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[Dancinggirl]

Hi and welcome to MM anais
Pleased to hear that you are getting the right treatment at last.  VA is very unpleasant and is far more common than one might imagine - sadly due to women's embarrassment.
You are not alone in having worries about HRt treatment - there have been so many scare stories and the leaflets don't really give good information.  Spotting and some bleeding is very common with any HRT treatment but the continuous HRT treatment will give some erratic spotting/bleeding for some months, so I wouldn't worry at this stage. The blood you are getting now will be from the uterus as it adjusts to the HRT - basically the progesterone is stopping your womb lining from building up. If after 6 months you are still getting spotting then get this checked out - they may tweak the dosage or how you use this HRT regime.  The recovery of all your 'lady bits' will take at least 6 months so do expect things to be sensitive in the mean time.
Don't worry about slight discharge either, again this is quite normal and should be slightly yellow in colour. Whilst Replens can be helpful, many of us find that vaginal gels like Multi Gyn Actigel or Hyalofemme can be better - a good squirt of one of these on the end of the finger and pushed up inside and around the outside after a shower each day can help to keep things lubricated, soothed and healthy - do try using these alongside all your other treatment.
Hopefully you will get other benefits from using systemic HRT - it is now known that 5 years of HRT in our 50s can protect your heart and bones in the long term. Even when you eventually stop systemic HRT, it will probably be wise to continue with Vagifem in the long term and possibly for the rest of your life. DG x

[anais]

Thanks for your reply Dancinggirl

The full HRT was prescribed specifically for osteoporosis as I have low bone density. The consultant put the case very strongly and gave me printed information so I could make my own decision, so here I am.

PMB is such a cause for anxiety. On one hand we read that it's abnormal and you should see your doctor ASAP, which I did and was referred for investigation on a 2WW referral last July. I was told my scan results then and there. The endometrial thickness was something like 2mm. The smear test was torture, or rather the speculum was sheer agony and they had to find a small one for me too, but the result came back normal, cells showed atrophic pattern (no surprises there) and repeat in 5 years. The consultant who did the investigations referred me to the postmenopause clinic. I had a cystitis infection at the time too, so that was also explained as a symptom of oestrogen deficiency.

I'm not that bothered about the discharge as I see it as a sign that my tissues are responding to the hormones and the swab taken by the nurse was clear. My "lady bits" became enlarged with painful swellings all along the edges of the labia minora, it's been three weeks now and although the swelling has gone down a lot the painful 'edges' are still sore and the edges feel raw in places with a sort of gritty in texture. That all started within the first week of HRT. It seems to be almost gone some days only to flare up by the evening. I don't know if this is a consequence of chucking hormones at atrophy/dryness and the cells waking up with a shock. I doubt very much it was thrush especially with a clear swab. Another one to raise with the consultant, I think.

I really don't know what to make of the bleeding. How long does it take for the symptoms of VA to settle after HRT? Before HRT I think I must have been very dry inside but in after 3-4 weeks on full HRT the difference is amazing. But surely this wound prevent bleeding on a impact? Or does that take time?

Just as an observation I found it strange that I had these blood streaks after 4 weeks, which ties in with the typical menstrual cycle even though I don't have them any more.

I suppose I'll just wait for my appointment and raise all my concerns on the day, but appointments don't always go as planed sometimes. I'll be armed with a list!

[Dancinggirl]

anais - I'm afraid you must expect there to be more that just blood streaks - most of us will get some proper bleeding( like a period) in the first few weeks or even months on HRT - I doubt your streaks are just to do with the fragile skin due to atrophy.  My gynae describes the effects of HRT as "the body waking up" so one must expect some strange aches, pains and the whole of our 'lady bits' will plump up again.  The grittiness and soreness you are describing is typical for VA and it will take some months for the hormones to work their magic. You may well have some low grade thrush or bacterial vaginitis as this is also common in menopause , even if using HRT; this is due to the flora being out of balance because there aren't the natural secretions to keep things healthy. The vaginal moisturising gels I mentioned before will really help with this - I'm afraid doctors don't know about Multi Gyn Actigel or Hyalofemme and rarely suggest extra lubrication with HRT but I've always found I need it and I'm not alone.  You are clearly getting good advice and the right treatment so I would try to relax and not worry and let the hormones do their magic - you will probably feel great in 3-6 months as it can take time to truly work.
 Dg x

[Hurdity]

Hi anais

I agree with Dancinggirl - you should expect some bleeding for up to 6 months when starting continuous combined HRT if your body has been starved of oestrogen - and as you are being treated for atrophy your tissues should have thickened up by now to the extent that they are less fragile (but also depends what you are doing - eg re intimacy - which can be regarded as a form of trauma to an atrophied vagina!).

Yes PMB is a worry - but in your case - the first bleeding was due to VA, and the second bleeding due to the HRT. Any bleeding while on the early months continuous combined HRT would not be referred to as PMB and subject to a speedy referral - since it is normal. The fact that your lining was 2 mm showed that it was atrophied. You may continue to get some streaking/bleeding if you absorb the gel really well - and you might find that 100 mg progesterone is not quite enough. Only time will tell. Are you taking it orally?

As Dancinggirl says - try not to worry - but do note down what happens over the course of the next few months, and how you feel and hopefully you will be pleasantly surprised

Hurdity x

[foreign body]

hi ladies,
for 18 months i have been taking estrogel (one pump and a half) and utrogestan 100 mg (vaginally) in a sequential way - utro for 8 days every 4 weeks - because i cannot tolerate progesterone.

I have noticed that some of my symptoms have returned. I have 4-5 hot flushes a day, but i can live with them, insomnia (i hate) and very low libido, though i don't suffer from vaginal dryness, low mood and some anxiety. The last time i checked the womb lining four months ago, it was thin (3 mm.)
Now i am tempted to increase the dosage of estrogel to see if it makes any difference.
Is it normal for our bodies to develop a tolerance for estrogen and require more? I feel that the amount of estrogel i use is no longer effective.
What is your experience?

[foreign body]

At first i was on 1 pump a day, without utrogestan and felt very good. But when my lining became a bit too thick, i had to add utrogestan, despite my jntolerance. That's when i increased the dose of estrogel. It worked for about a year, but now some symptoms are back.

[foreign body]

Thanks a  lot! it's reassuring to know one can increase the dose of estrogel. On the current dose i don't even get a bleed.

[Mary G]

foreign body, it could be that you have now completely stopped producing your own oestrogen and you need more gel.

I take 1 pump of gel every 12 hours to get an even dose and it works well so you could give it a try.  If that doesn't work for you, perhaps you can increased to 3 pumps everyday.

[anais]

Dancinggirl and Hurdity, thanks for your helpful replies.

You'll have to bear with me, I'm completely new to HRT so I don't know what is "normal" and to be expected, or not. When I read the posts here everyone seems au fait with all the different HRT regimes and symptoms, but when I first joined it was all like a foreign language to me. I know we're all different here. We've all got different medical histories and some of us have other conditions too, some peri, some premature and some postmenopausal and we all have different symptoms and priorities.

An update:

I saw the consultant today. He wasn't all that bothered by the streaks of blood. He has advised me to repeat the 2 week reload with the Vagifem and continue inserting one every other day indefinitely. Nobody said I might have bleeding on HRT, so I wasn't to know it might be "normal" to get a bit of bleeding. I reported it anyway. He rechecked my TV US scan and smear result and didn't think there was cause for concern at this stage.

Sex? What's that? Lol! I'm afraid for now it's impossible due to VA and probably what they call "introital stenosis". Or born-again virgin syndrome, as I call it. I think I'm going to have to get one of those dilator sets to train myself once the HRT builds up. But I'm not ready for that yet.

My DEXA scan shows I have lost bone density in the two years since my last scan, so I've gone from "major osteopenia" to a diagnosis of osteoporosis. Not good at 53, hence the reason why he was recommending systemic HRT. He feels that I could gain some bone density on HRT but it's a very slow process, he says.

He also ordered a blood test to check my oestrogen levels now that I'm on full HRT, and also vitamin D. Previously my vitamin D levels were in the good range of normal but he recommends 800 to 1000 IU daily anyway. So I can do that no problem.

The consultant advised me to expect the external soreness etc to settle down with the HRT in time. The swab sample didn't show candida or BV. I'm confident that it's not an infection but I understand that the microflora is probably changing as a consequence of the HRT. If it doesn't settle I can always get another swab taken anyway. I used the anti fungal cream for over 2 weeks and it didn't cure it, and with a negative swab, I doubt it's thrush and I don't seem to have BV symptoms, but it is always a good idea to keep an open mind.

The breast and nipple tenderness that started in the first week has slowly settled down, almost back to nothing much at all.

So far I'm happy with my NHS treatment. The only problem was getting referred in the first place and the 6 month wait for my first appointment. If my oestrogen levels are lower than optimal he says he will write to me and advise me on whether to stay at 2x measures per day or increase to 3x, and he will also advise me on my vitamin D intake depending on the results but he's pretty keen on keeping my levels on the high-ish side. My dietary calcium intake is good, he's not advocating calcium supplements in my case, only vitamin D. I'm on 100mg Utrogestan at night. I take it orally. I know some people take it internally but for now I'll take it orally because I don't want to change anything. It makes it easier to know what works and what doesn't as I'm getting used to the regime. I might try inserting it later on, maybe after the first 6 months of doing it as prescribed.

The consultant wants to see me in 4 months time so I'll just carry on with the current regime, as he prescribed. If he advises 3x measures per day, I'll do that. If not, it's business as usual.  I'm increasing the Vagifem as advised as of today. So, let's see if that improves the VA and other local symptoms like the soreness and swelling. I was very dry on the outside even after 6 weeks on Vagifem. My bladder is doing much better now anyway, which is a relief.

Thank you, everyone. I am a newbie so I came here pretty clueless about all of this. 

[Trufflecat]

Good luck anais. This forum is a marvel isn't it? I only started on HRT to improve my appalling and worsening moods, but until I looked on here I had never even heard of VA, which sounds just awful and which I am very keen to avoid. I hope yours improves soon.

[Hurdity]

Hi anais

Thanks for your detailed update and so glad that you are receiving good treatment.  Yes as the others have said, we were all newbies once - and actually your updates are really clear so that those of us who reply are able to see exactly what's been going on

Stellajane - speak for yourself! I don't think anais said or even implied this! However your replies don't look bossy to me and nor do anyone else's so I don't think you need to worry on that score!

Anais - yes please do keep us posted - it is so important to be able to prevent osteoporosis and such a worry to be diagnosed with this at 53. This is one of the reasons many of us on here strongly advise women to take HRT - because we now spend so much of our lives post-menopause so osteoporosis has longer to develop even if we don'd develop it at your young age. Of course some women will never develop it - but you cannot know this can you - so better to try to prevent it if possible - and failing that to treat it as you are doing.

Hurdity x

[Pollie]

Anais - I can't post any links but along with a high level vitamin D supplement you need to consider vitamin K, manganese, magnesium and Boron. I am at risk of osteoporosis and my research revealed all of the above have a part to play as they interact with each other.

Pollie

[anais]

Thanks everyone for your replies.

Nobody was bossy, lol! When I first joined I didn't have a clue what people were on about with all these different HRT meds, and I wasn't expecting to have the full works prescribed by either. When I saw here that the Estrogel/Utrogestan combi seemed to be one of the best systemic HRT regimes, I was happy to find out that I had been prescribed it.

My consultant actually said the amount of oestrogen in Vagifem is so low – just like a lot of people on here are saying – that it's OK to take it every other day especially now I'm on Utrogestan. Some of you were on the 25mcg dose but obviously that's out of the question for newbies to HRT.

When I first mentioned the menopause to one of the GPs at the group practice when I was peri, she recommended magazines like Family Circle!!! I couldn't have a smear because of the pain when  the nurse was using one of those metal speculums. She said it was due to menopause in her jolly hockeysticks voice. I had to abandon it because it was impossible because of the pain. Now, this nurse supposedly deals with HRT as one of her specialities. But did she mention HRT? No! Not a word! And as for the other GP, he would be starting me on bisphosphonates right now as I've now crossed the diagnostic threshold for osteoporosis. Did he mention HRT as an option 2 years ago? No! My consultant says I'm too young to start bisphosphonates because there is a limit to how long they can be used for, and HRT is the better option at 53 although bisphosphonates can be used later on.

I was ignorant of HRT because the media and many women say it is "bad" and best avoided unless the menopause symptoms are making your life hell. My hot flushes fizzled out after my last period, so obviously I thought HRT wasn't appropriate in my case.

But... osteoporosis/major osteopenia, one bladder infection after another, after another, after another etc, abandoning a smear test because of pain, you'd think one of them would have put two and two together. Or is it that they are too frightened to prescribe HRT these days? I had to have a referral for PMB on the 2 week wait pathway before HRT was even mentioned. That was the first time I was told about VA. And I even had yet another cystitis infection on the day and I was just about to go and pick up my antibiotics afterwards l! All I can say now is that I'm glad that the two doctors I saw on that day mentioned the possibility of HRT to help with all these symptoms, and referred me to the menopause clinic.

This forum is the best place online for all things menopause especially with information relevant to the UK. I am very, very fortunate to be able to see a good consultant at a very good NHS hospital, but this site is an absolute goldmine of information and the regulars are real stars, welcoming everyone and offering so much help. Thank you, thank you, thank you!!!

[Hurdity]

Thanks for your kind words anais. As Stellajane says it is so rewarding to know that time spent on here sharing our limited experience and knowledge (because some of us are older and have been through it for longer) is helping other women

Hurdity x

[catlike]

Ladies- I think I got it wrong!!

I've been trying to work out why I was not absorbing the Estrogel. Initially I thought it was working better for me to rub it in as that was what I was used to doing with the E cream. Anywaay- the other day i thought let's just try the 'smear and leave to dry' method and WOW... now it's working! I'm feeling really good- and I'm on the prog part of cycle too! My breasts are sore, but hey I'll take that any day over the low moods and energy.

So- just thought I should let y'all know. It's a breakthrough for me  . Although I don't want to get too excited just in case... but so far- last few days- all really good! And I am finding I need less of the gel too- one and half pumps is working fine for me.