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[Sphynx]

I have been bleeding for the last 3-4 days. I have been on this for exactly 6 months today. I haven’t bled before, only the odd bit of brown spotting, not even needing sanitary protection.
I have a telephone appointment Monday, but was wondering if this has happened to anyone else, and what happened as a result.

My menopause symptoms are all under control. Would it be a case of trying something else, or going up or down a dose? I’m on 50.
I take Vagifem twice a week for something else.

Thanks

[bombsh3ll]

I wouldn't worry about it at all, bleeding happens on hormone therapy. The vast majority of cases are entirely benign.

However guidelines recommend investigating any bleeding that happens after 6 months of a change in hormone therapy for those who are definitely postmenopausal.

You are right on the border, assuming you are 12 months or more from your last period.

It will largely depend on the GPs level of experience and comfort whether they insist on investigating or watchful waiting.

Other personal risk factors may also be considered such as obesity, history of anovulation or protective factors such as recent or longstanding COCP or IUS use.

You should also make sure cervical screening is up to date.

There's no good reason to change a treatment that is working for you, in fact chopping and changing makes bleeding more likely, not less.

[Dotty]

Hi were you 12 months without a period before going onto hrt ?

[Sphynx]

Thank you for your responses. I hadn’t had a period for 14 months before I went to ask for HRT.

I don’t have any health issues, and I always attend all screenings which are all recent.

I’m hoping because it’s 6 months exactly today, I won’t have to have any scans just yet.
I’m very susceptible to side effects of most medication, so I feel lucky not have had any besides this bleed.  The thought of having to stop, or change is bothering me.

Does anyone know why breakthrough bleeding occurs? It is not enough progesterone?

[Pauline67]

Morning Sphynx

This happened to me after been on  Evorel Conti, i started bleeding in about the 5th month on it and it did continue.  I went to my GP and she changed me over to Evorel 75 and Utrogestan 100. Ive now been on the new HRT for 10 months maybe longer now and everything (touch wood) is fine. I was a little scared to change over but it was the best thing i did.  My GP told me to take 2 x Utrogestan at night and my bleeding stopped within a few days, after a while i went onto 25/28 days and im now on 1 x Utrogestan a night and no bleed at all.

I hope you get yours sorted 

[bombsh3ll]

It's unlikely to be insufficient progestin as there norethindrone in conti is pretty potent compared to others, and is combined with a relatively low dose of estradiol.

It is more likely to just be a bit of atrophic bleeding, where a very thin endometrium can become a little unstable.

Happens to me from time to time - I am on a very progestogenic pill.

Not harmful at all, but does create headaches where unnecessary investigation is triggered.

I believe new guidelines are coming out soon from the BMS to address this, recognising that not every bit of brown discharge on hormone therapy needs to be referred as suspected cancer!

[Sphynx]

Morning Sphynx

This happened to me after been on  Evorel Conti, i started bleeding in about the 5th month on it and it did continue.  I went to my GP and she changed me over to Evorel 75 and Utrogestan 100. Ive now been on the new HRT for 10 months maybe longer now and everything (touch wood) is fine. I was a little scared to change over but it was the best thing i did.  My GP told me to take 2 x Utrogestan at night and my bleeding stopped within a few days, after a while i went onto 25/28 days and im now on 1 x Utrogestan a night and no bleed at all.

I hope you get yours sorted 

Thank you for this. I’m glad you found something that works.

[Sphynx]

It's unlikely to be insufficient progestin as there norethindrone in conti is pretty potent compared to others, and is combined with a relatively low dose of estradiol.

It is more likely to just be a bit of atrophic bleeding, where a very thin endometrium can become a little unstable.

Happens to me from time to time - I am on a very progestogenic pill.

Not harmful at all, but does create headaches where unnecessary investigation is triggered.

I believe new guidelines are coming out soon from the BMS to address this, recognising that not every bit of brown discharge on hormone therapy needs to be referred as suspected cancer!

Thank you. This is very helpful. So much knowledge in this forum!

[Sphynx]

Update, Dr said she’ll put off the scan, since I tend to bleed or spot with covid (which I’d just had), but to call if I bleed again. Typically, 4 days after speaking to her, after changing my patch last night, I’m bleeding again. I’ve sent her an online consult, and she’s calling next week, but will refer me for the scan.

What is this scan usually? Just an ultrasound? It’s stressing me out.
I’m autistic, and just had faff changing work shifts to attend breast screening last week, and now I’ve got this to look forward too. I only really leave the house for work or shopping, and have Lichen sclerosis too, and don’t fancy anyone going near my bits and pieces if the scan is internal incase I’m in a flare, or it causes one 😩

Anyone been through this recently?

I have been bleeding for the last 3-4 days. I have been on this for exactly 6 months today. I haven’t bled before, only the odd bit of brown spotting, not even needing sanitary protection.
I have a telephone appointment Monday, but was wondering if this has happened to anyone else, and what happened as a result.

My menopause symptoms are all under control. Would it be a case of trying something else, or going up or down a dose? I’m on 50.
I take Vagifem twice a week for something else.

Thanks

[bombsh3ll]

It is typically a transvaginal ultrasound (internal) scan so that they can sample a thickened lining at the same time if needed.

However you can ask for an external scan only.

I have vaginal stenosis so cannot get internal scans.

My private ovarian screening ultrasound is therefore done externally and always shows enough detail although this can depend on your body habitus.

This wouldn't permit a biopsy but this is a bridge you could cross IF you needed to.

On a continuous synthetic progestin your lining is very unlikely to be thickened.