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[Hurdity]

Hi there

I am just posting this in case anyone's interested in my experience.

Some of you know that I am post-menopausal and take bio-identical HRT in the form of Estradot 50 mcg patches and Utrogestan 200 mg capsules vaginally 12 days per 6-8 week cycle – ie I still have a bleed. This is with the blessing of the lovely part-time GP at the local practice who specialises in all women's gynae issues and has done for over 30 years.

After some minor bleeding and other minor problems last year which needed investigations (nothing wrong) she was happy for me to continue with my HRT, but because of the thickened lining and a small fibroid, suggested that to be on the safe side I should take a course of norethisterone once a year to “strip the lining” of the womb, as she put it, in case there was any thickening on the longer cycle. Knowing how it gave me migraines when I used  Evorel sequi patches when I first started HRT, I put it away in the drawer trying to think of a time when I wouldn't mind feeling rough for a while.

Mid August I decided to take the plunge – most of my work is within term-times, and my holidays had finished, so I cast aside my “nil-by-mouth” HRT regime for the first time, and popped norethisterone pills (5mg) for 12 days for this cycle. I felt a bit weird, wired, dizzy and spaced out the first day after taking them but surprisingly did not get a headache or a migraine despite the high dose compared to patches/combi HRT pills! However I got very tired especially in the mornings (more than usual) and was very ratty with my husband (more than usual  ).

Then I was worried about what the withdrawal might feel like, and the bleed. Because norethisterone is more stable than progesterone I didn't feel the effects of the withdrawal for a couple of days and thought I'd got away with it, but last Sunday I felt as though my head would explode – massive tension and headache for about a day and a half – but no migraine – so just like normal pmt. Then I started the bleed and the tension melted away as the effects of the progestogen wore off and I started to feel myself again.

The bleed is definitely heavier than usual/last time – so I am wondering if either my lining has got gradually thicker (due to the longer cycle), or possibly that my small fibroid (identified last year) has grown in the presence of oestrogen. I shan't know until next cycle.

All in all it wasn't as bad as I had anticipated although I felt quite low on the norethisterone and when I had the bad head, I just thought of the difficult choices we have to make when post-menopausal and want to continue with HRT, and still have a womb, as most of us do.

Either you throw in the towel (sanitary?  ) and give it all up and suffer the consequences, or you go for continuous combined HRT and suffer the low grade side effects of progesterone without the wonderful moments on oestrogen alone, or you continue with a cycle – and suffer continued pmt both from the progesterone and withdrawal from it, and the cursed bleed – which wears a bit thin once you're in your 60's!!!

However all in all I am not complaining – just reflecting – as most of the time I feel generally well on HRT! Also noting that your body doesn't stay the same – I had no idea that I could take norethisterone and especially at a high dose orally, and not get a migraine! I'm not a convert though – it's still synthetic but maybe will take it once a year if it enables me to stay on HRT long term.

Hurdity x

[pepperminty]

Thanks . I have been reading your useful information.I am starting femoston if it doesn't agree. I will try the Utrogestan 200 mg capsules vaginally .As you say, you can't enjoy the oestrogen alone with the progesterone if you have a womb! So those of us who are intolerant are a bit stuffed ! Best wishes pepperminty x

[honeybun]

I could just not contemplate having a bleed now st 54 and bleed free for over two years.
I'm glad your regime is working for you.
Progesterone does pull me down. It makes me feel very flat but I guess that's how it's going to be.

HRT is never easy and not the magic potion that most of us would like.


Honeyb
x

[Limpy]

Thanks Hurdity - That was really interesting, lots of things to think about.
I haven't had a bleed for 2 years, have to say, I don't miss them.
Hopefully, I can stick with the conti HRT.

[Dana]

I gave up on Utrogestan a while ago because I just wasn't coping with it. Instead I gave medroxyprogesterone a try. Initially I am using it on a 4-6 weekly cycle of 5mg for 10 days which was the length of time my doctor recommended, seeing as I seem to have issues with prog.

The first month I took it things went really well. No side effects at all. However, when the bleed started it was much heavier than it had been when using the Utro. This has made me wonder if the Utro just isn't that great at making sure the lining is shed properly - at least for me anyway. I was using Utro vaginally, and for about 12 days monthly, so there shouldn't really have been that much of a build up, yet there was. I also had more cramping and that would also seem to be a sign that there was a build up.

I have just finished my second course of 10 days 5mg medroxy, and there were still no side effects. I haven't started a bleed yet, so I don't know how heavy it will be this time. Hopefully, seeing as I had a good "clean out" last time, this one will be lighter.

If things continue go well on a 4-6 weekly routine, I am going to try it as a continuous method of 2.5mg per day. However, I would like to use prog continuously as a patch, so I would need to experiment with norethisterone, because medroxy doesn't come in patch form (pity).

So all things considered, and as much as I would like to be as "natural" as possible, maybe being totally natural isn't all it's cracked up to be, because I'm certainly doing a lot better on medroxy than on Utro. On Utro I was starting to become very despondent about what my long-term HRT options would be because I just wasn't prepared to suffer on such a regular basis, and having a hyster certainly wasn't an attractive option. However, now I'm feeling more positive that there seems to be a much better alternative for me.

[Dancinggirl]

Thank you Dana and Hurdity
It's great to hear your experiences. When I had withdrawal bleeds on Sequi HRT I always had the nasty headache followed by terrible period cramps as the bleed started  - that left me feeling dreadful for 2-3 days afterwards.  I think I've tried every type or progesterone except Utrogestan and Dydrogesterone (sadly I was never offered Femoston which is a shame).  As I had to take HRT due to premature menopause I put up with these nasty side effects. In my mid 50s I had the Mirena for over four years and it was definitely the kindest option for me at the time. 
AS I am now only using local oestrogen (Estring) I am wondering if I should agree to having a withdrawal bleed once a year to enable me to continue using Estring so your posts have been really helpful for me.
What I would like to happen is that I get my womb thickness checked in about 12-18 months to see how things are and whether I need to have the occasional withdrawal bleed but I know I will probably have to get this done privately. I had to push to have a DEXA scan done - the NHS is so strapped for cash I think any quality of life stuff really has to take a back seat.
Thanks again ladies - so helpful  Dg x

[Greyhoundgal]

Thanks Hurdity, an informative post.  I have a question....I recently switched from Femoston 1/10 to the Femoston Conti which I started about 3 weeks ago.  I've just started a slight bleed but this would be when I would have had one had I stayed on the 1/10, is this anything to worry about or will it settle down in time?  By the way, I'm one of the weird ones that actually feels better with the progesterone so in the main this new pill is suiting me down to the ground - I felt well on the 1/10 but the last 3 weeks have been really good, no symptoms, no flushes, just feeling goooooooood 

[Dancinggirl]

Greyhoundgal
When starting with a conti HRT it is quite normal to have some break through bleeding for the first few weeks or even months.  I assume this is the body adjusting to the combination and the uterus shedding a bit as it adjusts.  It should tell you this is the information that comes with the pills.  Dg x

[Greyhoundgal]

Greyhoundgal
When starting with a conti HRT it is quite normal to have some break through bleeding for the first few weeks or even months.  I assume this is the body adjusting to the combination and the uterus shedding a bit as it adjusts.  It should tell you this is the information that comes with the pills.  Dg x

Thanks DG, I did read the whole sheet when I got them but then threw it away    I kind if thought it was normal, just wanted to check with someone who might know rather than bothering the nurse at the surgery.