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[Kathleen]

Hello ladies I thought I'd report on my latest meno adventure as it may be of interest to some of you.

I am almost 58, four years post meno but still having issues with anxiety, sweating etc. I began using Evorel 25 mg patches in January, increasing to 50 mg and then at the beginning of July I went up to 75 mg. For progesterone I was using Utrogestan orally for quite a while and more recently, vaginally.

Late last week I noticed a dark brown discharge which became heavier and turned almost black. I made an appointment to see my GP today and in the meantime I cut the 75 mg patch in half and went back to taking the Utrogestan orally. My concern was that the full patch was too strong and/or the Utrogestan wasn't absorbing properly. Over the weekend the discharge reduced and today there is very little.

I've just come back from seeing the Doctor who was not concerned about the discharge as it seems to be clearing up but he added that if it does continue I should go back and see him. He was happy for me to carry on cutting the patches in half and said that getting the dosage just right is a case of trial and error. I didn't mention using Utrogestan vaginally but I may continue with the oral route for a while.

So ladies there you have it, I was half expecting to be told I needed some investigation but instead I'll be trying to manage this myself and see what happens.

I hope this little tale may be of help to anyone in a similar situation and I'll keep the forum updated on any progress.

Wishing everyone well.

K.

[Rowan]

The dark brown discharge turning almost black might be a indication a small mount of endometrioses ( and/or old blood from further up) being activated by your increase in estrogen, cutting down on your estrogen will probably sort it out, your Doctor probably realised this but has told you to come back  if it continues which is good.

The progesterone had caused it to shed.

[Hurdity]

Hi Kathleen

It's not clear from your post whether you are taking Utrogestan continuously, and I presume you are as you are post-meno?

If this is the case then I would have thought the doctor should actually investigate why you are bleeding - although some bleeding/spotting is expected in the first 6 months or so of using conti HRT.

Firstly re the Utrogestan - you would be more likely to absorb more progesterone using it vaginally than orally because of the uterine first pass effect - the progesterone goes straight to the uterus where it is needed. Taken orally the same dose is not likely to provide the same amount to the womb linging as it is unstable as a compound and some is lost in digestion.

Continuous progesterone does not cause the lining to be shed - it acts on the uterus in a dose dependent way to prevent the oestrogen from building/thickening the lining. It is the fall in progesterone levels that causes a thickened lining to be shed (this sometimes happens with fluctuating progesterone, and especially if the dose isn't high enough to keep the lining thin).

Secondly you have increased to a fairly high dose of oestrogen for someone of your age and post-menopausal and you need to ensure that the progesterone dose is sufficient to prevent uterine thickening.

Abnormal bleeding can be caused by a variety of reasons, one of which is a thickened lining. It could well be that this is what's happening to you, but if might just be a temporary blip, but I am surprised that the doctor did not refer you just to check, although as you have only been taking HRT for a short while this could still be part of the settling in.

Halving the patches may well prevent any build-up of the lining but I am sure ideally you would want to have at least 50 mcg.

I'm not sure about the endometriosis silverlady - this is a condition in which parts of the endometrium are found outside the uterus and in fact the problem is they continue to grow in the presence of oestrogen and cannot bleed.

Hurdity x

[Kathleen]

Hello silverlady and Hurdity and thank you for your responses.

Hurdity - I take the Utrogestan on days 1 to 25 so there is a break of a few days only.  I was happy to take it vaginally but I was concerned that the discharge would interfere with absorption especially as the tablet is coated in a sort of plastic.

I agree that a 75 patch was probably too high for me, I was just desperate for some relief I supposed.

It may be because I've only been using these patches for eight months and the discharge has now all but stopped that the GP seems so unconcerned, I will keep a close eye on things however.

Thanks again for your comments ladies and take care.

K.

[Rowan]

Hurdity  Chocolate cysts can develop post menopause in the endometrium, with estrogen and progesterone, they are usually left alone. 

http://www.doctorslounge.com/gynecology/forums/backup/topic-44946.html