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[Sunshine123]

Hi all,

I'm in a bit of a mess at the moment!

I'm hoping to hear experience/reassurance from others on evorel conti.

My history is that I'm 35 years old and went into premature menopause following cancer treatment. I was diagnosed with cervical cancer when my daughter was born 3 1/2 years ago. It was an incredibly traumatic time and because of this I am now prone to extreme health anxiety. I was successfully treated with chemo, radio and brachytherapy and have been well ever since.

I have been on evorel conti patches for approx 2.5 years. I am under the menopause clinic at the local hospital and during a phone consultation 4 months ago I asked if I'm on the right dose, I was struggling with fatigue, brain fog and low libido.

They advised me to increase to 1.5 patches of evorel conti which I did 3 months ago.

3 weeks ago, due to an error in my prescription ordering I found myself with only one patch available for a couple of days. This triggered period pains, brown spotting which then let to a "mini period". This came to a stop last monday.

On wednesday I saw the consultant, she examined me and could see no signs for concern and said the bleed was likely HRT related.

She talked about increasing me to 2 patches of evorel as my oestrasdiol was 179mmol/l but decided to leave me on 1.5, add in testosterone and repeat bloods in 3 months.

I was bleed free for 6 days, no discharge at all, then yesterday the bleeding started again suddenly.

I know this can happen with evorel conti and seems to be common 3 months in/after a dose change but I'm panicking and fearing the worst. I have an appointment with my oncologist tomorrow so I'm doing the right things and getting it checked.

Can anyone offer any advice/reassurance?

Also, is anyone on 2 patches of evorel or do most people split the hormones at this stage?

I would be very grateful to anyone who reads/responds to this message.

Thank you

[Hurdity]

Hi Sunshine 123

 

First - sorry to hear about your cancer and premature menopause.

Regarding change in dose and bleeding - this is common. When you went from 1.5 to one patch you reduced the dose of progestogen which will normally trigger a bleed if the womb lining has developed sufficiently to shed although theoretically thia should not happen if the doses of oestrogen/prog are balanced. However some women also experience bleeding when oestrogen levels drop. There is no way of knowing except to get checked out and mention to your doctor which you have done.

You say the consultant examined you - but did you have a scan? That would normlly be the first step in investigating any unscheduled bleeding as I understand so I woud go back and ask for this if you are still concerned.

In terms of your other symptoms and the dose. Increasing and decreasing oestrogen dosage by halving patches of evorel conti is off-licence though I gather regularly prescribed by consultants. The problems is that not only is your oestrogen level still low but with 1.5 patches you are simultaneously increasing the progestogen dose (necessary to protect your womb) which gives rise to continuous and maybe increasing progestogenic side effects in women who are sensitive to this. (eg fatigue and brain fog).

You are very young to experience menopause, and your oestrogen levels are low for someone your age, and in your position I would want to have a higher oestrogen dose to maximise benefit and well-being. Personally I would want to have separate oestrogen and progestogen as you suggest - which makes it easier to tweak and personalise the doses. Also have you thought of returning to a cycle? After all most women of your age would still be having periods. OK  it's great not to bleed but in terms of how you feel - maybe you would benefit from a higher oestrogen dose combined with a cyclical progestogen given separately? That way you woud get the benefit from a couple of weeks or so on oestrogen only. This is not usually recommended in women with endometriosis though.

Something to think about and I hope this helps. Let us know how things go?

Hurdity x

[Sunshine123]

Thank you for this Hurdity.

I am going to call the menopause consultants secretary this morning, haven't been able to get through so far. I'm sure they will suggest a scan of some sort but this in itself is terrifying for me.

[CarryWarry]

Hello Sunshine

I have suffered with bleeding on and off for five years and still trying to sort it.  Hurdity has given expert advice.  You poor love - my heart goes out to you and it’s only natural to worry (my daughter had a melanoma aged 21, she’s 28 now and still photographing her moles...rightly so). BUT bleeding can be common if hormones aren’t balanced properly.  I am now trying an evorel conti patch WITH one pump of estrogen gel (only since Sunday). So I have upped the estrogen with the gel so that progestogen isn’t upped.   Before this I had the mirena coil supplying the progestogen and progynova 50 mcg patch for estrogen.  I would go 8 weeks no bleed or maybe more then BAM bleeding for 6-8 weeks then it would stop and start more than my granddad’s old banger! 😘
Last Friday I had a camera in my womb and a biopsy to check for cancer - my womb looked fine except for a 10cm fibroid in wall of womb (which I’ve had for years) I await results.  I am not worried because I’ve had this problem for so long I roll my eyes at it.  I totally understand why you must be worried though, but I’m sure you’re ok 
I would listen to Hurdity’s advice - she is ace.  Try not to worry my lovely - thinking of you and let us know how it goes- it’s such a nightmare getting appointments now.  Big hugs xx

[Sunshine123]

Thanks for this Carrywarry. It's reassuring to know that hormones can be responsible for all sorts of chaos and that the bleeding I'm having doesn't have to mean my cancer is back.

I just need to get my big girl pants back on and face whatever appointments and investigations are necessary to get to the bottom of this.

[Sunshine123]

I've now had a message back from the secretary to tell me to stop taking my HRT until I see my oncologist. I didn't get an explanation why and am worried about the effects that stopping will have.

Panicking now!

[CarryWarry]

You poor thing Sunshine.  Fancy them not explaining more...it’s pitiful. Also bloody insensitive.  Is it worth emailing them tomorrow to request more info? I really feel for you - makes me mad. I was meant to be seen within 2 weeks but they lost my paperwork for 8!!!?  Shameful.

Carry x

[Sunshine123]

 I did manage to get a response. The consultant herself called me back which was good. She said the only reason she suggested it is that it may help to reduce the bleeding if they want to examine me at the appointment. She also said that she will book me for an ultrasound to look at my lining if my oncologist doesn't want to do CT/MRI. I felt a bit calmer after that, it's so important to have an explanation!

[CarryWarry]

So glad you got an explanation.  The specialist I saw on Friday when I had my hysteroscopy told me that my bleeding would stop completely if I came off hrt.  I had thought my big fibroid was to do with it but she said not as it’s in my wall cavity as it were.
Let us know how things go. It’ll be fine I’m sure  x

[Sunshine123]

Hi ladies,

I've seen my oncologist today, he said he's not too concerned about the bleeding I have been having and thinks it is most likely down to the HRT. He is referring me for an MRI scan to be certain but said this is hopefully just for reassurance.

In terms of my HRT he very much said it's back over to the menopause consultant. The last thing she said to me yesterday was to remove my evorel conti patches to see if it reduced bleeding for a potential examination today. It's possibly reduced slightly by defintely hasn't stopped in this time.

I am going to call her secretary and ask what I should do about HRT moving forward. My scan is 3-4 weeks wait and I would really like the bleeding to stop.

What would you advise me to do?

Should I ask to continue with the evorel conti at same dose to see if it settles?

Should I go cold Turkey and not use any HRT for a couple of weeks? - bit scared how my body might react to this option

Should I ask to go onto a new HRT with separate oestrogen and progesterone? Part of me thinks now is a good time to change if my body is in chaos anyway.

Anyone have any thoughts, advice, experience to share on this?

Thank you