what your own natural cycle is.

I do agree that the endometrial biopsy is not a bad procedure - I’ve had two endometrial biopsies. But I don’t think that he should be making you nervous and concerned. Let us know how it goes.

10-27-2017, 04:06 AM

I should add if you were deep into menopause....say 10 years with no period, they would want to see your lining under 5 mm or so. That would be 1) provided you were NOT on HRT and 2) because after that many years with no exogenous estrogen, your body should not be developing much of a lining. Try not to worry. I hope it all goes well and good luck!

11-12-2017, 02:55 PM

Thanks everyone for your reply. Having the endometrial biopsy tomorrow. I'm no longer worried about the results of the biopsy because I do think my doctor is just being over cautious. I'm just worried about the procedure itself and if it will hurt. He told me to take a couple ibuprofen before my appointment and that it is quick as a pap smear with a little cramping. I can probably deal with that I'm just kind of a worry wart and would rather not deal with it at all.

11-29-2017, 07:47 AM

I agree that your doctor seems overly cautious. Did you get the results of the biopsy? I hope it wasn't too painful / uncomfortable and all proved fine!

11-29-2017, 07:52 AM

Yes, biopsy results were fine. It was uncomfortable, but only for about 10 seconds.

Post Menopausal Bleeding and HRT

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