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[lilbebel]

Hello all, I’m hoping for some wisdom and reassurance if possible. My last natural period was two years ago so I am officially one year in full menopause.

Last October I was on 100 mg of Prometrium (which I take vaginally), continuous and the 50 Estradot patch. I felt I still had symptoms of inadequate oestrogen, so I started on the 75 patch. After one month, I started spotting. The spotting turned into two full periods since then with constant spotting in between. I have acne on my chin, large painful breasts, weight gain, acute anxiety, mood swings, crying, and generally feeling like a pile of poo.

My question to you all is are the symptoms I have listed signs of oestrogen dominance in post menopause due to HRT? Have any of you experienced something similar when increasing a dose? If yes, did it stabilise after a while or did you have to adjust your dose again by either increasing your progesterone, decreasing your oestrogen, or having a merina coil inserted? And, how are you getting on now?

Honest to God, I’m at my wits end.

[Petra]

It does sound a bit like that to me, but I'm not an expert in the ebb and flow of estrogen/symptoms. I went up from 50 mcg patch to 75 mcg patch at one point and lasted about five minutes. I did NOT like how I felt, and though I probably should've given it some time to settle down I didn't. What got me was anxiety and mood issues. So this is not very useful. I feel like those two symptoms settled down when I dropped back to 50 mcg.

(I'm currently dealing with insomnia, but won't bore you with that.)
I don't know Prometrium, but wonder how long you've been taking that vaginally because when I was on Utrogestan, I tried it vaginally for a while and a month or so (can't remember exactly) had a bleed (after years and years of no periods, I'm 62!) and my meno doc said, oh, it was probably because the progesterone wasn't being absorbed adequately via the vaginal route. But who knows. This endless journey has left me not really believing much my docs say about anything anymore. Sigh.

[sheila99]

I would cut a piece off the patch so get a dose somewhere between the two. All post menopausal bleeding should be investigated to rule out other causes. If all is well you either need to increase the progestin (I don't know anything about the one you're on either) or else change. A mirena is usually the best at controlling problem bleeding.

[lilbebel]

It does sound a bit like that to me, but I'm not an expert in the ebb and flow of estrogen/symptoms. I went up from 50 mcg patch to 75 mcg patch at one point and lasted about five minutes. I did NOT like how I felt, and though I probably should've given it some time to settle down I didn't. What got me was anxiety and mood issues. So this is not very useful. I feel like those two symptoms settled down when I dropped back to 50 mcg.

(I'm currently dealing with insomnia, but won't bore you with that.)
I don't know Prometrium, but wonder how long you've been taking that vaginally because when I was on Utrogestan, I tried it vaginally for a while and a month or so (can't remember exactly) had a bleed (after years and years of no periods, I'm 62!) and my meno doc said, oh, it was probably because the progesterone wasn't being absorbed adequately via the vaginal route. But who knows. This endless journey has left me not really believing much my docs say about anything anymore. Sigh.

Thank you for your input.yes, increased anxiety and mood swings are the most problematic for me. Prometrium is the name for Utrogestan here in North America. I did some research and there are smal studies showing that the first pass vaginal route absorbed significantly more progesterone into the uterus than the oral route so it’s possible the womb has too much progesterone and could be bleeding because of atrophy from excess progesterone. Sigh. I am waiting on the results of an ultrasound to see the endometrium thickness to know whether to increase or decrease progesterone. Ughhh.

Like you, I did notice poor sleep on the 50 mg patch.

[lilbebel]

I would cut a piece off the patch so get a dose somewhere between the two. All post menopausal bleeding should be investigated to rule out other causes. If all is well you either need to increase the progestin (I don't know anything about the one you're on either) or else change. A mirena is usually the best at controlling problem bleeding.

Thank you. I tried cutting a bit of the patch but the bleeding persisted. I think my body is so confused at this point.
Prometrium is Utrogestan in Canada.
My gynae is doing the appropriate follow up regarding the bleeding. It’s all so exhaustingly inexact and confusing.

[Hezzi]

Hi lilbebel. Sorry to hear about your experience and hope it reassures you to hear I am experiencing something similar.
Due to a rise in anxiety mainly, Dr increased my Evoril conti 50 to 75 with additional provera (prog) pill. That was about a month ago and from about a week in I started with very sore tender breasts, bloating and for the last two weeks spotting on and off with associated cramping. I only have a feeling that this dose is too much for me, though Dr felt I was doing fine with new meds, as the anxiety is at much more manageable level. Also I'm aware that its only 4 weeks and may need to give it time to settle. However it feels like the bloat/cramp/sore breasts/spotting is going to go on forever! Aaarrrhhh!
I'm also not sure what to do - go back to Evoril 50, cut a bit off the 75 patch, try Utrogestin (though have read somewhere that in Scotland it's difficult to get from Dr) or give up entirely! 

Lilbebel - How long did you try with cutting a bit off?  And are you now back to where you started? Or any further forward?
Petra - did you just make the change from Evoril 75 to 50 ? Or also cut a bit off? Did Dr agree?

So helpful to hear others experiences - gives more balance to decision making!

[lilbebel]

Thanks for sharing your experience. I’m going to speak with my gynaecologist next Monday and I’ll give you an update. I tried trimming the patch for about a month but it didn’t make a difference to the bleeding. My breasts did stop hurting though. I don’t want to go back down to the 50 patch because it wasn’t enough. I still had too many symptoms like insomnia and depression. I’m thinking that if these are side-effects of the 75mg dose that actually makes me more functional, I may just have to live with them. I will give you an update though. There seems to be so much a trial and error and I thought it would be much more straightforward than it actually has been.

[Hezzi]

Good luck with things Lilbebel, hope all goes well and look forward to your update!
Agree how trialling it is! 

[lilbebel]

 :)Thank you so much.

[lilbebel]

Hello, the good news is ultrasound shows everything is okay and no need for biopsy. Bleeding is due to switch in HRT dose and is common up to 6 months after an adjustment.
Still non the wiser about painful breasts and weight gain but I am pretty sure it’s too much estrogen. I could try cutting the patch again but that will likely start the bleeding nonsense again (have stopped bleeding 2 weeks ago). Not sure what to do.

[Hezzi]

Great to hear lilbebel that all is well! I also had an ultrasound yesterday and everything was normal. Like you, bleed, cramping, spotting, sore breasts etc I put down to the increase in oestrogen and provera (progesterone pill) as I went back to my original combined patch (evorel conti 50) and all symptoms gradually got better. Hard to say which element caused symptoms though.
I've read somewhere on the forum that it's more likely to be the progesterone that provokes a reaction rather than estrogen. Perhaps you could try a different product? I would discuss further with either your doctor or specialist and see if a different brand/product is better.
Maybe someone with greater experience might reply as I'm quite new to this game too! Good luck on your quest!

[lilbebel]

Great to hear lilbebel that all is well! I also had an ultrasound yesterday and everything was normal. Like you, bleed, cramping, spotting, sore breasts etc I put down to the increase in oestrogen and provera (progesterone pill) as I went back to my original combined patch (evorel conti 50) and all symptoms gradually got better. Hard to say which element caused symptoms though.
I've read somewhere on the forum that it's more likely to be the progesterone that provokes a reaction rather than estrogen. Perhaps you could try a different product? I would discuss further with either your doctor or specialist and see if a different brand/product is better.
Maybe someone with greater experience might reply as I'm quite new to this game too! Good luck on your quest!

Thank you and I’m very happy to hear everything is all clear from your ultrasound too. That must be a relief that everything regulated once you went back to your previous regimen. It’s always a bit nerve wracking having ultrasounds and whatnot but I suppose the doctors are doing their due diligence with these procedures. Would you believe, I’ve started spotting again today. Spoke to my doctor and she said that I could try increasing my Prometrium (Utrogestan) to 200 mg a day and see if that works. If not, she said the Merina Coyle might be a good option to try. But you are right, she didn’t mention tinkering with my oestrogen. She said we need to get the progesterone dose and delivery method right to stop the bleeding. I feel like a teenager all over again.

[Hezzi]

Thanks Lilbebel!
Isn't it frustrating when you think it's all settling down, when something else pops up!
I really hope the increase in the progesterone is the solution. I had a mirena coil many years ago pre menopause - was a bit uncomfortable fitting/removing but it worked well.
Hope all settles soon!

[lilbebel]

It is indeed frustrating. And thank you so much for the encouragement. I’m glad the coil worked out for you.