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[Sunflower59]

Hi
I'm new to this forum and HRT.
I am 58 and post meno. Periods stopped at 50 - were very heavy for last couple of years and prescribed Transaxemic to lighten.
Menopause seemed to be going ok, just usual mild symptoms which tolerated as thought it would soon pass. Then for past couple of years started to suffer with insomnia/anxiety to the point where I was getting a couple of hours sleep a night.
Started on Estradot 50 for 2 months and felt great. Dr advised as levels were low increase to 75 last month and then started  utrogestan 100 on 1st of month. Started spotting on day 4 and then the flood gates opened and for the past 6 days have been having a very heavy period - having to change pads every couple of hours. I've had to stay off work as my job is car based and I can't get to a loo often enough. Plus I was feeling really light headed and dizzy. I was due to take the utrogestan for 12 days but stopped at 10.
What I'd like advice on is has the heavy bleed been caused by the progesterone or is it the higher dose of oestrogen? Or could it be because I've taken the Estradot for 3 months and the uterus lining has built up? I've ever had a scan.
Any advice greatly appreciated.
Thanks

[Dotty]

I would think it's the changed level of patch. If you were feeling ok on the 50 patch there is no need to increase. Also, if you are post meno you should take utrogestan every day. Taking it for 12 days will give you a bleed which you don't need if you are post menu.

Bleeding can be expected in first 6 months of starting hrt.

[Hurdity]

Hi Sunflower59

 

The heavy bleed has occurred because you took oestrogen only for 3 months without a progestogen as you say and the uterus lining has built up from the 50 mcg and then even more so once you have increased to 75 mcg. Once this happens (uterine build-up) - as soon as you start the progestogen, it seems that the lining becomes unstable and if it has thickened - it starts to come away. Normally the progesterone changes the lining from proliferative (building up) to secretory ( changes structurally ready for fertilised egg). When progesterone levels drop signalling no fertilisation, the lining then comes away as the normal bleed. It could also be that your lining had built up a bit since your last period although this does not happen with all women - mostly it atrophies eventually in post-menopause and becomes very thin.

As Dotty says you could take progesterone all the time but I would want to make sure the lining was properly shed before starting a regime like this.

Also 100 mg daily oral Utrogestan may not be sufficient to prevent bleeding if you are on 75 mcg oestrogen - which is a higher dose. Many of us opt to remain on a cycle so that we don't have to take progesterone all the time and especially those of us who take it vaginally, and then the bleed is regular and predictable.

Hurdity x

[Sunflower59]

Thanks for the replies.
So firstly, do you think I should go back to Estradot 50 as I was ok on it. I just want to be at a level where I feel ‘normal'?
I don't mind having a bit of a bleed if it levelelled out and became a normal bleed after taking HRT for 6 months or so. But I cant cope with very heavy periods where I literally can't go out of the house as I have to change my pad every couple of hours, feeling like it's pouring out of me and having very low bp and feeling faint. But I guess there are no guarantees you just have to try it out and see how it works.
In your experience if the built up lining had shed this month is likely to be lighter next or will it alway be thicker until something is done surgically?
I'm not keen to take progesterone continually, or have the coil fitted.
Should I get a scan to see how thick the lining is or wait and see what happens next month?
With this on going cycle would you recommend taking Ibuprofen to reduce the flow or should I just leave it to run it's course?
Thanks again for your help.

[Dotty]

If your symptoms stopped on the 50 patch then stick to that one. Levels don't really count as every woman is different. Some women feel fine with low levels of oestrogen and others feel awful.

Don't be scared of taking utrogestan continuously. I take it continuously and I have no side effects . There will be lots of women taking it continuously who don't come on these forums.

Hopefully the heavy bleeding should stop. I had a heavy bleed after 3 months on Elleste Duet Conti But Have now switched to Oestrogel and have had no bleeding at all.

[Hurdity]

I was on Estradot 50 mcg for most of the time I've been on HRT. I increased slightly to 62.5 mcg when I started teststerone as I didn't want to become T dominant. I felt absolutely fine on this dose (50 mcg) - as Dotty says. It is only if you are taking HRT for a premature or early menopause to help prevent osteoporosis when the actual levels could be important but in practice the dose at which symptom relief is obtained will give you the minimum leves required anyway, from what I've read. I agree with her - if you felt fine on 50 mcg then stay with it especially at your age.

You lining should continue to shed if you have the balance between oestrogen and progesterone right.  Normally if you have no other problems ( thickened lining, firboirds, polyps) the lining should gradually get thinner with each successive cycle provided the progesterone is sufficient for the oestrogen dose you are taking. I would suggest you mention the very heavy bleeding to your doctor in case they want to have a check over since it is so long since your last period, and perhaps they might refer you for a scan or investigation just to check all is OK?

Dotty that's really encouraging to hear about feeling fine on taking Utrogestan all the time!

Hurdity x

[Dotty]

Thanks Hurdity. I feel great compared to how ill I felt last October. I was worried about taking the Oestrogel and Utrogestan but so far so good. I'm on my 5th month. X