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[Sphynx]

I don’t have periods and I’ve been in Evorel Conti since January. I started bleeding at 6 months in, was sent for an TVS which was fine. GP will discuss this in a week or so.
I haven’t had bleeding since, but now I am spotting brown, and shedding what I assume is my lining. Is this because I’m not getting enough progesterone? I have no clue.

What I might do is swap to something new. The GP did touch on getting the Mirena, which I don’t want. Or something else in combination with progesterone pills? I don’t remember exactly…..

[bombsh3ll]

Bleeding is a common side effect of hormone therapy, and with a synthetic progestin in a fixed dose combination, you are very unlikely to be getting insufficient progestogenic activity, as these are much more potent than progesterone.

There may be other preparations that suit you better, for example taking separate estradiol and a progestogen, either synthetic or micronised progesterone, which allows dose customisation.

[sheila99]

A mirena is usually the most effective option for problem bleeding. If you use a separate oestrogen and progestogen (such as utrogestan) it gives you the option to increase the progestogen until the bleeding is under control. Are you definitely meno? If you still have periods of your own it's harder to prevent bleeding on a conti regime.

[Sphynx]

A mirena is usually the most effective option for problem bleeding. If you use a separate oestrogen and progestogen (such as utrogestan) it gives you the option to increase the progestogen until the bleeding is under control. Are you definitely meno? If you still have periods of your own it's harder to prevent bleeding on a conti regime.

As mentioned in my post, I don’t get periods anymore, and do not want the Mirena.
I’m thinking I’ll opt for a patch and utrogestan to trial next, and see how I get on. Bleeding or not, I don’t feel as energetic and upbeat as I was when I first started taking Evorel Conti, so hopefully this might rectify things.

[Sphynx]

Bleeding is a common side effect of hormone therapy, and with a synthetic progestin in a fixed dose combination, you are very unlikely to be getting insufficient progestogenic activity, as these are much more potent than progesterone.

There may be other preparations that suit you better, for example taking separate estradiol and a progestogen, either synthetic or micronised progesterone, which allows dose customisation.

Thank you. My GP said I was on the best patch, and optimal dose for me as it cleared up all but one of my menopause symptoms. This was fine, until the first bleed at 6 months. Hopefully taking each separately will help.

[joziel]

If you don't want the Mirena, you can try a separate patch and utrogestan. The patch should be exactly the same just without the progestin part of it, which you replace with the oral utrogestan.

Then you have the option of taking MORE utrogestan to stop the bleeding, because you are not taking a combined 2-in-1 product but you can adjust each hormone individually.

You might also need an estrogen increase as the Conti only has 50mcg of estrogen in it and isn't adjustable or in other doses. If you are feeling not as energetic etc, you might want to try increasing to 75 when you get separate patch and utrogestan - however it might be a good idea to delay that until the switch to utrogestan so you can see how you are on a 50 patch and if the utrogestan stops the bleeding at that dosage. (Since raising estrogen may cause more bleeding, not less.)

You should always aim to have the estrogen dosage you need so don't stay on a lower estrogen dose due to the bleeding or progesterone issues and fear of those, though.

There are other options too - there are other oral progestins you can take like norethisterone, dydrogesterone if I spelt that right etc etc. Have a read of this: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

[Sphynx]

If you don't want the Mirena, you can try a separate patch and utrogestan. The patch should be exactly the same just without the progestin part of it, which you replace with the oral utrogestan.

Then you have the option of taking MORE utrogestan to stop the bleeding, because you are not taking a combined 2-in-1 product but you can adjust each hormone individually.

You might also need an estrogen increase as the Conti only has 50mcg of estrogen in it and isn't adjustable or in other doses. If you are feeling not as energetic etc, you might want to try increasing to 75 when you get separate patch and utrogestan - however it might be a good idea to delay that until the switch to utrogestan so you can see how you are on a 50 patch and if the utrogestan stops the bleeding at that dosage. (Since raising estrogen may cause more bleeding, not less.)

You should always aim to have the estrogen dosage you need so don't stay on a lower estrogen dose due to the bleeding or progesterone issues and fear of those, though.

There are other options too - there are other oral progestins you can take like norethisterone, dydrogesterone if I spelt that right etc etc. Have a read of this: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

Thank you very much, that’s very helpful.

[Jillyboo]

I was never able to settle on any so called 'no bleed' form of HRT and had repeated episodes of spotting which was a nuisance.  In the end my GP suggested I remain on a sequential regime. For me having a few days of predictable bleeding was far preferable.