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[Aroundincircles]

HI.  I am 51 & I have been on HRT for 4.5 years.  I've tried various preparations, Elleste Duet and then Elleste Conti before switching to Livial Tibolone 6 months ago in a desperate effort to regain some libido!  I was warned that some 'spotting' may occur and sure enough it has - every day for 6 months!  It's pretty unpleasant, like the last day of your period, everyday.  Need less to say it's done nothing for my libido!  it has however been great for all my other symptoms - moods, night sweats etc. I've now seen my GP who took bloods and swabs as I mentioned the odour that accompanies the bleeding and have been assured that there is no infection.  She has recommended fitting a Mirena Coil and sticking with the Tibolone.  Does anyone have any experience of this?  Is it likely to stop the brown blood and therefore the accompanying smell?? Feeling very frustrated as the GP I'm dealing with doesn't appear to know anything about HRT at all.  There has also been no suggestion of investigating the bleeding as it started at the same time as I started on the Tibolone but I'm not sure if that's ok either??

[Dancinggirl]

Hi and welcome to MM Aroundincircles
This slight spotting should have settled by now!!!! I wouldn't have the Mirena fitted and use Tibolone at the same time. You could have the Mirena fitted and use Oestrogel alongside which might be a better option.
Re libido; I have recently been on Oestrogel with Utrogestan and have found this has definitely improved my libido.  I'm afraid we are all different and how we respond to various HRT treatments will also vary.
Libido is often difficult to restore once it's lost.  Are you definitely post meno?
DG x

[Mary G]

Having a Mirena Coil with Tibolone does sound like an unusual combination.  I was told that Tibolone can be very effective for libido but if it has not done anything for you, then you might want to change.  If you are lucky enough to be able to tolerate synthetic progestins, then the Mirena could be a good option for you but I would agree with Dancinggirl and suggest that the oestrogel might be worth a try rather than continuing with the Tibolone.  If you can get the oestrogel dose right, I would assume two pumps per day, you might well find that you never get periods when using it with the Mirena.  Also, you would not have to worry about the womb lining building up because the Mirena would force it to shed when necessary. 

[Pollie]

Hi

Go back to your GP and   ask      insist on an ultrasound to measure the thickness of your lining.

The GP should do this on the grounds that you have Post Menopausal Bleeding -

If the lining is too thick as a result of HRT this may be the reason for the spotting and yes mirena could be the answer, however there can be lots of other reasons and it is  very wrong of your GP to assume it is 'only HRT' that is causing it.

If GP says you don't need one ask your GP how they can be sure it is not cancer......

Not saying this to scare you at all but this is why women have scans when they have unexplained bleeding and it will help you decide which HRT suits you best.

Pollie

[Hurdity]

Hi Aroundincircles

 

I agree with the others and especially what Pollie said. If the bleeding started when you started the Tobolone and hasn't settled and there is an odour (although this has been investigated for infection so not sure what would be causing it?) I would definitley insist that it is investigated. Tibolone can cause endometrial thickening and is listed as a common side effect. I know it is licensed for post-menopausal use but this is one of the side effects that can happen and one of the reasons I wouldn't use it when I was looking for something to help libido.

This is an extract from the SPC on the web ( prescribing info):

Reasons for immediate withdrawal of therapy

Endometrial hyperplasia and carcinoma

• The available data from randomised controlled trials are conflicting; however, observational studies have consistently shown that women who are prescribed Livial in normal clinical practice are at an increased risk of having endometrial cancer diagnosed (see also section 4.eight). In these studies risk increased with increasing duration of use. Tibolone increases endometrial wall thickness, as measured by transvaginal ultrasound.

• Break-through bleeding and spotting may occur during the first months of treatment (see section 5.1). Women should be advised to report any break-through bleeding or spotting if it is still present after 6 months of treatment, if it starts beyond that time or if it continues after treatment has been discontinued. The woman should be referred for gynaecological investigation, which is likely to include endometrial biopsy to exclude endometrial malignancy.

http://www.medicines.org.uk/emc/medicine/8552

Insist - I agree. I would say your doc is being negligent if you are not sent for a scan at this point 6 months down the line. Thereis no point fitting a Mirena if there are underlying problems with the Tibolone.

Hurdity x

[Aroundincircles]

Thanks all for advice.  Have now spoken to another doctor who has told me that I need to come off of HRT for 8 weeks to prove that the bleeding is related only to the Tibolone.  Stopped three days ago and have already fallen out with the husband and feeling awful, anxious etc. Am thinking I might just go back on it and put up with the bleeding until after Christmas 

Dancinggirl - not sure where I am in the menopause as  I've been on combined HRT for so long & that produced a period each month.  I did go on to a continuous HRT (Elleste) for 3 months prior to the Tibolone and didn't have any bleeding.  The blood test I just had apparently came back as 'normal'... whatever that means!

[Dancinggirl]

Aroundincircles
Hurdity as always has given good info and advice - I would say you need a womb scan to check things are OK. Do ring the surgery back and ask what the tests showed e.g. actual oestrogen and FSH levels.
When on HRT you get a withdrawal bleed and this is NOT a period - it is merely the womb shedding to protect it from thickening and causing problematic and erratic bleeding - HRT is controlling this.
If you had conti HRt before and didn't have bleeding then you are likely to be post meno.
I have found that Oestrogel with Utrogestan has really helped my libido - but we are all different and what suits one won't suit another. 
I wouldn't go back on the Tibolone - it may be good to take a break first anyway to access where you are in your meno - you could ask for another blood test in say 4 weeks to really see what your hormone levels are and then go from there. After a scan you can try something different. If you are over 54 then I'd try my regime continuously - I've found it great!! 
DG x

[Hurdity]

This is a difficult one - I had unscheduled bleeding on HRT (after sex) and was told to come off HRT and if it continued then they would investigate - but I had a consultation with Dr Currie who said I didn't need to stop, so I went back to a different doc and they then carried out an investigation into the cause of the bleeding. This is what your doc should do I feel. Personally it is a difficult time of year to try to come off HRT and I certainly wouldn't want to suddenly stop now!

Are you able to go back to the same or a different docs in the practice and ask to change HRT while at the same time having an investigation - they really should check your lining after this length of time bleeding on Tibolone? If you don't feel able to do this could you have a £25 consultation with Dr Currie and then depending on what she says, then go back to a different doc? If you were OK on Elleste Duet conti then this sounds like a good plan for the time being - and put up with the lack of libido until after Christmas and you can be properly investigated and perhaps work out an HRT type that is better for you?

Hurdity x