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[Hopeful2]

Hello ladies.

I'm looking for some advice again please.

I saw a private menopause specialist today for 30 mins. I was having problems with new oestrogel bottle with symptoms returning, which I didn't even mention, felt it was a bit rushed.

Another NHS gynacologist had done previous oestrogen test last month which showed 316. So she said I could go up to 3 pumps if I wanted.

But she wasn't happy that I was taking the utrogestan 100mg every day for 25 days as I'm still having erratic periods. She said I should take 2 tablets for 14 days instead. Is this correct, do I have to do this? I had trouble taking 2 together before that's why my GP said I could take it over 25 days instead. Would be very grateful for some of your advice please. Thank you very much.

[Hopeful2]

Hello ladies.

Sorry to message again, but does anyone know if this is correct or can I stay with the 25 days which agrees with me. Would be very grateful for some advice please.

[CLKD]

MayB put your regime into the search box, it seems that everyone is busy  and I have no knowledge of HRT.

[joziel]

Hopeful2, either way is considered 'safe' in terms of protecting your uterine lining. The only difference is that you will get more breakthrough bleeding if you try to use a continuous utrogestan regime (100mg every day) before you are menopausal, instead of a sequential regime (the 2nd half of your cycle). And persistent breakthrough bleeding will get doctors worried and might see you referred for scans and investigations... so they try to prevent it.

What was the trouble you had, taking 2?

[Mary G]

Assuming you are post menopause, that doesn't make a great deal of sense.

If are taking 100mg for 25 days that totals 2,500mg per month.  If you take 200mg for 14 days that totals 2,800mg per month so there's not much in it dose wise.

The whole point of taking a break for a few days each month is to let a bleed through to stop the lining building up.  I don't see why changing to 14 days of Utrogestan would help.  Also, with a relatively low oestrogen blood level, I wouldn't have thought you would be getting lining build up.

When did you last have a transvaginal uterine scan and what was your lining measurement?

[Sage 🍃]

Hi Hopeful2,

I'm not as clued up as Mary G on Utrogestan, but as I understand it you are still having proper periods albeit erratically, so you must be peri? Maybe she thinks it's better that you have predictable withdrawal bleedings than erratic periods and that's why she has suggested the sequential regimen. But if you are intolerant to 200mg of Utrogestan, that's something you need to tell her. By the way, I think you should have mentioned the new Oestrogel bottles issue because it seems to be affecting many women. Anyway, good luck sweetie 

[Hopeful2]

Thank you both so much for your kind replies ladies.

My last proper period was in May then another in August brought on by upping oestrogel. I am happy taking it days 1-25 and it's taken me a long time to settle on it as I am very sensitive to hormone changes. When I tried to take 2 at start my neck was burning & red & throat tight so afraid to try again.

She didn't do blood test, but that last gynacologist who did one last month, oestrogen 316, FSH post menopausal, don't know what that means. And he never said anything about changing the utrogestan.

[Mary G]

Hopeful2, did the gynaecologist give you a transvaginal uterine scan to check your overall gynaecological health and tell you what your womb lining measurement is?  If they didn't, they should have because without knowing that your are working blind and it's all guesswork.

The other private doctor should have explained the thinking behind their advice.  Always question doctors and make them explain their actions.  They have no right to suddenly change your regime (if you were happy with it) without a very good reason and if they didn't even give you a scan, that decision is completely baseless.

Unless you were given a very good reason for changing - with some evidence of course - I would stick to your original regime.

[Penguin]

Can you follow up email with private specialist and explain that you didn't get a chance to ask what you wanted to, and can they amswer x and y?

I'd not change a regime that was working for me without very good reason. Perhaps they need to do the scan to find out the cause of the erratic bleeding,  that would be a good enough reason for a referral wouldn't it. Perhaps the private specialist can write to your gp to request they do this? The private specialist I saw last year wrote to the GP with her hrt recommendations, plus asked them to look into something else, which they did.

As an aside, if oral gave you such problems, could you try vaginal for the utrogestan? If you mean you throat was burning inside, maybe that could be alleviated by using another route.

[Hopeful2]

Thank you both so much for your replies ladies.

I felt very nervous at the apt after heavy bleed & very sore boobs after upping oestrogel. She said to change to 2 x 14 days utrogestan as that would protect womb lining better as periods not stopped. I said I had trouble taking 2 but she said try it anyway but if it didnt work go back to original way, so I think your right I should stay as I am. She didn't do a scan, I've never had one. I was disappointed with the apt, as I guess I needed some support my anxiety is so bad and I didn't find her easy to talk too.

Thank you both for taking the time to chat 💐

[Penguin]

Anxiety is really hard and I'm sure it makes a lot of my symptoms worse or at least make me notice them more. Are you doing / taking anything to help manage your anxiety, as I think you would probably benefit from looking at this angle a bit more closely?

Sore boobs are common when you increase the estrogen, hopefully it should settle.

I'm more concerned that you didn't find the doctor that great. Is there another one at your practice that you could see instead? It's really important that you have someone you feel comfortable with.

I also think you've made right decision to stay as you are if it is otherwise working. But it would be a good idea to request a scan if you keep getting the bleeding as it could well be a simple fix.

[Hurdity]

Hi Hopeful

Are you saying your periods are very erratic while taking 200 mg Utrogestan for 25 days out of 28? For the record this is not a continuous regime but is the one that Besin's recommend for post-menopause or as an alternative to taking 200 mg for 12 days (I haven't looked this up recently to check whether they have changed this) -and they say the bleeding will be less on the 25/28 regime). If you are in early peri-menopause with very frequent ovulation then your bleeding is likely to be unpredictable anyway as your cycle breaks through - combi HRT does not normally suppress the cycle.

It is only abnormal bleeding which would be an indication for a scan and your docs should know this. In peri-menopause and on HRT with irregular cycles breaking through, a scan of the womb lining thickness would not be able to tell you anything because it thickens anyway both with HRT and as part of the cycle. If you have any worrying bleeding then go back to the doc.

FSH measurements also are not helpful whilst on HRT - and they cannot tell you  whether or not you are post-menopause.

What symptoms do you have that have returned that led to the doc suggesting an increased dose of oestrogen? One off oestrogen blood tests are also not really indicative especially if you are peri-menopausal, but 300 + pmol/l is a perfectly healthy oestrogen level per se, (but depends where you are in menopause) though some women seem to need more.

I agree it is best to talk to a doc you are comfortable with if you can, and especially if you have paid for private treatment!

I hope you manage to resolve your symptoms and regulate the bleeding if possible.

All the best
Hurdity x