Print

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

[Hurdity]

Hi Diamonds and pearls

How long were you off HRT before starting this regime and sorry I can't remember what you were on before?

As others have said you can get spotting initially with conti HRT although your oestrogen dose is very low so there is much less likelihood of any build-up. Personally also I would have thought a drop in progesterone levels should not cause bleeding on a conti HRT, unless the lining is building up, in which case more progesterone is needed. (Bleeding on a conti implies that the there is lining to shed and therefore the progesterone is not doing its job!). However I don't know the reason for the initial bleeding commonly encountered when starting conti HRT as this does seem to settle eventually if you are post-menopausal.

I hope you don't mind my asking if it happened after sex or just out of the blue? I also can't remember what they looked for when doing the investigation? In my case last year I had all these investigations which were also clear and gynae decided it was due to the cervical ectropion and wonder whether your cervix was looked at too?

I am sure it's nothing to worry about but I would monitor it and go back to the doc if it happens again. There is no reason to stop HRT if there is actually nothing at all wrong!

Hurdity x

[Diamonds and pearls 53]

Hi Hurdity, I was off hrt for 10 weeks  and this was my 3rd experience of bleeding-very minor every time, and all checks-smears,swabs,transvaginal scans plus a good look at the cervix by a consultant proved normal. Gp had thought she could see an erosion on the cervix but the Gynae consultant said not so no need for a Colposcopy.No explanation could be found except that it was the hrt. I was on Indivina  conti tablet hrt (low dose) and had been for the past 4 years.The first time it happened, about 14 months ago, it was after intercourse (had to stop hrt and it stopped quickly)  but the following 2 occasions it just appeared.The second time I didnt stop taking hrt and it stopped after 2 weeks but the 3rd time the Gp said I must stop and again bleeding  stopped after 2/3 weeks.
Every time my lining was very thin,last time ,less than 1 mm so I can't believe I have any significant build up..must confess this time-and last-have felt quite' hormonal' too when the bleeding started -tender breasts and my bra feels tight.
I battled to stay on hrt and feel so anxious that if this continues I will have to come off it. And I can't go any lower re the dose I am on either.I just really hope it is a settling in period as life without it was miserable.
Diamonds and pearls x
   

[Hurdity]

Strange isn't it?

It doesn't seem like oestrogen breakthrough bleeding if the lining was thin, but equally I would be surprised if you bled due to temporary fluctuation in progresterone levels if the lining hadn't built up. It's certainly beyond my understanding - but the most important thing is that you have been checked out and all is OK.

I think I mentioned elsewhere that my doc at the surgery gave me some norethisterone to take once a year to "strip" the lining in case it built up on the Utrogestan - but so far I haven't taken it.

It seems we all react differently....

Try not to be anxious and make the most of how much better you feel if you can, and hope it settles soon!

Hurdity x

[Diamonds and pearls 53]

Hurdity, neither the  G.P nor the consultant could give me an answer as to where it was coming from.. just said it was the hrt!I just looked back at my diary and last time it took just under 4 weeks for it to stop, and 3 of those weeks I had been off the hrt on GP's orders. It was never anything more than a faint pink stain and never increased in quantity..very strange.Don't know how long to leave it before seeing the doctor if it doesn't stop..I know what she will say and I'm all too aware that this will be the end of my chance to take hrt... I know this sounds ignorant but what actually causes a bleed? ..is it the oestrogen or the progesterone..if its the prog could 100mg over 25 days be a bit too much when paired with only 25 mcg Oestrogen? or am I grasping at straws?
Diamonds and pearls x

[Sarah2]

One small thought- could it be vaginal atrophy?
Are you sore?
Reason I ask is that it is possible for the vaginal walls to bleed very slightly through small tears, or just chaffing of the thin tissues. This can show itself as a stained discharge.
The amount of oestrogen you are using now may well be too low to restore vaginal health to pre-meno levels unless you use topical HRT too.

I think your dr is being unhelpful if she wanted to take you off HRT because of this spotting. The cause needs to be found and it may be nothing to do with HRT.

It's the reduction /withdrawal of progestins that cause a bleed. Too much however can I think also make the uterine lining too thin and fragile and it can bleed that way . 

You could as an experiment reduce the progesterone next month to 12 x 100mgs days in a cycle and see how that goes but you would have a bleed perhaps.

[Diamonds and pearls 53]

Thank you Sarah..actually this time I do feel a little sore and today have felt my bladder is a bit irritable..lots of visits to the loo.When I saw the consultant (the first time) he did say there was a very slight indication of VA but no more than he would expect for someone my age. Have never had any problems before though.
I don't use topical oestrogen but was thinking of asking for it as a precaution..will definitely  do so now.
As I mentioned, I did wonder if the 100 mg Utrogestan was too much to balance out the oestrogen and as my lining is so thin (less than 1 mm when a had my last transvaginal scan in Nov) perhaps your suggestion of bleeding coming from fragile uterine walls could be the answer? I also feel a bit like I used to when I was premenstrual-headachey,sore boobs etc...I imagine that's the prog too?
I would like to try your suggestion of reducing the prog but don't know if I should do this without seeing my GP- and I am scared to see her in case she says that's the end of hrt without yet more investigations.I'm afraid the Consultant I saw had no answers either and just wanted me off it as I was 60...   It's a dilemma!

Diamonds and pearls x

[Hurdity]

Hi again

Just to clarify re your question about what causes the bleed and Sarah's reply - it's not just a question of "the bleed" - I think I posted elsewhere that there are lots of reasons for abnormal bleeding -  including those mentioned by Sarah2, vaginal atrophy, ulceration of the enodmetrium caused by too much progesterone, and progesterone withdrawal bleeding. There is also oestrogen breakthrough bleeding (too much oestrogen caused by over thickening of the uterus lining), and oestrogen withdrawal bleeding (caused by sudden reduction in oestrogen levels) - where the lining is sufficiently thickened to have something to shed. There are other causes of course, like certain abnormalities so there is no way of knowing which except by testing/investigation.

When you had the scan which showed the lining to be 1 mm, did the consultant look at the surface - ulceration causes by too much progesterone would be visible? Here is some information I found about progesterone breakthrough bleeding:

Progesterone breakthrough bleeding occurs when the progesterone-to-estrogen ratio is high, such as occurs with progesterone-only contraceptive methods. The endometrium becomes atrophic and ulcerated because of a lack of estrogen and is prone to frequent, irregular bleeding.

You did say yours is just a streak/spotting - whch was all mine was really (spotting).

I agree with Sarah2 that many of us need topical oestrogen as well as full HRT - I do, and I am on a higher oestrogen dose than you - I have never experienced true VA in that sense though. I would have thought though, that you would be aware of soreness, irritation etc if your VA was so bad to cause bleeding - but I have no experience of this! Certainly worth asking for topical oestrogen as this can only do you good!

So frustrating not to have consensus amongst consultants, because mine ( who investigated my bleeding with hyesteroscopy) said he was quite happy for me to continue, which has really made me feel positive about it all, especially as I'm 61 in May eek! If only women did not have to spend our time worrying so much about this crucial part of our lives.

You really need a proper consultation with a specialist to advise on whether to reduce the progesterone, or conversely increase the oestrogen  - which is the other option - especially if you are still experiencing symptoms).

You could always have an e-mail consultation with Dr Currie - giving her a brief run down of your history and what the investigations showed and mentioning your worry re the GP/consultant, as you have done on here, and then ask the question as to what she would advise - eg re some of the suggestions given here. It costs £25.

Hope this helps!

Hurdity x

[Diamonds and pearls 53]

Thank you Hurdity for your very detailed answer-now this is the kind of in depth response I would have liked to have received from the last Consultant I saw..but no,he just glanced at the transvaginal scan ( done by a radiographer ) and said it was obviously a fibroid -which I had been previously informed by a different Consultant (and a Radiographer) was small,calcified and redundant!When I mentioned this he changed tack and just said it was the hrt and I must come off due to age.He did not comment on the surface but of course I was about 6 weeks off hrt by then so presumably the surface would have recovered from too much progesterone anyway?
 You are lucky to have found a supportive Consultant Hurdity,I have felt like I am banging my head against a brick wall on several occasions. I may well email De Currie and see what she advises.. hopefully my GP would pay attention to her recommendations.
As always your input has been informative,thanks so much for your support.I will keep you posted..

Diamonds and pearls x 

[Diamonds and pearls 53]

Hmm more of a bleed today..this time more bloody but still only appearing when I wee /wipe.Wonder if I should stop the Utrogestan early? (Due to stop for 3 days on Sat) and see if that makes a difference..or should I just carry on and see what happens? Feel so conflicted!
Diamonds and pearls x

[Hurdity]

Sorry to hear this Diamnonds and Pearls.

I would continue to take the Utrogestan as directed.

Interesting that you do have a fibroid but I wonder if they suddenly become "alive" again with stimulation from oestrogen?

Hope it doesn't develop into a proper bleed! How frustrating and disconcerting for you.

Hurdity x

[Diamonds and pearls 53]

Thanks Hurdity, I think you are right-better not start 'tinkering' with the dose at this stage..no further developments so far but am anxious every time I visit the loo! Just hope everything settles down..out of interest, on your long cycle regime how long does your bleed usually last and is it fairly predictable? 
Diamonds and pearls

[Hurdity]

Hi Diamonds and pearls.

My withdrawal bleeds on HRT have always been completely predictable - always 1-3 days after stopping the progesterone, usually 2 days. They are usually about 5 days long and not very heavy. So far (last 7 years) I know exactly what's going to happen and when - I'm lucky, I do realise. I just hope the small fibroid they found last year ( they weren;t worried) doesn't grow but consultant didn't seem bothered about and I am sure I would soon notice! I have never tried longer than 2 months though, but I never head any breakthrough bleeding on this regime - just the post-coital spotting due to ectropion.

Hopefully yours will clear up soon!

Hurdity x

[Diamonds and pearls 53]

Hi Hurdity,
The long cycle regime sounds tempting, especially as you only have to take the prog every couple of months..how many days do you actually take if for? I wouldn't think you need to worry about the fibroid,and yes I am sure you'd notice if there was any activity.
The good news is my bleeding has stopped!-I won't celebrate just yet but perhaps it was just to do with absorption or the balance of the two hormones.Funnily enough it stopped after I had applied my new patch and the PMT type symptoms have subsided too..I will see what happens and sincerely hope that things will settle now but I can't help wondering if the dose needs tweaking..
Diamonds and pearls x 

[Hurdity]

Spotting is normal in the first few weeks or even months of HRT and hopefully in your case it will settle.

I take 200 mg vaginally for 12 days per 7 weeks (ie the 12 days is within the 7 weeks). This is based on the fact that you probably need less than half the dose vaginally that you do orally because so much is lost to digestion when taken orally.

On the oral dose you take 12 days of Utro after 16 days of oestrogen only (50 mcg patch). If using vag then double the oestrogen only days (because as above you probably need no more than half the dose - then this gives 12 days Utro after 32 days oestrogen = 44 days which is just over 6 weeks. I've rounded up to 7 and I'm sure this is ample for me. I would be getting breakthrough bleeds and a thickened lining if not and if this happens I might reduce to 6 again.

We are all individual and I don't have any major abnormalities in my uterus (well I didn't last year) so I am hoping for the best! There is no knowing whether this will work for you but you are on a low dose of oestrogen so you need even less progesterone to oppose it.

Hurdity x

[Diamonds and pearls 53]

Thanks for that info Hurdity, so if I understand you correctly you can only do the long cycle if you take the Utrogestan vaginally? Otherwise, if you take it orally, it is a monthly cycle with the prog being taken for 12 days each month? And on 25 mcg would I  still be on 100 mg Utrogestan? Sorry to ask so many questions but I need to be clear if I speak to my GP as she didn't know much at all and had never heard of it being used vaginally when I mentioned it.
I really hope things will settle down for me as I was quite happy with the way things were, but it's good to have all the options available in case I have to go back to my GP.
Thanks again for all your advice,
Diamonds and pearls x