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[SammyH17]

Hi, I'm 49 years old and have been post menopausal & on sequential HRT for 9 years 2 pumps of Oestrogel daily & 2 x Utrogestan 2 weeks of the month. I was having some mood changes/fatigue so my doctor changed me to a continuous regime 2 pumps & 1 utrogestan daily and added in Androfemme. I've been bleeding most of that 5 months. I know that can be normal but how long should I allow that to continue before I change something? Is there still a chance that it will sort itself out? I spoke to my doctor and she suggested increasing my oestrogen (even though my blood levels show I'm absorbing well) progesterone and testosterone (showing 1 which she says is still low) but I'm reluctant to change too much as I won't know what is/isn't working. I'm feeling quite good at the moment so other than the bleeding I'm happy with the regime. (Been checked out and whilst my womb is thickened nothing sinister going on) can anyone offer any advice please? Thank you in advance x

[sheila99]

I don't think increasing oestrogen is good advice. If your symptoms are controlled on the current dose you don't need more and it will only lead to more build up and/or more bleeding. How thick is it? If it's more than 4mm you could increase the utrogeston (some people have to use 200mg continually) or perhaps try a mirena which sorts out bleeding and thickening for most people. They say you should give it 6 months to settle but after 5 I would expect it to be getting less. If you're bleeding and it's thickened it points to insufficient progesterone.

[SammyH17]

Thank you for replying. I did think the same thing re the oestrogen. I know that there's not 'one size fits all' but just thought there was a lot of 'you could try this or that'. I've gone with increasing the testosterone because it's still low levels but will leave oestrogen for now. I'll give the 200mg utrogestan a try, just didn't want to take more in case it changes how I'm feeling and if I didn't need it but 5 months on still not settled. The thickness of my womb was 8mm I think.

[joziel]

I agree with Sheila. Increasing estrogen will only make bleeding worse, not better. Are you sure you didn't mishear her and she didn't say to increase progesterone?

So... If your bleeding was fine and regular when you were on sequential and now you are getting this bleeding when moved to continuous, it would really suggest that it's too early for you to go to continuous.

Women go through menopause at different rates and at 49, you could very well still be in peri-menopause. In which case, you are very likely to get break-through bleeding if moved to continuous too soon.

You say the reason you were moved was due to 'mood changes and fatigue' - but that's not a reason to move to continuous. Being on continuous or sequential doesn't better manage those kind of symptoms(!!). Otherwise everyone would be wanting to go on continuous...! Instead, it sounds like you were getting some of your low estrogen peri symptoms returning and you probably just needed an increase in estrogen - but to stay on sequential.

So if I were you, I'd go back to sequential but increase the estrogen to 3 pumps. Ta da.

[SammyH17]

Hi, thank you for replying.

No I definitely didn't mishear. She suggested I increase all three hormones because I'd said I still didn't feel great, had been bleeding most of the 5 months and my testosterone levels were still low. She mentioned something about the increased oestrogen 'quietening down the ovaries' at the increased level? She also suggested trying 200mg of utrogestan and if that didn't stop the bleeding trying a mirena coil.

I was told I was post menopausal 9 years ago due to a very high FSH level and no period for 11 months. I was surprised to hear that I could be Peri menopausal and not post. I was fine in terms of bleeding on the sequential routine but just didn't feel 100%. I did try increasing estrogen myself but I didn't feel any better. Could testosterone have been the missing link? It's all a bit confusing. Maybe I should just go back to the sequential. The doctor said that clearly my body wants to have a bleed so that might be a better option. Just seemed so many different options and not really sure now what to try now 

[joziel]

A lot of this seems to be trial and error really 

Testosterone seems to function separately and not to be part of the estrogen-progesterone thing, so whatever you do, you could try adding that in and seeing if it helps with your symptoms.