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[Teresa]

Hi All,
I hope someone who is or has been in a similar position, may be able to share their experiences. I’ve been on HRT now for about 18 months. Post menopausal, I’m on continuous 100mg utrogestan and 75mg Evorel patch. I’ve been fine on it, apart from some unscheduled bleeding. I had my first unwanted bleeding, last March, about 7 months into HRT and I had a scan, plus a hysteroscopy, plus biopsy which showed nothing wrong, apart from a lot of fibroids which I’ve had for quite a while. My lining was ‘normal’.

I’d had no further bleeding at all since then, but Fast forward another year where I’ve had more bleeding. This time it’s been like a light period, though brown and it lasted 11 days, much longer than a year ago. I have an appointment coming up with a gynaecologist, luckily in April, which I’ve been waiting a year for, (which I was going to cancel earlier but luckily kept it) where the bleeding is to be discussed, but in the meantime, my GP has suggested I could double up the utrogestan or wait for my appointment. He said I don’t need a scan or any further investigations as I had that last year. He thinks the bleeding is due to not enough progesterone, but it doesn’t explain though why I had nearly a year with no bleeding. 

I think I might try and double up the utrogestan to see if it helps, but I stupidly didn’t ask if I should just take two together, or split it over different times of the day instead. If others have been in a similar position, how did you double up, just take two together?
Thankyou in advance,
Teresa

[CLKD]

MayB put the product names into the search box to C if threads pop up?  Make notes ;-)

[sheila99]

Grrr I typed a long reply and it's disappeared. Yes, you just take 2 together but it will only work if bleeding is caused by the lining thickening. I'd want another scan to check as it's been a year since the last one. Fibroids are a known cause of bleeding and oestrogen can cause them to grow. As you haven't had bleeding over the year imo a thickened lining isn't top of the list of suspects.

[Teresa]

Hi CKLD & Sheila99,

Thankyou for both your replies. My particular case doesn’t really appear on Google unfortunately….
Shelia, I agree with you . It’s only when I wrote this on here that it dawned on me that I hadn’t had a bleed for such a long time, so why suddenly now. My GP said that ‘women bleed occasionally on HRT’ and that ‘it was to be expected’. I did ask for another scan, but like I said, he said I’d already had investigations last year. The gynaecologist last year said if I was to get bleeding again, to try Evorel conti, ( they didn’t know it only went up to 50 and I’m on 75) or get a mirena coil. I’ve had two before and the second became dislodged and I had to have a hysteroscopy to get it out, so I don’t fancy that  He said that as my appointment to see the gynaecologist was only in about 6 weeks, I could discuss it all then if I wanted to wait.

If you were me, would you insist on a scan? They normally do those within two weeks….I wonder if they will think I’m making a fuss. He was adamant I didn’t need one.

Teresa
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[CLKD]

Why look at GOOGLE   

Unless you use NHS sites you may well be overwhelmed by un-true statements.

If you are worried then discuss the possibility of a scan with the Nurse Practitioner, a GP doesn't have to refer if he/she doesn't consider it necessary.  Could it be that your hormones are aggravating the replacement therapy = bleed. 

[sheila99]

Maybe try a different gp? Bleeding can be expected in the first 3-6 months of a new conti regime but bleeding after that should be investigated as a cancer risk. You could have a look at the NICE guidelines, if you could find this on an NHS site it would help. Or perhaps contact the practise manager.

[Teresa]

Hi again Sheila and CKLD,

I don’t know what’s causing it CKLD…and the fact I’ve been fine for a year is odd. I wish they’d found a reason for the bleeding before but they didn’t. I don’t know what caused it then and have no idea now. I did get some twinges on my side before the bleeding, rather like PMT pains ( from memory). They’ve stopped now.
Both, I was thinking of trying another GP, there is a female Dr there, the only female and she is anti HRT (I can tell from things she’s said) I usually avoid her, but I think I’ll have to speak to her and get a second opinion.
I must admit I thought they would investigate every bleed, despite the fact of when they occur, or how far apart.

Thankyou again,
Teresa
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[Teresa]

I just read the NICE guidelines and it says if bleeding occurs after a period of no periods, it should be investigated…

Teresa

[CLKD]

No GP shouldn't put their personal preferences towards patients, that's not what they are paid for.  I had that argument with a GP when I was 17!  He got told quite promptly that his religion (RC) shouldn't interfere with my need for birth control.  I got it.

There's a 2 week period to refer for any untoward bleeding after a break of periods etc..  MayB have a talk with the Nurse Practitioner in your practice?

Brown blood has been held up somewhere, often due to not enough hormones to push it through, red blood is fresh and less of a concern.  I always had 2 days without a bleed at the end of each period, followed by 24 hours of brown staining 

[Teresa]

Hi CLKD,
Thankyou -yes, you’re right re- their personal beliefs. She kept saying ‘ not that I’m anti HRT or anything’ when she was saying bad things about it…she kept repeating that and when someone keeps repeating that like that, I just thought she really was anti HRT.
The blood was brown, all the way through….it was never bright red. There is a nurse at my surgery but I don’t think she would over ride the Dr. It’s getting through the Receptionists that’s going to be hard I think. I will say I’m after a second opinion about my problem. I did get as scan last year within two weeks, so hopefully that would be the same this time.
Thankyou,
Teresa
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[CLKD]

Sounds like the nurse is either very young or anxious about prescribing 

U could ask for a referral to a dedicated NHS menopause clinic: not a gynae : as there are waiting lists it might be worth while asking now, the appt can be cancelled if you don't need it.

[sheila99]

https://www.nhs.uk/conditions/post-menopausal-bleeding/

I'd start by telling them you want a referral as a cancer risk on the 2 week pathway - though I think I'd be telling the practice manager rather than the receptionist.

[CLKD]

Agreed.  Receptionists might have had 'extra training' but to be honest, my medical requirements ain't nowt to do with them!

[Teresa]

Hi CLKD & Sheila99,

Thankyou both again….and for all your advice….well, I called the Drs Surgery this morning and managed to get through the Receptionist’s questioning & get a telephone appointment with the GP who is against HRT  I couldn’t get an appointment with a Nurse for today this was for the female GP who is against HRT.

The GP called me just now and after I explained what’s happening, she has referred me for a two week scan 😊 She did add that I can’t keep having these done and have to think about the long term, which of course I know, ( as I really don’t enjoy having scans- nobody does)
She also reiterated all the risks of being on HRT again to me, which of course I know as well and I knew she would and she asked me if I really wanted to stay on it and I said I did. I could almost hear her sigh.
Anyway, at least I’m getting a scan 
Thankyou both again,

Teresa
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[sheila99]

  Good news. Hope it goes well.