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[gillybilly]

I was under the impression that taking progesterone each day (100mg) stopped the endometrium from growing

I don't understand how I take 1.5 pumps if oestogel (a bottle lasts nearly 6 weeks so under the standard dose) I have a nearly 7mm thickness reading

[sheila99]

The guidelines have changed recently to 200mg per day, presumably they found 100 was insufficient for some women. Presume you're meno? If you still have a cycle it can be 16mm before a bleed and not a concern.

[Kathleen]

Hello gillybilly


I also understand that taking 100mg of Utrogestan orally every day stops the womb lining from building up. I think this particular dose is protective for up to 100mg oestrogen patch or 4 pumps of gel or two 1 mg sachets of Sandrena gel. If this is right then it does seem odd that you have developed a thickened lining on a low dose oestrogen.

Are you using the Utrogestan vaginally? This works for some ladies but I often had spotting or bleeding when I used it that way, since taking it orally I haven't had any of those problems.


Hopefully some of the more knowledgeable ladies will be along to comment and give you some advice.

Take care.

K.

[gillybilly]

Hi
I had early menopause at 43 I'm now 54.  I started hrt because I got diagnosed with osteopenia at about 51 - no other reason (so 8 years after last period)

I saw the guidelines have changed for people taking 4 pumps to 200mg

But I take the smallest dose of 2
not quite full squirts

I had a well woman scan a few days back as I bled for a few days after missing a dose
I was told my endometrium was 6.7 - 7.1mm and an now on an urgent 2 week referral

I take the gel and tablets every night on my arm , and tablets orally

Really scared and anxious

[bombsh3ll]

You had untreated early menopause for 8 years. You are at a very LOW risk of endometrial cancer.

An endometrium of less than 11 is also extremely unlikely to be malignant.

Endometrial cancer typically presents with chronic, irregular bleeding, not a one off withdrawal bleed triggered by missed progesterone.

It is good to get checked but you really have very little to worry about.

There is a completely disproportionate, literally hysterical  reaction to bleeding on MHT within the NHS. This is a common side effect and almost never malignant.

It doesn't warrant a "suspected cancer" referral as no menopause literate doctor would suspect cancer clinically in your case.

This results from the system being unable to distinguish between a postmenopausal woman not on HRT with unexplained bleeding, which raises a higher suspicion of malignancy and really does need urgent investigation, and a woman on HRT with a recognised side effect who could be investigated routinely without all the drama, because until very recently only 10% or less of women were prescribed MHT.

As much as we would like to think there is a set dose of progesterone for each dose of estrogen, in reality we are all so different that what suppresses the lining in one woman may need to be doubled or tripled in another to achieve the same effect, even though both take the same estradiol dose. It's like shoes - some people need a size 3, others need a 10.

Particularly this is the case when the estradiol is taken through the skin - there is such wide individual difference in absorption (more than 10x) that two women could use the same amount of gel or the same patch, and one would have a really good level of estrogen like a menstruating woman and the other could have undetectable levels. The first obviously needs a robust dose of progesterone, the second is taking progesterone pointlessly (and probably wondering why she feels like crap).

If you double the progesterone between now and your investigation, you may well be pleasantly surprised with a nice thin endometrium by then.

[gillybilly]

Bombshell

Thank you so much for your detailed reply.
It is very much appreciated

The pelvic ultrasound I had also showed blood (though that could have been remains of the bleed I don't know)  and an "irregular area of fluid in endometrium' that may have be a polyp

I may try the double dose, I have reduced my oestradiol to 1 squirt per night, so the ratio has changed slightly anyway
It may be that (reduced oestrogen) that's causing the mass anxiety

I've come to realise that what the drs, web etc tell us, isn't actually the reality

[Dotty]

Hi missing a dose of utrogestan can cause bleeding.

The guidelines on taking utrogestan have only changed for higher doses....4 pumps / 100 patch.

[Kathleen]

Hello again ladies.

Dotty -  Thanks for confirming that the Utrogestan guidelines had only changed for higher doses.

gillybilly - Back in the day I was on  the equivalent of six pumps of gel and Utrogestan vaginally every other day, so a lot of oestrogen and very little progesterone. I had some issues with breast tenderness and maybe a tiny bit of pink staining occasionally.  I missed one dose of Utrogestan and the pink staining soon turned to spotting and then bleeding. It only took one missed dose to lead to a bleed. I had a scan etc and everything was okay with my lining but I decided to reduce my oestrogen anyway. In your case it is likely that your missed dose of Utrogestan has caused your bleed.

I take your point though that Utrogestan should be doing a better job of keeping your lining thin and I expect that you will want more info on that aspect of your HRT regime from your GP. In the meantime there may be some ladies here who have had your experience and can advise you.

Take care ladies.

K.