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[discogirl]

I restarted my hrt in march after having 3 months off due to heavy bleeding (I was using cyclogest for my progesterone and I don't think I was absorbing it well) anyway, I'm now on 2 pumps of oestrogel and 100mg of utrogestan which I take orally and I'm sleeping really well on the 2 pumps of gel.

Yesterday however i had a small bleed and I'm now wondering if I should decrease my oestrogel dose or maybe increase my utrogestan to 200mg, I'm a bit reluctant to decrease my gel as I do feel better on 2 pumps.

My gynae clinic after my bleed wanted me to have a coil fitted but I really don't think my body would take to the coil.

Just wondered what anyones thoughts were. Thanks x

[Pauline67]

Morning Discogirl

I started bleeding on Evorel Conti after 8 months i changed to Utrogestan and Evorel 75 and my GP told me to take 2 caplets a night and it worked a treat, bleeding stopped within days.  After a few months i reduced to 1 a night and ive not had a bleed since.

I know every womans body is different but maybe speak to your GP.

[Kathleen]

Hello discogirl.

I think the standard response to post meno bleeding is to reduce the oestrogen content of your HRT, that has certainly been my experience. However your change of progesterone could be the cause of your recent small bleed so your clinic may suggest giving your body more time to adjust.

I got on well with Cyclogest but I did notice that some pink flecks appeared during the day. This went on for some time and I eventually had a scan and all was well. At the same time I moved to my GP surgery for my HRT and because they don't prescribe Cyclogest I was given Utrogestan 100mg to be taken orally, my oestrogen gel dose was unchanged.
On this new regime the pink flecks have stopped and I haven't had any spotting or bleeding.

I hope this is helpful in some way and take care.

K.

[discogirl]

Hi Pauline67

Yes I am tempted to adjust the progesterone to 200mg first see how I get on, I really don't want to change my gel dose as I do feel quite settled on the 2 pumps, however if I have to I will.

Hi Kathleen,

I stopped the cyclogest in December, I think it was. I was using it rectally but my blood estrogen levels had spiralled out of control as I wasn't absorbing it.. After my 3 month break I restarted on 1 pump of gel then increased to 2 pumps after 3 months. If my increase in utrogestan doesn't sort it I will have to decrease the dose of oestrogel. It's only on the loo paper but after my last episode of heavy bleeding I'm very careful now. Hope your keeping well x

[Dotty]

Hi Discogirl…if you’ve been settled on the same dose for 6 months then the guidance is that the bleed should be investigated.

I’ve constantly suffered with post menopausal bleeding and have had three Pipelle biopsies and a hysteroscopy over the last 4 years….nothing found thankfully. I saw a consultant two weeks ago who said that the bleeding is caused by the hrt so my options are to stop hrt , have a Mirena coil, or change the progesterone ( double the Utrogestan or move to Provera ).  If you need 2 pumps of gel, then decreasing the oestrogen is not going to help you.  I’ve tried decreasing in the past and the bleeding didn’t stop !

It really is a merry go round ! x

[bombsh3ll]

I would increase the progesterone to 200mg and observe for another 3 months before rushing down the PMB pathway.

The 6 months guideline applies only to women who are postmenopausal.

It is only 5 months since march, and also it is not 12 months since you last bled.

There's no good reason to decrease a therapeutic dose of estrogen.

This is often suggested by non menopause specialists who are focused solely on stopping the bleeding and not the woman's overall health or quality of life, and are unfamiliar with the multiple other medical options we have for achieving amenorrhea.

[Wenj27]

Have just read your post and i started spotting 6 weeks into combined hrt post menopause iam now 4 monthsin and have just notice the spotting is every 3 weeks and lasts about 5 days and i am moody and anxious before hand.  Although i am going through these tests could it be my progesterone is 2to low im ow estrogen 50 and 100mg utrogesten. Iam driving myself crazy xx

[discogirl]

Hi Dotty and bombsh3ll

Dotty - Hope you're okay. I only bleed very slightly just for one day, now it appears to have stopped. However I am tempted to stay on this regime see how I get on and increase if I bleed again. I'm still being monitored by my gynae for my small cyst which thankfully hasn't changed, I've just had a scan, but haven't got the results yet so I will see how much my endometrium has thickened by since restarting the hrt.  And I agree decreasing the gel won't change anything, if anything I may have to increase the utro. What are you going to do about your PMB? Increase your progesterone?

bombsh3ll - Yes as I said to Dotty, I am tempted to wait and see how things progress and if I bleed anymore then I will have to increase my progesterone to 200mg. It's taken me so long to get settled on this dose of estrogen and as Dotty says it wouldn't do any good to decrease the estrogen dose anyway.  Thanks for replying x

[discogirl]

Have just read your post and i started spotting 6 weeks into combined hrt post menopause iam now 4 monthsin and have just notice the spotting is every 3 weeks and lasts about 5 days and i am moody and anxious before hand.  Although i am going through these tests could it be my progesterone is 2to low im ow estrogen 50 and 100mg utrogesten. Iam driving myself crazy xx

Hi Wenj27

As we've been discussing it's usually the hrt that needs adjusting. I'm wondering if your under a meno specialist talking to them about increasing your progesterone dose and see how that goes.

Its usually nothing but to be on the safe side I tend to report all of my post meno bleeding x

[Wenj27]

Thankyou my anxiety is in overdrive thinking about the hyteroscopy and results😔 I hope you get all sorted too. I'm coming back as a man lol xx

[CherryC]

Morning - @pauline67 can I ask how you found taking 2 utrogestan caplets at night? Did it make you feel tired the next day etc? Did it feel different to just the 1? x

[Hurdity]

I stopped the cyclogest in December, I think it was. I was using it rectally but my blood estrogen levels had spiralled out of control as I wasn't absorbing it.. After my 3 month break I restarted on 1 pump of gel then increased to 2 pumps after 3 months. If my increase in utrogestan doesn't sort it I will have to decrease the dose of oestrogel. It's only on the loo paper but after my last episode of heavy bleeding I'm very careful now. Hope your keeping well x

Your oestrogen levels will not be affected by absorption or not of progesterone, if you're post-menopausal and no natural cycle of your own. Oestrogen levels will be solely affected by the external oestrogen dose you are applying and then absorbing. The lack of progesterone absorption will have led to endometrial thickening and bleeding which you reported.

What was the results of your investigations after the heavy bleeding? Was there thickening and if so how thick, and was everything else otherwise normal?

I agree with the others - if you are happy on 2 pumps of estrogel, no need to decrease, but you may need to increase progesterone if bleeding continues and if investigation shows more thickening (or change to cyclical - or eve 25 days out of 28?)

Hurdity x

[discogirl]

Hi Hurdity,

Well I saw my gynae on Monday morning.

Regarding oestrogen levels being solely affected by my external application of oestrogen dose and my lack of absorbing the progesterone, that is exactly what my gynae said. So she agreed that I should increase my utrogestan to 200mg continuously and see how I get on.

Regarding my heavy bleed in November, the biopsy was fine, nothing amiss and it was as I suspected that I hadn't been taking enough cyclogest to counter balance the oestrogel I was applying. I had been taking the cyclogest rectally and I was not taking the full 200mg pessary.

I had a scan 2 weeks ago which showed that my cyst (which I've had for years before starting hrt) was still small no change and my gynae was happy with that. My recent scan showed my endometrium thickness was 6mm.

I am happy on 2 pumps of gel. The bleeding was a very small amount and only three or four times on Saturday and I've had nothing since.

I am tempted to stay on my current 100mg utro and see if I get anymore bleeding, however I don't want to tempt fate and risk my endometrium thickening up again. So to be on the safe side, I will increase my utrogestan

I suppose changing to cyclical or 25 out of 28 days is an option, I will monitor and see how I get on.

Hope you're okay x

[Dotty]

Hi Discogirl. Your lining measurement is the same as mine.  I bleed when mine is thick and thin! Last year I was told that the lining of my womb was 4mm and I was bleeding because it was too thin and atrophic. I was advised not to raise the Utrogestan as this would make the bleeding worse. I feel I’m always being given conflicting advice and I don’t know which advice is correct.

I will need to see my GP at some point to decide what to do…..but it seems that no one has the answer !

Keep smiling xx

[discogirl]

Hi Dotty

its awful when you get conflicting advice.

its hard to get that balance isnt it.

Are you having bleeds at the moment and are you still on 100mg utro?

I hope you get sorted soon xx