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[Mustard1]

HI there,  I know that I should know the answer to this but I don't.  I am on Everol Conti 50 plus 1 1/2 pumps of estrogel.  I had to increase my pump by 1/2 as the anxiety just won't shift.  I did so on discussion with my menopause specialist.  However, I am bleeding again.  It seems to link to when I increase oestrogen but this may be coincidental.  I hadn't had a bleed for 9 years until I was put on this.  I have no problem with the bleeding but would just like to know what is the cause the progesterone or oestrogen.  I had previously being on KLliofem 2/1 so obviously the progesterone is much more on the Conti.   Would really appreciate any replies.  M xx

[Dancinggirl]

When on any hrt regime there needs to be enough progesterone to keep the womb lining thin to avoid bleeding. A higher dose of oestrogen without sufficient progesterone is likely to cause bleeding. Everyone is different though and the type of progesterone can be a factor - if you are using Utrogestan orally it isn't that good at protecting the womb lining.
The Mirena is often the best option for a non bleed progesterone. DG x
 

[Hurdity]

I agree with Dancinggirl - that if you increase the oestrogen ( ie adding the gel) without adding any more progestogen, then your lining will thicken and then bleeding can happen.  Spontaneous bleeding from an over-thickened uterus lining is likely to be abnormal uterine bleeding and should not be allowed to continue unchecked as it can lead to endometrial hyperplasia so you should ask your specialist to refer you for a scan. Depending how long you have been on the Evorel conti though - bleeding on continuous combiend HRT is normal for the first 6 months but as you are taking more oestrogen than the licensed amount for this HRT type I would get it checked. I would say you need more progesterone but see what happens at your check with your doc.

(Btw Dancinggirl she is using Evorel conti for the prog not utrogestan....)

You can't compare the progestogen doses of oral vs trandermal HRT. Kliofem you would be taking 1 mg per day (=1000 mcg). Evorel conti provides a daily release rate straight to the body of 170 mcg so very much less - but it's straight into the system. The amount of progestogen for each type of HRT is calculated to be approximately enough to keep the endometrium thin in most women - although individual variability means some need more and some less than the licensed dose.

Hurdity x

[Mustard1]

Dancing Girl and Hurdity - Thank you so much - that has really helped.  Mxxx

[Mustard1]

Hurdity - I have an other question then.  Sorry.  The Kliofem was 2/1 so 2000mg per day of oestrogen i.e. double the progesterone of 1000 mg.  This ratio seemed to work for  9 years until it suddenly stopped.  Now I have - oestrogen (50mcg + 1 1/2  pump i.e. 112 mpg) i.e. 162 mcg plus 170 mpg of progesterone so the ratio  is not the same.  I have assumed that the ratio matters so you loose when you swallow the Kliofem but assume you loose similar amounts.  Is that correct or am I havering (as we say in Scotland).  I think I may well be havering as I am not a doctor but I know that my anxiety is hormone related and know that when on the Kliofem I did not suffer anxiety.  It is my menopause doctor who is telling me to increase the oestrogel.   I will make another appointment to see her but I only get telephone appointments as I live in Shetland and she is on the mainland.   I have been on Everol Conti since 17th March so in my seventh month but the bleeding started in June. AGAIN SO SORRY TO BE A PAIN BUT YOU SEEM TO HAVE A GREAT UNDERSTANDING OF QUANTITIES AND THIS WHOLE THING.  M xx