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[Dollydream]

Hello, so pleased to have found this friendly and helpful forum. I'm 51 and after suffering hot flushes l went to the GP and asked about HRT. I had been nearly a year without a period so she suggested l try the combined hrt and the first month went by with me feeling fantastic, no flushes.  Then the breakthrough bleeding started a month ago accompanied by stomach cramping every morning.  I have spoken with my doctor who has suggested this is normal and to carry on and not to change to sequential. This past week, the bleeding has worsened though and affected my IBS which was quite settled and has now flared up with a vengeance and had me rushing to the toilet and l'm wondering if my body is actually absorbing the hrt because of that.  Have a doctors appointment next week. Any advice?  Am starting to think life with the flushes is better than this. Help.....!

[Dancinggirl]

Hi and welcome to MM Dollydream
Do tell us which HRT you are using and what dose - it helps us to advice you better.  DG x

[Dollydream]

It's kliofem.

[Mary G]

Dollydream, welcome to MM.

Your HRT contains the 'heavy duty' norethisterone, probably one of the least well tolerated forms of synthetic progesterone but from what you have said, this does not seem to be your problem. 

I have taken continuous combined HRT (Angeliq) in the past but I have never had breakthrough bleeding.  Perhaps this is more common with your type of HRT because it contains norethisterone which is very strong.  If you now have IBS you might not be absorbing the HRT very well and that could be a problem particularly if you don't absorb the progesterone part because it will result in yet more breakthrough bleeding.

Your next move really depends on how well you tolerate synthetic progesterone.  If you normally get on well with it (i.e. you don't have suffer with migraines, low mood or depression while taking it) then why not try another type of continuous combined HRT with a more gentle form of synthetic progesterone?  I would not recommend Angeliq because the dose is far too low and I found it to be completely ineffectual but you could look into other types of CC HRT with 2mg of oestrogen - very important that you stick to the higher dose of oestrogen. 

I'm sure other members will have some helpful tips on other types of HRT you can try.  I am severely intolerant to all types of synthetic progesterone so I use bio identical Oestrogel and Utrogestan which I have found to be the best form of HRT by far but it does mean having periods again which might be a drawback if you suffer with IBS. 

[Dancinggirl]

Hi Dollydream
Kliofem is a medium dose continuous HRT and with any continuous HRT some bleeding and spotting is to be expected in the first 3-6 months before is stops altogether. The IBS may well be effecting the absorption as MaryG suggested so could be resulting in more of a bleed. I think your best option would be to try a combined patch instead. Using patches means you often get a better delivery of the hormones and nothing goes through the digestive system which can aggravate IBS.
Evorel Conti would give you the same dosage and type of hormones so I would try that first.  Many women do very well with patches and actually get fewer side effects.  The alternative would be to have a Mirena fitted and use transdermal oestrogen as either gel or patch - this is a very good way to prevent any unwanted bleeding and is often tolerated better if women find that progesterone gives side effects. In other words, you have options and it can be trial and error before you find the HRT that suits you.
I would certainly ask you doctor if you could try the Evorel Conti patch and explain you feel the pills are aggravating you IBS - this shouldn't be a problem.  Do look under TREATMENTS at the top of this page to find the info - you could print this off to show the GP if need be. Keep us posted  DG x

[Mary G]

One more thought and taking up on DG's point, oral HRT is notorious for causing all sorts of digestive problems so the transdermal route would definitely be the way to go for you.

[Hurdity]

Hi Dollydream

  from me too

In addition to the points made by Mary G and Dancinggirl - you did say that you had gone almost a year without a period - so it could be that you weren't actually post-menopausal when you started HRT and the breakthrough bleeding might just be your own hormones breaking through.

I do agree though that the more likely explanation is the oral HRT, having aggravated your digestive system and your IBS, is then affecting the absorption so that progestogen levels fluctuate leading to the sort of bleeding you are experiencing.

Also the reason why you didn't get any in the first month was probably because your body had been without oestrogen and so took a while for there to be any lining that might shed at all.

I would definitely go for transdermal HRT - and I agree you could try Evorel conti at first, but if it doesn't control your flushes then as she suggested you would need to go for separate oestrogen/progesterone or Mirena coil to enable you to increase your oestrogen dose.

Hurdity x

[Dollydream]

  Thanks ladies for your informative replies.  I hadn't thought about the Mirena coil.  One question, does it have the same hormones as cerazette the mini pill - I used to take that 2 years ago and had no problem - obviously I realise that my hormones have changed, but I tolerated it quite well, had no periods and my IBS was quite calm.  Perhaps I could suggest that and the oestrogen patch.  Weirdly enough the bleeding has calmed down today, (it must know we're talking about it!!!)

[Dancinggirl]

The Mirena coil has a synthetic progesterone and I suspect Cerazette is also synthetic, if not the same one - if you were fine on that then you would probably be fine with the Mirena.
You might want to continue with your current HRT to see if things settle over the next few weeks. If it doesn't then I'd try the combined patches first.  Dg x