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[Kurly]

Hi all, I'm 52 and after being fobbed off with antidepressants for about six years, I have been on HRT for over a year now, using Oestrogen and Utrogestan on a cycle, gradually increased gel to 4 pumps a day and 200mg of Utro for 12 nights. I've been muddling along, hoping and praying to feel like myself again. The gel helps my main symptoms but I'm still exhausted and have an empty brain most of the time.
Saw a new GP who agreed since I was 1 year in, that we could change me to continuous cycle and this would stop my monthly periods (they have remained pretty heavy and usually last about a week, sometimes they'd start on day 9 of starting Utro not the 12th day if that's relevant) She also recommended I try an Evorel patch for convenience so I'm now using a 50 and topping up with gel.
I was on for 10 days, 14-24th March, then last Sunday I came on again and am still bleeding now! Due to go on holiday on Sunday and feeling really demoralised that instead of bleeding less, I am now going to have to find the loo every couple of hours on holiday.
Any tips on how I can reduce this before I go away? I descended into a menopause google hole where I think I read if bleeding more than once a month the BMS says I could increase my Utro to 2 tablets a night - but surely Utro's role is to activate womb lining shedding, so wont that make it worse? Can I take tranexamic acid alongside HRT or is it not recommended?
When I told the Dr I was now bleeding more not less, she said it 'should settle down'. I am already taking iron as my ferritin serum is low, although I cant take the full dose as it does a number on my digestion.

[sheila99]

I'm confused, can you tell us exactly what you're on now? Evorel conti patches give only the amount of progesterone for the oestrogen in the same patch so if you're using gel too it will be insufficient to protect your womb. If you still have your own cycle a conti regime is not going to stop it, conti should be used for those who no longer have a cycle of their own. If you want to be bleed free in peri your best option is a mirena. Some women are in their early 60s before they reach meno so your age is no guarantee you're there.
On the gel did you have other meno symptoms? Testosterone might be worth trying but there are many, many causes of fatigue - thyroid, vit d etc so it would be good to rule these out too.
I'm not too sure how you'd stop the bleed now, probably stop oestrogen but symptoms may be worse than the bleed. Not sure they'd give you tranexamic acid unless you're flooding but you could ask.

[Kurly]

Hi Sheila,

I am currently using an Evorel 50 patch, changing twice each week (just oestrogen) and topping up with gel and since seeing my GP, taking 100mg of Utrogestan every night.

Prior to the visit, I was just on the gel (4 pumps daily) and Utrogestan but on a cycle of 2 x 100mg for 12 days, then 16 days gap and repeat.

I'm guessing the change from only 12 days of Utrogestan to every night has upset the rhythm somewhat and that's to be expected, but dont understand why the move to continuous was necessary as it seems more problematic.

I would also expect my body would not be happy if I just suddenly stopped all Oestrogen. I was hoping there was a magic workaround you guys had figured out. I read all about how it all works but then my brain conveniently dumps all the information; it's like I cant retain anything and feel slightly out of it all the time. Maybe I dont tolerate the progesterone well now its been increased.

[Kurly]

Thanks for answering Poppy,

It feels like a minefield. I try to research and when I went to the Dr's initially I had to ask for Utrogestan and gel as they wanted to give me a combined pill and my sister had breast cancer found on her first mammogram. I didn't feel comfortable with that choice and I also had elevated liver ALT levels so I felt that transdermal oestrogen was the way to go. I am now thinking that perhaps the Utrogestan is not my friend haha.
I've decided to leave my oestrogen at the 50mg I'm getting from my Evorel 50 and continue to take 100mg Utro each night. Hopefully this will reduce the bleeding in time - have I got this right? I either increase the utro to account for the relatively high oestrogen I was taking so ergo this should work, if I can cope with lower oestrogen levels while I'm away.
When I get back I will ask for repeated blood tests to check my iron levels despite asking me to source ferritin the Dr hasn't asked to check this and I suspect this continual bleeding will be making it worse.
Thanks everyone for helping. I'll update when I'm back off holiday. If the bleeding becomes unbearable I might just take the tranexamic acid but that will again be processed by my liver ( I am teetotal but apparently have fatty liver and cysts on my liver and kidney)

[flossie fiddler]

Hi there, it’s definitely a minefield and can sometimes require a lot of tweaking before we get the right combination, but the benefits are worth it. I have a similar issue in that I’m on a Conti regime and am bleeding every 3 weeks. I’ve been on HRT on and off since I was 48 - I’m now 58 - and in that time, I’m finding that Conti always makes me bleed more than a sequential regime. I’ve had several scans and a polypectomy in the 10 years, but even after the polyp was removed, Conti still made me bleed, so it’s clearly a thing with me. I had an 2.5 year break with no bleeding and it was only when I started Conti HRT again that the bleeds started again. Investigations are imminent, starting with my scheduled cervical screening later this month but I think if all is well with investigations I’m going to switch back to Evorel Sequi. I don’t mind having a bleed, and at least on Sequi, I know when it’s coming. And if investigations show anything like a polyp or fibroid, I’ll deal with that if it happens.

Hope my experiences help you with decisions, and put your mind at rest that bleeding can be normal for many women on HRT