HRT and Me: Fibroids, Polyps and Adenomyosis

Close up of a red dahlia to illustrate fibroids, polyps and adenomyosis

This week I’ve mostly been thinking about my uterus. Apparently, a transvaginal ultrasound will do that to a woman.

Up until this point I have to admit to a lifetime of thinking about other body parts; I fret about my liver, worry about my heart, and am acutely aware of my digestive tract, but I’ve never thought about my uterus.

Until Tuesday afternoon when, feet in stirrups and naked from the waist down with a Registrar and a Consultant Gynaecologist sitting between my legs, taking turns to control the ultrasound probe in my vagina and talking in excited hushed tones, I had little else to do but think about my uterus.

Retroverted Uterus

It turns out I have a retroverted uterus for a start. This means that my uterus tilts backwards towards my spine instead of straight up and down. This affects about 20% of women and can be caused genetically, through pregnancy, menopause or pelvic inflammatory disease and endometriosis. In my case I think it’s genetic.

The pressure that the retroverted uterus places on the rectum and the ligaments around the tailbone explains why I’ve always experienced pain with periods and any form of penetration including tampons. (Tell me if I’m over sharing.)

Causes of Heavy, Prolonged and Painful Periods

I’d been referred for an endometrial scan because, as I described in my post HRT and Me: Progesterone Intolerance, for the past few months I’ve been experiencing heavy, painful and prolonged periods where the walls of my womb feel as if they’re being scraped with a comb of nails and by the end of a ten day bleed I feel positively anaemic. The ultrasound revealed several possible causes.

Fibroids

Firstly, it showed that I have several fibroids, which are benign tumours of the muscles of the womb, that can cause excessive bleeding.

Fibroids are very common and affect about 40% of women in the lead up to menopause. Usually they don’t cause any problems and shrink after menopause, but they are often the reason why women are advised to have hysterectomies. However, mine are relatively small and so are unlikely to be causing any major symptoms.

Polyps

There was also evidence of an endometrial polyp (uterine polyp) which is a lump or growth in the inner lining of the womb. They can cause irregular menstrual bleeding, excessively heavy menstrual flow or bleeding between periods.

Adenomyosis

I have some adenomyosis too, which is when endometrial tissue, which normally lines the uterus, grows into the muscular wall of the uterus. This causes small pools of blood to form in the uterine wall which don’t drain during menstruation. Over time this causes the uterus to enlarge and become engorged with blood. One of the symptoms of adenomyosis is heavy, prolonged periods and menstrual cramps.

According to the Mayo Clinic website, “Most cases of adenomyosis, which depends on estrogen, are found in women in their 40s and 50s, with a low incidence after menopause. Finding adenomyosis in middle-aged women could relate to longer exposure to estrogen compared with that of younger women.”

Thickened Endometrium

My endometrium (the lining of the womb) was thicker than it should be and that is slightly worrying as it is a symptom of endometrial cancer. In the UK the threshold is 5 mm; anything over that increases the likelihood of endometrial cancer. Mine is 5.6mm, which is only slightly over and may be completely insignificant.

Oestrogen Dominance?

Again, there is a connection with oestrogen as oestrogen is responsible for causing the lining of the womb to thicken every month in order to prepare the uterus for the possibility of implantation of an embryo. Both fibroids and adenomyosis are also associated with excess oestrogen and I wonder if my oestrogen dose of 100mcg patches twice a week has been too much and is now causing all these problems?

The Wisdom of Your Fibroids

In her book The Wisdom of Menopause, Dr Christiane Northrup writes about the wisdom of your fibroids.

“Fibroids can often represent blocked creativity, or creativity that hasn’t been birthed yet, usually because it is being funnelled into dead-end relationships, jobs or projects…. that we have outgrown.”

She suggests that if you have or have had a fibroid, you ask yourself the following questions:

What are the creations within me that I want to put out into the world before I’m no longer here?
If anything at all were possible, what would my life look like?
If I had six months to live, what relationships would I release from my life immediately?
What relationships would I give more of my time and attention to?
What relationships truly feed and nourish me?
Which ones drain my energy?

It’s an interesting, if uncomfortable thought. Even if you think it’s nonsense it’s still worth thinking about what this time of life means to you if you are perimenopausal and what you’d like to change or improve. Creativity and a new lease on life are some of the positive consequences of the menopause.

Hysteroscopy and Polypectomy

Back to the outcome of my transvaginal ultrasound. I have now been referred to the day surgery unit to have a hysteroscopy and polypectomy at the beginning of March.

A hysteroscopy is the process of looking inside the womb (uterus) with a special telescope called a hysteroscope. They will take a sample of my endometrial lining for testing and remove the polyp. I’m not sure if they are going to remove the fibroids as well and I also don’t know if I’m going to have a local or general anaesthetic. I hope to find all that out at my surgery pre-assessment appointment next week.

Next Steps

In the meantime, I’m feeling scared and fed-up. I’m growing more convinced that my HRT is no longer agreeing with me. Yet the thought of returning to the person I was before I started on HRT leaves me cold. So, I’m not sure what I’m going to do in the long-term.

For now I’m going to continue on my reduced dose of 75mcg of oestrogen and the extended dose of progesterone that the Consultant recommended. After I’ve received the results of the hysteroscopy I’ll have to reassess.

Whatever the outcome, it looks like I’m going to be thinking a lot more about my uterus in the weeks and months to come.

If you’ve experienced heavy, painful and prolonged periods please go and see your gynaecologist and have your uterus checked out. And if you’ve had a similar experience to me I’d love to hear from you. Please leave a comment in the box below.

Photo: Thanks to Susanne Nilsson for her photo of a Red Dahlia on Flickr.com (CCL)

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6 Responses to HRT and Me: Fibroids, Polyps and Adenomyosis

  1. Yvonne hilton March 2, 2016 at 12:18 pm #

    Hi ladies I had a scan and they found two polyps in uterus and fybroids on my cervix thickening uterus too. Iv had pain in back hips and very fatigued. Waiting for my gynaecologist to see me. I had very painful periods for two weeks at a time very heavy. Really scared of the outcome

    • Angie Macdonald March 2, 2016 at 7:58 pm #

      Hi Yvonne. I’m really sorry to hear this. Are you on HRT? The thickened uterus lining may be due to too much oestrogen and your fatigue may be due to iron loss from the heavy periods. Please let us know what the gynaecologist says and whether or not he/she thinks they will be able to remove the fibroids.

  2. Cathy February 25, 2016 at 12:24 pm #

    What was the result? Did you have d &c? Still having issues? Still on hrt?

    • Angie Macdonald February 29, 2016 at 3:36 pm #

      Hi Cathy. I didn’t have a D&C. There was no sign of cancer, thank goodness, and they never found the mystery polyp. I’ve still got fibroids and adenomyosis. I continued to have major issues with progesterone and periods from hell which I wrote all about in http://writehealth.co.uk/hrt-and-me-utrogestan-vs-cyclogest-natural-progesterone/. I’m still on HRT but I’ve been weaning myself off over the past year. March will be my last month on it and then I’ll be HRT free. I’m not feeling great but am hoping to find an alternative treatment in the coming months.

      • Caroline March 9, 2016 at 6:15 pm #

        Dear Angie

        Last week I was persuaded to have a Mirena coil fitted. From day one it was uncomfortable, put I persevered. A week later I was in so much pain, I asked for it to be remove. The GP who inserted it examined me and said it was in the right place and sent me away again. That afternoon I was doubled up in pain and was sick. To cut a long story short, it turned out that I had a urine infection. She finally removed it this morning (after one week) whilst I lay there sobbing in the consulting room. I am now at a complete loss as to what to do next. I can’t manage without the oestrogen and the Utrogestan gives me upset tummies, makes me cry incessantly and generally feel lousy. Have you found any alternatives as yet? A friend recommended homeopathy….

        • Angie Macdonald March 9, 2016 at 7:23 pm #

          Oh Caroline, I’m so sorry! You have just experienced my worst nightmare and made me very glad I stuck with my decision not to have the Mirena coil inserted. I’m afraid I haven’t found an alternative. I have been weaning myself off HRT for the past year and in about three weeks’ time I will stop completely. I don’t know what I’m going to do yet and am feeling very anxious in case I become the wreck I used to be and fall apart completely. Whatever happens, it will be interesting.
          Are you postmenopausal? If so then Tibolone is an alternative that doesn’t have the progesterone side-effects. I have found that a lower dose of oestrogen results in a more ‘pleasant’ period with fewer cramps. Some gynaecologists like Professor Studd give Utrogestan for only 7 days to women who are progesterone intolerant. I switched to Cyclogest vaginal pessaries, also natural progesterone, and felt a bit less depressed but a lot more angry and irritable. That might be a way to not get an upset tummy as it doesn’t have to pass through your digestive system but is absorbed locally. I wrote about my experience with Cyclogest pessaries in more detail in this post: http://writehealth.co.uk/hrt-and-me-utrogestan-vs-cyclogest-natural-progesterone/ . It depends what your main menopausal symptoms are as to what complementary therapies may be useful. If it’s mainly hot flushes and night sweats then hypnotherapy and cognitive behavioural therapy are meant to be the most effective treatments. Acupuncture may also be useful. I hope that helps. Let me know how you get on.

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