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[KittyKats]

Hi Ladies,

I started Estrogel (now on one pump and a quarter) and Utrogestan (100mg vaginal alternate evenings) continuous regime in April. In the last week I'm having what I think is a painful period with cramps even though I haven't had a period for 13 months and thought I was post menopausal.

Just wondered if anyone else had a spontaneous bleed like this on HRT? My GP said I will need an ultrasound scan but there is a wait of several weeks as services are slowed right now. I'm really worried as I have a fibroid uterus. I was told by the gynaecologist that spotting was possible but this is much heavier than spotting and the cramps are awful. I had very sore breasts last week so I'm wondering if this is a natural period. I'm 50 and my last period was last June when I was 49 and 8 months.

Any advice gratefully received!! 

[CLKD]

   have you taken pain relief?

[KittyKats]

Hi CLKD, no I haven't. The pain is very sharp like needles. I used to get this years a go during my period. The bleed is really heavy. Very worried.

x

[Dotty]

Hi a continuous regime of Utrogestan is usually advised after you have been period free for 12 months. As you hadn't gone 12 months without a period before starting hrt it's possible that you are not ready for a continuous regime. You might be better taking the Utrogestan on a sequential basis.

Also breakthrough bleeding can happen in the first 6 months of starting hrt, so as you've only been on hrt since April then a bleed is normal. X

[Hurdity]

I agree with Dotty....you were not post-menopausal when you started HRT.

Hurdity x

[KittyKats]

Thanks Dotty and Hurdity for putting my mind at rest. It does feel like a normal period and I felt dreadful in the run up to it. I'm also feeling much hotter than I felt before so maybe my hormone levels are dropping. This menopause sucks!

The gynaecologist put me on continuous as she said it was best not to have periods. I didn't realise it was not advisable. Makes me wonder why she said this 

xx

[Dotty]

Hi KittyKats
Unfortunately HRT does not stop periods like the contraceptive pill can do. If you are still having periods then you will still have periods even on continuous hrt.

Your gynaecologist may not be a menopause specialist . Not all gynaecologists understand HRT.

You can take Utrogestan continuously if you wish to in peri menopause but the problem with this is that you are likely to get random bleeding.

You may be ok on continuous but you will need to take it for 6 months to see if your body settles on it. Breakthrough bleeding can be expected in the first 6 months of taking HRT and does not need any further examinations . If you decide to stick with continuous and you continue to bleed then try the Utrogestan on a cycle....200mg for 12 days. Hope that makes sense . X

[KittyKats]

Hi Dotty,

Thanks for your message. What I don't understand is this bleed is 13 months after I had my natural period but I guess I was only 10 months without a period when I started the HRT. The gynaecologist is one of the top specialists at UCL but I guess as you say she is not particularly a menopause specialist.

I was originally prescribed HRT because I was having horrid vasomotor symptoms where my heart would race during a hot flash. What I don't understand is I've had two of these awful episodes in the last few days having not had one since starting HRT. I'd recently increased the oestrogen to the pump and a quarter so I thought I'd feel even better but now the bleeding and racing heart  Makes me think my hormones have naturally dropped.

The GP has referred me back to the gynaecologist but might invest in an appointment with a menopause specialist.

Thanks
x

[CLKD]

You don't have to pay to see a menopause clinician in the UK.

Gynaecologists rarely deal with menopause as a separate subject  and your GP should know better!

How's the pain today?

[KittyKats]

Hi CLKD, the pain is almost gone today but I'm having a heavy flow and had a horrible hot flash with racing heart last night. I feel I'm back at square one.

The reason I'm under the care of a gynaecologist is because of my history of fibroids. I have lots of small ones that they call a fibroid uterus so I had to have HRT prescribed by the gynaecologist I was under the care of. The GP has really alarmed me and said any bleeding more than a year after a period needs to be investigated. I'm feeling really down about it all.  The menopause has made me feel I'm out of control of my body

[Dotty]

Hi KittyKats
Your GP is right that any bleeding after 12 months needs to be investigated. However, you weren't 12 months period free when you started the HRT , so you need to start counting again from when you started it.

I'm not sure I'm making sense!

You hadn't gone 12 months without a period when you started HRT and so you may have started bleeding naturally. There are many ladies who go 10 or 11 months without a period and then have one and have to start counting again.

Any bleed within 6 months of starting HRT is ?normal? and is not a concern.

Unfortunately some GPs and gynaecologists know very little about menopause. X

[KittyKats]

Hi Dotty - thanks for the message. Yes I do think a lot of practitioners are clueless when it comes to menopause. I've been told different things by different people. One GP last year said it's post menopause if it's 2 years under 50 without a period and 1 year without if you are over 50. I'm thinking because I was 49 and 8 months when the periods stopped that actually I have to count one year from 50 which would take me to this October! If that makes sense. I will try not to worry. Thanks so much for your advice
x

[CLKD]

rubbish 

It's 1 year from the last menstrual period. Period ..........

How's the pain today?

[Dotty]

Hi it's one year from your last period. The 2 years if under 50 is for contraceptive purposes. X

[KittyKats]

It explains it here as a GP explained to me last year. I know it's confusing.

A diagnosis of a natural menopause is made from a combination of factors with most
emphasis being placed on the pattern of periods and the presence of menopausal
symptoms. In the late 40s and early 50s the absence of periods or infrequent periods
along with symptoms such as hot flushes can alone be used to diagnose the menopause
and blood or urine tests are unnecessary. In women under 50 the menopause is
diagnosed after 24 months without a period, for women over 50 the menopause is
diagnosed after 12 months without a period.

http://www.bridgewater.nhs.uk/wp-content/uploads/2014/02/The-Menopause-what-to-expect-when-you-are-expecting-the-menopause.pdf