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[Sid]

So I had my scan today and the sonographer noted a lining of 7mm which she said she would have to “phone through” to my GP who she thought would refer me to gynaecology. I have no doubt my GP will now stop prescribing HRT  (she is not a fan generally and has not been supportive of me taking it since I moved to the practice).  There is no menopause clinic in the area I live (I saw a private specialist initially who prescribed HRT but the cost is prohibitive - £250 per consultation). I take 2 pumps oestrogel daily but I think the problem is with the Utrogestan.  I have been taking this cyclically PV as don’t seem to absorb it well orally.  Continuous HRT has just not worked for me (break through bleeding). I have severe osteopenia (diagnosed before menopause) and a strong family history of really bad osteoporosis so I would be gutted to come off HRT. Is there any other stronger progesterone I could take? I don’t seem to have any adverse reaction to progesterone.  Feeling awful 

[CrispyChick]

Mirena??? But I'm no expert xx

[Dotty]

Hi there is no need to stop taking hrt. Have you had bleeding ? x

[Sid]

Hi

I take Utrogestan for 12 days each cycle (200mg PV) and have bleed after which lasts 4-5 days x

[Dotty]

Hi Sid
It could be that your body is not yet ready for a continuous hrt and that’s why you are getting breakthrough bleeding.

You are able to stay on a sequential regime for as long as you want.

Your other options would be a Mirena coil or Provera or taking 200mg of Utrogestan daily. xxx

[Sid]

Thanks, Dotty. I am really worried that my GP will stop my HRT. Unfortunately, she won’t accept that women should be on sequential HRT for more than a year after a menopause. As the scan has shown a lining of 7mm, I am certain she will not prescribe any longer x

[sheila99]

If your gp is going to be difficult a mirena might be your best best as that is pretty much guaranteed to keep your lining thin. If your gp need guidance (otherwise known as a kick up the backside  ) it might be worth an email to Dr Currie who runs this site, costs £30.

[Mary G]

Sid, you probably just need to have a bleed to get the lining thickness down.  If you stop the progesterone for a while, you will have a bleed which will get you back to within the 5mm range for women on continuous combined HRT.  Alternatively your GP could prescribe a course of norethistrone (a strong synthetic progesterone) to ensure a thorough bleed.   She certainly should not stop your HRT.

The gynaecologist I saw recently would not have been overly concerned about a woman on HRT having a measurement of 7mm as long as there were no abnormalities on the scan.

Going forward, you perhaps need to consider a Mirena coil as others have suggested.

[Sid]

Hi Mary, I have a good bleed for 4-5 days each month (very similar to how my periods were), so I don’t understand why the lining is thicker than it should be 

[Mary G]

Sid, 7mm is not dangerously high but you probably need a course of a strong synthetic progesterone like norethisterone to have a good clear out.

You will probably be advised to have a Mirena coil or change to a stronger type of progesterone.

Utrogestan doesn't work for everyone.

[Hurdity]

Hi Sid

First of all - can you say why you had the scan in the first place?

Also what day of your cycle did you have to scan in relation to your bleed?

Also are you post-menopausal ie one year without natural periods before starting HRT?

The main thing is that if you are taking utrogestan cyclically then your womb lining acts like it does when we're fertile during our reproductive years - the oestrogen causes the womb lining to thicken. You then take the progesterone which changes the structure of the womb lining getting it ready for implantation of the fertilised egg. Then you stop the progesterone. This signals to the body there is no fertilisation, womb lining not needed, so it is shed. During all this time it is varying in thickness - growing,  consolidating and then shedding.

A scan should only be taken at the immediate end of bleeding to show whether it has been shed. There is no normal thickness for post-menopausal women on cyclical HRT because it will be way over the standard post-meno thickness just before the bleed. Do you see?

Unless this did happen ( ie your scan taken at the end of the 5 day bleed) then your doc really does not understand the process and you should refer to a higher authority or ask to see someone else in the practice if you can.

Even if your scan did show this thickness at the end of the bleed, all you would need to do (if the bleeding is not problematic or heavy/painful etc) is to either take a synthetic progestogen for a two or three cycles to "strip" the lining as my GP used to say, or take the utro for a few more day per month for say 3 months eg take it for 20 days.

She is out of order to consider stop prescribing and it is your right to continue if no medical reason why not.

You could pay for a £30 consultation with Dr Currie and then show your  GP the (e-mail) letter?

I am late 60's and still on cyclical HRT (even though I hate having to bleed at this age) but really do not want to have to take progesterone all the time. That would be the pits! Doc is fine with it ( NHS GP).

And yes if you have osteopenia that is one very good reason that you must continue with HRT and it is your doc's duty to work with you to find a regime that works for you in order to protect your bones! How old are you?

Good luck and please keep asking us if you need any more help

Hurdity x

[Sid]

Hi Hurdity, my GP insisted I had the scan and was not happy to carry on prescribing HRT unless I agreed to it. She does not think post menopausal women should be on cyclical HRT (it makes her twitchy!) and was not happy that I was still having monthly bleeds.  I had no symptoms, had a bled each month, was happy with the regime I was on but reluctantly agreed to the scan to avoid problems with my prescription. The scan was done on day 9 of my cycle. I went onto HRT 4 years ago aged 53. I was still having periods at the time so started on cyclical HRT and have remained on it since. I have tried several times to switch to a continuous regime but it hasn’t worked. I think I may need a stronger progesterone, but my GP would just prefer me to come off HRT altogether and I doubt she would have any interest in suggesting alternatives 

[PHW1972]

Hi Sid

I have just had my hysteroscopy/ biopsy for my lining been 18mm  so I will let you know if my Dr stops mine I'm on everol 75 (although I have changed it back to 50 this week) for 2 weeks and everol conti for 2 weeks and had a bleed in December and 2 weeks after that also, I was going to ask for the conti when my results come back if they are OK, but on reading Hurditys post I don't think I will ask for that now. I just don't want to bleed and I thought if was post menopausal then I wouldn't on the sequi but maybe I would I'm not sure.

[Sid]

Hiya, I am post menopausal but take the HRT on a sequential regime and do have a bleed each month. It isn’t ideal, but I have always had break through bleeding when I’ve tried to change to a continuous regime. At least when I take it sequentially I know when the bleed will happen! Can I ask if you tolerated the hysteroscopy well?  I may have to have one and am a bit nervous x

[PHW1972]

Hi Sid
This is my 2nd hysteriscopy, the first one was a couple of years ago and not a great experience as no local anesthetic was used so I was really nervous and got quite worked up for this one but it was a different experience altogether, they used local and I didn't get any pain at all so please don't worry as now they routinely put local into your cervix and  it's not  painful xx