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)
I’m so glad I’ve found your site, I’ve been on hrt gel/tablets for about 11 months I’m 52 and had really bad symptoms to the point hubbie really couldn’t live with me the mood swings night sweats and fatigue were awful taking the treatment has fixed all of these things it hasn’t helped my libido but we can’t have everything just feeling human again and clear thinking is a god send. Everything was great for 2 months then all this started coming back and I had some break through bleeding all to be expected they upped my oestrogen and happy again, but the bleeding each month keeps getting longer and heavier I still feel amazing everything about myself is really good I’m really active eating well no other symptoms and when I get the chance even the libido is there again! I have only had this bleeding issue since starting hrt my periods have always been heavy and painful but regular and very rarely more than 7 days, the dr is tweaking things here and there and if things don’t improve they want to do blood tests to see what is happening with my levels but all this bleeding is really starting to get me down part of me is ok about it because all the other effects are gone but this part of continued bleeding is starting to grate! I’m not sure what I want to do coming of hrt and back to periods regularly sounds good as they may not be for much longer ? Or sticking with this to stay married and happy day to day sounds pretty good too, I don’t feel my drs are very forth coming and to be honest have said most drs just have very basis knowledge with hrt treatment they just don’t get the training! I don’t really want to go to hospital as the thought petrifies me and apart from the bleeding I feel amazing ! It’s nice to see other ppl having the same issues and after looking up everything not feeling so scared by all you see on here!
Hi Tara. A similar thing happened to me when I took progesterone continuously i.e. 100mg every day. I ended up having a period that lasted almost a year! My consultant thought it was because I was still newly post-menopausal (18 months). The solution was to change my progesterone to a cyclical regimen i.e. 200mg for 12 days a month followed by a period. It means I still have to endure a monthly period but at least I don’t have the breakthrough bleeding inbetween periods. So this may be something to discuss with your doctor.
As far as libido is concerned something the only thing that really helps is adding testosterone into the mix. This is quite a common treatment for menopausal women now and has to be prescribed off-licence. Again, something to discuss with your doctor. If you get no joy from your GP then please ask for a referral to a menopause clinic – unfortunately you may have a long wait. I hope you get this sorted soon.
Hello Angie and thank you for this as I have been searching the net for answers with no answers until I found you.
I am 55 and was diagnosed with a large bulky uterus prior to going into menopause, but nothing was done, I had 3 years with no periods and I was on the bio identical creams all that time with no bleeds, but the creams were just going up and up in price to beyond completely unaffordable. I had about a few months where I was not taking anything and the menopausal symptoms were just so chronic, I felt like I wanted to die, I take magnesium and vitamin D, but the aches and pains moods and hot flushes and fatigue were unbearable and nothing was making it go away.
So I went on the HRT pill about 8 months ago, all symptoms went! But I was getting periods monthly and they just became so heavy that I then became iron depleted and needed an iron infusion…. then changed to the patches about 3 months ago, the periods kept coming and this last one has been the worst, the pain not so bad, but the heavy clotting etc is bad. I changed Dr’s as the last one said I did not need to see a gynaecologist even though I had the scans saying it was this large bulky uterus and Adenomyosis. This new Dr told me to go off the HRT Patch immediately which I did and within days, the symptoms were back, I am now booked to see a Gynaecologist for biopsy next week, but today I decided to go back on the patches as I cant stand the symptoms ! especially the body aches, its like my limbs just ache and I feel like I am in a body of a 90 year old!
So are you saying that, you can stay on the HRT as long as its via this pill taken internally vaginally but only 12 days a month and you just put up with the periods? Can you please confirm this part to me? and how I go about getting this medication and what else do I need to do? so you just take a pill for 12 days? and does it work as effectively as the patches do?
What if the Dr here – in Australia does not know anything about this method that you do? as my Dr the other day only offered me an alternative to HRT – a medication called Tibolone which has high risks of a stroke! Or anti depressants !!!!!! (wtf)
I think if they tell me no HRT, I dont think I can do it, Doctors just don’t get how bad the symptoms are. I think I would rather be dead than have to put up with those symptoms.
I had a year of going to Dr’s for tests for chronic fatigue and to see what was wrong with me and the only thing that fixed me was HRT.
By the way how is your journey of health and healing coming along and oh yes, I definitely am blocked as far as creativity is concerned, my life has pushed me financially into a place where I do not want to be, so on a mental emotional level, I am not where I want to be in life in all aspects of my life but health and money its all connected.
Hi Lula, apologies for taking so long to reply and I’m really sorry to read about your struggles. Taking HRT in pill form has more risks so it’s better to take it through the skin in the form of patches and gels. I’m afraid I don’t know anything about the consequences of having a large bulky uterus but as someone who has adenomyosis I am absolutely fine taking HRT in the form of oestrogen patches (Evorel 75) and natural progesterone capsules (Utrogestan 200mg) taken vaginally for 12 days a month and I just put up with the periods. The good news is that natural micronised progesterone is available in Australia – the brand name there is PROMETRIUM so your doctor should be able to prescribe it. If you’re post-menopausal one option is to take 100mg of Prometrium every day – ultimately this should result in no periods but a nice thin endometrial lining. Please note that you need to take HRT in two separate forms – oestrogen (patches or gel) and progesterone (capsules). Please let me know if you’re not sure about anything and I hope you’re in a better place now.
Hello
I am 47 and enduring the same turmoil as you.
I started with perimenopaus around 5 years ago and things have gone from bad to worse.
I was diagnosed with adenomyomatosis and fibroids approx a year and a half ago.
My constant on and off periods stopped 6 months ago and I begged for HRT which felt like it gave me my life back again but now I’m constantly bleeding again.
I’m on a waiting list for a histarectomy and have been waiting for 6 months now.
I’m floored all the time with constant low aching pain.
I feel like a hypochondriac 🙁
You are not alone x
Oh Clare, I’m so sorry to hear what you’re going through. I had a similar experience to you when I was put on a combined HRT patch – Evorel Conti – which meant I had synthetic progesterone (Norethisterone) in my system permanently. I bled constantly for 10 months. The bleeding stopped when my consultant finally agreed to let me take Utrogestan vaginally with Evorel patches. At first I took 100mg daily because I was postmenopausal by then, but the bleeding continued. It was only when I switched to taking 200mg vaginally for 12 days a month that the bleeding finally stopped. I now have a monthly period with some side effects – mostly bloating – and am as right as rain!!
You’re not a hypochondriac at all and I wonder if it’s worth going down the route I went down before you have the hysterectomy. There may be no need for it if you have a similar response to mine. Fingers crossed!
Today I’ve had a vaginal scan & bladder scan. I’m 58 & on my 7th month of HRT. The radiographer said I had thickening on my cervix. Also a possibility of a polyp but may be a blood clot. I get the results in a week. I’ve been bleeding regularly since the 4th month, they last over 15 days & in the beginning I get cramps.
Although I’m late to HRT ( oestrogen gel & progesterone tablets, continuously) I definitely understand the feeling of not wishing to return to my post menopausal year’s without HRT. I feel so much better, I even look fresher but I’m thinking I’ll be taken off HRT.
Hi Kerry. Apologies for the late reply to your comment, I have been ill. I sincerely hope you haven’t been taken off HRT seeing as you are feeling so much better on it. It can take some time to adjust to continuous progesterone. In my case I had continuous bleeding for 11 months and so I had to revert to a sequential regimen whereby I take the progesterone tablets (Utrogestan) vaginally for 12 days a month and then have a monthly bleed. I was hoping to be period free but ultimately this works best for me.
On the subject of polyps, I have had two vaginal scans that have clearly shown a polyp and when I have undergone the awful ordeal of a hysteroscopy (twice) there was nothing there! I hope in your case it was nothing serious. Remember, taking HRT is ultimately your decision and about the quality of your life.
I am 55 and taking hrt since end 2017;
Before I was taking pill; in the last 3 years for 3/4 months and stopping when spotting became important
Periods were ok; I switched to this mode next to some episodes of heavy headaches and vomiting during periods but haven’t had it afterwards
First hrt was oral in continuous combined oestrogen and progestative
Everything was ok until February this year when I got metrorragy
Echography did not show anything except small fibrom
I stopped hrt to get another echography with conclusion : difficult to interpret maybe some adenomyosis for which nothing can be done
After 3 weeks hrt interruption I had to resume due to major sleep issues and did not bleed any more
Hysteroscopy early April did not show anything ( only endometrial atrophy) and doctor told to continue hrt
Mid June I asked to switch to patches because I thought that heavy irritable bowel syndrome could be due to hrt (crisis started early 2018) and it seemed to relief symptoms (less frequent and intense)
I had some intermittent light bleeding with the patch but early August it became continuous and more important and I also got pelvic pain;
My doctor was not reachable and I saw someone else who told me I have adenomyosis
She told me to stop the patch for one week (which I am currently doing) and then switch to sequential scheme : 1 patch per week for 3 weeks followed by 1 week break ; progesterone during the 1st 2 weeks of the patch (dose and scheme differ from the explanations in the box)
I started having period day after patch removal with real pain during 1 or 2 days and am now ok
Different treatments (Belgium)
Femoston Conti
Estalis 50/250
Système 50 / 1 utrogestan 100
Thanks for your advice
Hi Lamote. I’m sorry to hear you also have adenoymyosis. Unfortunately, as a fellow sufferer, this means we are more likely to have heavy bleeding and period pains. The advice your doctor in Belgium has given you is different from the advice given here in the UK and the standard product information. Here, women on patches change the patches twice a week and never take a break from the oestrogen patches. The oestrogen part of HRT is continuous, it is only the progesterone part that may be sequential or continuous depending on menopausal status. In the UK the recommended dose of Utrogestan is 200mg for 12 days a month or 100mg every day of the month if taking it continuously. It might be an idea to check with your regular doctor if you are receiving sufficient amounts of HRT and if the regimen you have been prescribed is correct.
Hi I’ve read all your comments looking for answers but still seem confused I’m 51 and was diagnosed adysomosis 6 years ago I really suffered badly with pain and bleeding they changed my coil after the other one had embedded itself into my uterus which didn’t help after they changed it all felt better after a week no pain or anything . About 2 years ago I started hrt dues to really bad hot flushes and all seemed OK until a month ago the pain that I had with the adysomosis returned for one night with a vengence since then nothing except swollen tummy and then this week after 6 years I started bleeding do I need to worry does anyone know what it could be I have other health problems with spine and feel like these new symptoms are not helping I feel so tired and painful more than normal I’m emotional but just had a bereavement which is obviously that but am very worried that this could be sinister what has just started anyone have any idea
Hi Tracey. Any unexplained bleeding needs to be taken seriously. This doesn’t sound right to me. It may be nothing but I think it’s a good idea to get it checked out by your GP or gynaecologist as soon as possible.
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
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.
What was the result? Did you have d &c? Still having issues? Still on hrt?
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.
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….
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.
I have fibroids and adenomyosis and am considering HRT as I am 55vand suffering from joint and muscle pain. Following your experience would you suggest I dont bother a d try and tough it out? My very heavy periods have all but stopped and I have no period pain at all…just this awful joint and tendon trouble.
Hi Lucy
I don’t believe in toughing anything out anymore – life is too short and there are so many options available to ease pain. Before you go down the HRT route I would suggest you check your vitamin D levels first as low vitamin D can cause horrible joint and muscle pain. I also suggest taking a magnesium supplement before bed as this can help with pain at night (400mg).
However, in my experience the only thing that ultimately took the joint and muscle pain away was HRT! I still take vitamin D and magnesium – the magnesium helps particularly with cramps at night – and vit D with knee pain and of course with Covid now.
If you do take HRT you will need to take it sequentially by the sounds of it as it sounds like you’re not postmenopausal yet. The only thing to be aware of is that you may have some horrible cramping to begin with especially with the adenomyosis but then it might be completely fine. I am now taking Utrogestan (200mg) vaginally for 12 days a month and my periods are generally okay, not too heavy. I do have to take ibuprofen for the first couple of days generally for period pains but I’m no longer passing out with pain which is a blessed relief!
I hope that helps. Any more questions please do get in touch.