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[kimdb]

Hello lovely ladies. Ive been on hrt for about 7 years and generally havent had any big issues.  Last November (2023) I had a review as I was getting quite achy and the nurse increased my hrt from Evorel conti 50mg combined patch to evorel 75 plus the utrogestan 100mg. After around 3 months I had a week of bleeding then it stopped then about 2 or 3 months later had another bleed but it continued in varying degrees of light, spotting to heavier bleeds and hasn't really stopped since then which was April 2024.  I went back to nurse who said she could either increase my utrogestan to 200mg a day (but couldnt guarantee the bleeding would stop) or I go back to my old Evorel Conti 50mg or the Mirena.  I was concerned to increase the utrogestan to 200mg perhaps without reason? I dont think I want Mirena coil though.  She has requested a ultrasound too as a precaution but I really feel its the HRT.  So ive been back on the Evorel conti 50mg for about 10 days, bleeding stopped for about 4 or 5 days but now back to bleeding again and worried I will get all the aching back too. SO, THE QUESTION IS, how long do you think it will take to stop bleeding after moving back down to my original HRT? should I expect it to take some time? Should I have tried the 200mg of Utrogestan or coil.  Confused where to go from here really.

I wasnt keen on the Mirena as I read so many people having issue with it getting imbedded etc which scares the life out of me!! But maybe im giving up too soon.

If any of you experienced ladies have any advice on how long my bleeding may take to stop now Im back on my lower dose I would love to hear from you, or any other advice too.  Im hoping the new hot flush drug veoza /fezolinetant might be available on the NHS (UK) soon this year which would be great as might then not need the HRT as the hot flushes are my main issue.  Thank you for taking the time to read my post.

[bombsh3ll]

You wouldn't be increasing the utrogestan to 200mg without a reason.

The reason this was advised is because 100mg isn't controlling the bleeding, and increasing it usually solves this.

Recent BMS guidelines actually now recommend 200mg if on a 75mcg patch.

Occasionally some women require a synthetic progestin to achieve amenorrhea, but I would definitely try the 200mg utrogestan first (unless you have tolerability issues with it in which case I'd suggest switching).

[kimdb]

You wouldn't be increasing the utrogestan to 200mg without a reason.

The reason this was advised is because 100mg isn't controlling the bleeding, and increasing it usually solves this.

Recent BMS guidelines actually now recommend 200mg if on a 75mcg patch.

Occasionally some women require a synthetic progestin to achieve amenorrhea, but I would definitely try the 200mg utrogestan first (unless you have tolerability issues with it in which case I'd suggest switching).

Hi Bombsh3II. I see Im thinking perhaps I made the wrong decision then and perhaps should go the 200mg route then.  Poor nurse, she must be sick of me, keep being undecided!!

[sheila99]

How long until your scan? It might show a reason for it. If it's been building up the more progesterone is the way to go but it's possible you have fibroids or polyps.

[kimdb]

How long until your scan? It might show a reason for it. If it's been building up the more progesterone is the way to go but it's possible you have fibroids or polyps.

Hi Sheila99 The nurse requested it on 9 Aug (NHS UK). The bleeding is very intermittent but most days and either light, less light, dark, red, brown etc, like you would expect a period, is bleeding from fibroids etc like this too then?

[kimdb]

Following on from my first post Ive now started the evorel 75 and 200mg of Utrogestan (last night).  Would anybody know how long Im likely to have to wait to see the bleeding stop now im on a higher dose of utrogestan? I realise its probably different for everyone.  I just wondered if its going to be months, days, weeks if anyone has any experience of this.

My regime was

Im 59 years old and was told to increase my hrt as i was getting bad body aches and mild flushes.  the new hrt stopped aches and was better apart from bleeding.

evorel 50 for 7 years (very rarely bleed)

Nov 2023 changed to evorel 75 and 100mg of utrogestan (one week bleed in Feb 2024 then intermittent but almost constant bleeding from end april 2024 onwards and continuing)

Moved back to evorel 50 on 9th Aug 2024 but changed my mind after reading more so moved back to evorel 75 but with 200mg utrogestan on 19th Aug 2024

Thank you if anyone has any further advice.

[bombsh3ll]

We're all individual but generally any change in hormone therapy should be given at least 3 months to settle and assess the effects (unless intolerable).

If you are going to stop bleeding on this though I would put money on it being less than that.

The worst thing you could do is to keep chopping and changing as this muddies the water.

You should have had the scan by then and this will hopefully exclude any causes of bleeding that requires specific treatment.

[kimdb]

Hi bombsh3ll thanks for that reply.  It's good advice.  I wont swop around now and see what transpires.  Thank you everyone for your help.

[kimdb]

just reporting back, so far the 200mg utrogestan seems to have done the trick and bleeding has stopped, thanks for everyone's help.

[kimdb]

Hello everyone, an update on this and recap:

I wonder if anyone can share any experience they might have with my situation?

Ive been on HRT since 2017. Im 59 years old.

After my HRT was increased from evorel 50 (combined) to evorel 75 together with Utrogestan 100 in Nov 23 after about 5 months I had intermittent bleeding, so the progesterone was increased to 200mg on 19 Aug 24 and then bleeding not so bad but still intermittent, ie nothing for 2 weeks then light bleed for 3 or 4 days or just spotting then again ok for 2 weeks then same bleed but getting less each time.  I subsequently had a ultrasound scan which shows fibroids. One thats 6.5cm which has evidently been there for some time, another 1.6cm and multiple small ones in lining of womb but lining is thin and ok.  Waiting to see gyno now which could take over 3 months or even more (UK NHS).

I have a few things I wonder if anyone might have any idea about in the meantime?

1.I really dont know if the bleeding is because of the fibroids or could it be the HRT still adjusting as I wasnt really getting bleeding all the years on evorel 50 apart from the odd rare one, its been 5 weeks since the increase in utrogestan to the 200mg dose.

2. Could being on the HRT exacerbating the fibroids and could taking the HRT over these years have contributed to  the fibroids not reducing as they often do in women after their fertility reduces?

3.Is it ok to stay on the HRT until i see the gyno? My Doctor said stopping the hrt is the only way to know if the bleeding is related to the HRT or fibroids but she didnt want to take me off the HRT and put me through all that if it was the fibroids in any event but she said the choice was mine.
   
Hopefully the gyno might be able to advise when I see them eventually about the HRT but as this could be 6 months as the NHS are so busy I wanted to try and find out more now if I could.

Thank you so much for any advice or experience.
Kim

[sheila99]

Unless you don't mind your meno symptoms returning I would stay on this and wait for the appointment. Yes, oestrogen makes fibroids grow but you can't tell now if they caused the bleeding or if the lining had thickened. Bleeding in the first 3-6 months of any new or changed conti regime can be expected so it's possible you would have bled anyway.

[kimdb]

Hi Sheila, thanks for replying. Yes I prefer to stay on the HRT for now, like you I agree it seems best to wait for the gyno appointment.  It might have been that the lining had thickened before moving to the evorel 75 as I did bleed almost continuously for about 2 months which started some months after the change in regime.  As the bleeding is improving a little Im hoping the 200mg utrogestan is helping.  At least Im in the system for an appointment now.  Thanks for taking the time reply to me.