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[florriepeck]

After discussion with a menopause specialist GP, I've changed from Elleste Duet 2mg to a regime of Evorel 50 patches, and utrogestan 100mg nightly for 25 days of a 28 day cycle.
I'm 56, and was hoping for no bleeds, but I'm now on day 5 of this new regime, and I've been bleeding quite heavily, with cramps, since day 2!
Could this settle, and just be due to changing over from the Elleste Duet?
The last Elleste Duet tablet that I took was the one for day 24 in the pack: I started the Evorel patches and utrogestan the following day ( the specialist GP advised this as the way to change over, ie as soon as I received my new medication, regardless of where I was up to in the Elleste packet, and as long as I didn't take old and new meds on the same day.
Can anyone reassure me that it's just the initial"shock" to my body that's caused the bleeding?

[Hurdity]

Hi florriepeck. If you have been taking cyclical HRT ie one that gives a monthly bleed at the end of the combi tabs then stopping this during the second part of the cycle would be expect to give a bleed even though you are transferring to a conti HRT. This is your normal monthly HRT withdrawal bleed not a shock to your body as such. You are shedding the womb lining which built up on the previous two weeks of oestrogen only (The Elleste 2 mg).As you are now taking a different type of hRT it may well take a while to settle so it's possible that you may encounter on and off bleeding or spotting for a while even after this period ends.

Is this bleed similar to your usual withdrawal bleeds on the Elleste?

Hope you settle on the new regime!

Hurdity x

[florriepeck]

Thanks, Hurdity: you've reassured me.
Yes, the bleeding is similar to my usual Elleste bleed, although going on a bit longer.
It makes sense what you said about it being a bleed after the period of oestrogen only.
I'm just a bit disheartened,as I had in my mind that I'm now on a no bleed treatment!
I'd not had support from my own GP or practice nurse, so this new regime has been prescribed after a consultation with a Newson Health GP: I have great faith in her.
I'm also eating more healthily and taking supplements, as advised on the Menopause Doctor website.

[Dotty]

Hi can I just add that you can take the Utrogestan daily. You don't need to have a 3 day break . Dr Newson advises that you take it daily x

[Katejo]

Thanks, Hurdity: you've reassured me.
Yes, the bleeding is similar to my usual Elleste bleed, although going on a bit longer.
It makes sense what you said about it being a bleed after the period of oestrogen only.
I'm just a bit disheartened,as I had in my mind that I'm now on a no bleed treatment!
I'd not had support from my own GP or practice nurse, so this new regime has been prescribed after a consultation with a Newson Health GP: I have great faith in her.
I'm also eating more healthily and taking supplements, as advised on the Menopause Doctor website.

 
I can't comment on bleeding with your particular type of HRT but bleeding during the 1st 6 months of Conti isn't uncommon. I didn't start Evorel Conti until 4-5 years post menopause but have had bleeding since last September. The NHS guidance is that it is normal during the 1st 6 months but has to be investigated if it continues after that. I have just had a hysteroscopy because of this but no problems were found so I am continuing with the patches. My bleeding is approx monthly and very light. I hope it is going to stop soon.

[florriepeck]

Dotty, Dr Hodson ( Dr Newson's colleague)advised me to take the Utrogestan for 25 days, then have a 3 day break: something to do with priming receptors.

[Shannonplussed]

I'm curious to know more about your last point, something about priming receptors. Does anyone have anymore info on this?

[Dotty]

https://d2931px9t312xa.cloudfront.net/menopausedoctor/files/information/457/Fact%20Sheets%20-%20Micronised%20Progesterone.pdf

Hi here's a link to Dr Newsons prescribing advice for Utrogestan. X

[Dotty]

Hi Avalon I think the advice you have posted is the same as the one I posted the link to. X

[Hurdity]

The licensed use of utrogestan for post-menopause is 100 mg 25 days out of 28 which some practitioners prescribe but in practice most prescribe continuous use. The 3 days break is to allow any lining to shed predictably if it has built up and this would be more likely on medium to high doses of oestrogen.

The alternate day vaginal use is something that Dr Newson prescribes off-licence to women who are progesterone intolerant and want to minimise the amount of progesterone they use. Again this is very much off-licence and based on research with some small trials. The research was with women on low to medium oestrogen doses and showed there was protection of the uterus from alternate day vaginal use.

In your position, and in view of your recent heavy bleed and also changing from Elleste Duet, I would start with what you have been prescribed ie 25 days out of 28. If the progesterone is protecting your womb then you should not get a bleed. After a few cycles if you do not get a bleed then go onto continuous use if this is what you prefer, and after discussion with your menopause specialist.

I don't know anythiing about the 3 days break and receptor priming? Not come across that one....

Hurdity x

[florriepeck]

Thanks, Hurdity, for your advice.
Yes, my plan is to take the utrogestan for 25 days out of 28, and see how it goes, hopefully with no more bleeds ( the bleeding that I originally posted about stopped after a few days).
I have an appointment for a Newson Health review in 3 months, so I'll be able to discuss the way forward then.
I do feel much better: I changed from the Elleste Duet because I felt that the norethisterone was causing me to feel anxious and tearful.