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[Susanas]

Hi, been following this amazing forum for ages and now need some much needed help please!

I’m 52 and been on hrt for almost 2 years. Had a bleed last year whilst on evorel conti patches so was sent for scan and Hysteroscopy which came back all clear. Was then put on continuous hrt ultrogesten 100mg without a 3 day break and 2 pumps of oestrogel daily as they said my bloods showed I am post meno.

All was fine for 7 months until I forgot to take the ultrogesten pills for 2 nights which then triggered a bleed.

 After a phone call they increased my ultrogesten to 200mg for 2 weeks and the bleeding has now completely stopped for over a month. Had an ultrasound and it is showing lining 6.3mm so they have sent me for an urgent 2 week referral even though bleed has now stopped.

The reason for my post is, whilst I wait for my appointment, I have decided to increase my ultrogesten to 200mg daily and reduce to 1 pump of oestrogel daily as I want to thin the lining asap! I am almost certain the bleed was due to the missed pills as I have had no bleeds since the last Hysteroscopy. Although not sure why my lining has thickened anyway with the hrt I was on. I really do not want another Hysteroscopy as the last one was horrendous.

Can I take 200mg every day without a break and will this make my lining thin?

If I had a 3 day break, would this trigger a withdrawal bleed even though I am post? Should I even be taking ultro wothout a break?

To avoid another barbaric hysteroscopy, can I not just have another ultrasound in a few months to see if it is thin due to increase of ultrogesten?

Will 1 pump of gel be enough for preventing osteoporosis as this was one of the main reasons I wanted to take 2 pumps.

Sorry for all the questions but everytime I talk to a gp or gynecologist they all say different things! I’m so confused. Thank you for your help!

[CLKD]

Hello.  We can ask for a GA or sedation during intimate examinations.

Osteoporosis : I haven't had any HRT and my bones are fine.  Now 71 I had a foot/ankle DEXA scan over 20 years ago, the best area is pelvis and hips as the bone is denser.  A good diet, regular brisk walking or other exercises will help .......... plenty of sunshine or add a VitD capsule to your daily intake.

though I am post.    ?

   browse round.  Make notes ;-)

[Susanas]

Hi! Thanks for your reply. I am a bit scared of GA although would be happy if they could offer sedation but haven’t heard this as an option before?

I am only concerned about osteoporosis as my gp did say that lack of oestrogen can cause it during menopause hence opting for 2 pumps as he said one wasn’t enough. I workout 5 days a week. So if I can get enough calcium via diet and excersise I am open to natural remedies if these do work.

I am in 2 minds whether to completely come off hrt if it is making my lining thick as the stress it is causing is more than it’s worth 😫

[sheila99]

If you weren't post meno everything that's happened would fit into place and the blood test for it isn't very reliable. What were your periods doing when you went on hrt? The more regular they were the less likely it is you're meno now. You need 50mg for bone protection. You can take 200 utro daily but only a scan will tell you if it's enough, ot could be that you need 300. If you're not meno it might be better to use axsequi regime for now and try conti again later. Of perhaps the 25/28 regime might be a good compromise. You should bleed if there's been a build up but not if there's nothing to she'd (at least in theory!).

[Susanas]

Hi thanks for taking the time to reply 😊 I was in cerazette and never had a period so they only assume I am post due to the bloods taken. If I ever missed one cerazette this would trigger a bleed so I assume I am sensitive to missed pills. I am slightly confused with the bleed. So do women, post menopause, have a bleed if they take continuous ultrogestgen with the 3 day break? If this is the case this would explain this last bleed as I missed it for 2 days by accident! I was under the impression that you should never have any bleed post menopause? Thank you

[joziel]

Yes Susansas they can do. It is called a 'forced bleed'. Some women prefer to do this because if there is any build up happening, it gets shed during the 3 day break in a scheduled way - and doesn't freak doctors out.

I am peri-menopause but I take continuous utrogestan due to endometriosis history, I take 300mg nightly - which is quite a high dose but as I don't have any side effects from it and as I am experimenting with high estrogen doses at the moment, everyone is fine with it.

I stop it for 3-5 nights once a month to schedule a bleed. (I try to wait for it to be almost stopped before I re-start as I want it to shed properly.)

Stopping for 3 nights once a month is actually the 'old' continuous regime. It used to be what everyone was told to do on continuous. But because it caused a bleed and some women didn't like that and it wasn't considered necessary in post-meno, they changed this to taking it every night. But it's perfectly safe to stop it once a month like this.

I wouldn't reduce your estrogen by the way. You don't really want to change a ton of things at once, which can cause more bleeding and upset and also isn't going to accurately reflect what you're doing long-term. I mean, you need to know what your body is like on that dose of estrogen in terms of lining. So changing it isn't going to give you much information if you need to stay at 2 pumps or higher long term....

[Susanas]

Thank you so much for this in depth reply 😊
The only reason I thought it best to reduce the gel to one pump is because my lining is now thicker since I have been on this regime of 100mg ultrogestgen and 2 pumps for the last 8 months, so this clearly doesn’t suit my body.
I could continue with 200mg ultro and 2 pumps I suppose but don’t really want such a high dose of ultrogestgen long term unless it is safe to do so. Plus I don’t really want a hystersocopy if I can avoid it and would rather get my lining thin and have a repeat ultrasound in a few months.
I may try the 3 day break to have a bleed and see if this works. My appt is next week but my previous gyneocologist just told me to stop hrt and have a hysteroscopy.

[joziel]

It's very safe to increase utrogestan pretty much to tolerance really. I take 300mg. Women in the US often take 400-600mg.

It's just the standard dose is 200mg, but that's not down to safety in any way. Increase if you want to...

[Susanas]

That’s handy to know, Thank you. I will continue with 200mg and have read on here that taken vaginally works better, so may try that as I’m sure I’m not absorbing it well. My lining has doubled in 8 months as my last ultrasound was 3.6 and is now 6.3! And that was taking 100mg daily.

[joziel]

I'd take 200mg orally and put another 100mg at least up the vag. 

[Susanas]

Yes I may do just that. So I take it I just shove it up as far as it will go? 🤣

[joziel]

Yes, if you have a Vagifem applicator you can balance one on top and use that to shove it up...(!).

[Hurdity]

It's best to be on two pumps of estrogel for better protection against osteoporosis.

I agree that if you are still peri-menopausal your lining will thicken anyway as part of your underlying cycle, if ovulation is still occurring now and again, and that you cannot determine menopausal status from blood tests alone.

Hurdity x

[Susanas]

Thank you so much all of you for your kind replies amd knowledge. That’s my thinking that I could still be peri with very erratic bleeds and bloods aren’t a true reflection. My scan mentioned a small cyst on ovary which I have always suffered from. I have been reading up on the coil last night and even though I really don’t want all these procedures, if they say in my gyno appt. that I need another biopsy or hysteroscopy, I may take the plunge and just get one fitted as at least the dose of progesterone will be direct into my womb. Never really even contemplated one before as used to hear so many horror stories back in the 80’s that it put me off for life! 🤦🏼‍♀️ I just don’t feel mentally ready to come off hrt just yet as I can already feel the low feeing creeping in since I reduced to one pump of oeastrogel, plus I don’t want to age faster than necessary if at all possible. I have read that women age twice as fast as men once menopause hits so if I can stall it with hrt, then I want to take it for as long as I am able to.

[joziel]

Susanas, you never need to come off HRT. None of this "just yet" stuff - you should aim to find a way to be on it for life.

A Mirena can be a great option for preventing all bleeding and allowing you to dose estrogen however you need without worrying about that. If you need to have an exam anyway, they can put one in at the same time...

Mirenas are a bit Marmite - many people love them and some people hate them. But you won't know which you are unless you try.... You can always have it removed again if it doesn't suit.