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[Christine49]

This is a long post sorry but if anyone has any suggestions please let me know!!
I have been on various HRT regimes for about 6 years. I’ve been on continuous regime for the last 3 but I’m still continually having bleeds.

I’m now on 75 evorel patch and 100 Utrogestan and still spotting and now another bleed this last day or so.

I’m totally fed up. Ive got a doc appointment but not for  another couple of weeks.

Basically I had upped ultrogeston at the end of last year to try stop bleed but I felt horrendous for 2 months and had an even heavier bleed. Went back to just 100 again and eventually after a bit of spotting etc for a couple of months I didn’t have any bleeding just the odd flush and a bit grumpy.

Then in May Doc then said to try testosterone which I did as a blood test showed it as low. But that didn’t do anything for me just made me grumpy and sex was sore again and then spotting again which would start after sex. I’m on vagifem etc

Stopped that in July and back to spotting, sore and now anxious especially health anxiety!!

I’ve had US scans last October and was only 5mm and had a hysteroscopy in 2022 which was clear and smear last year which was clear.

I really know what to do next. I’m scared if I stop HRT I will have bad flushes and sweats again and low mood. But I’m currently got low mood with worry, I’m bleeding, I ache all over! So confused!

[CLKD]

How often are U using VA treatment?  The spotting may B due to dryness in the vagina/vulval area.

U could put the product names into the search box: separately: to read the threads ....... make notes ;-)

In the meantime keep a mood/food/symptom diary to discuss with the GP.

[Wend861]

I've had a similar experience with spotting after sex and soreness. I have found an area of tissue inside that is raised and bumpy which bleeds. The Gp thinks it looks like cuts which I can only assume is caused when I insert vagifem. I have been referred to gynae.
It doesn't sound like your hormones are in balance. It will take a few months to settle after stopping testosterone. Have you tried oestrogel rather than patches? You can then vary the amount you need to feel an improvement.  Talk it through at your appointment and see if there is a better option for you.

[CLKD]

Hi Wend861 - 'cuts' are common cause of VA which happens due to loss of oestrogen.  If the 'vagifem' may be making it worse, mayB ask for 'ovestin/estriol' instead.  Or split the pessary and apply on the finger as far inside as is comfy. 

Why a gynaecologist and not a dedicated menopause clinic?  MayB your GP isn't au fait with the fact that there are specific clinics?  Perhaps ring and ask if the gynae knows about menopause etc.?  Many do not.  Let us know how you get on.

[Christine49]

Thanks for replies.
I use vagifem 3 x a week and cream on outer area plus Yes moisturiser.
Soreness is higher up I’m wondering if it’s polyps. 
Or it could be imbalance not sure how to sort it. I’ve tried so many options!
I’ve tried gel but didn’t absorb.

I’ve got a basic diary so will try again with gp next week unfortunately it’s a telephone consultation.

[CLKD]

Use nightly until the soreness has gone?   VA treatment is such a small amount and quality of life important, upping to every night may well benefit that sore area.  I had a 'spot' slightly inside the vagina which hurt on contact .........

[Wend861]

Hi CLKD, thanks for the advice. My Dr seemed mystified as to the cause despite me having been to her about vaginal soreness/sensations/discharge etc.
She referred me to gynae due to the bleeding after intercourse and the unexplained lumpy/cut area in my vagina. It's worried me though being put on the 2 week pathway and then getting a letter saying "suspected cancer". I know why but for someone with bad anxiety it's not helpful.
I tried to book in to see a private gynaecologist who specialises in menopause too but they are booked up for 6 weeks.

[joziel]

Christine, if you are bleeding randomly then you shouldn't be on continuous HRT. So that's the first easy thing to change.

You can either do sequential or you can do continuous but take a 5 day break to schedule a bleed. The latter is probably a better idea in late peri, because you will get all the benefits of continuous but also scheduled bleeds.

How to go about this? The next time you start to bleed, stop taking your utrogestan for 5 days and allow the bleed to happen. Then re-start it again. See how often this happens. You will likely find a pattern to it, meaning that you are still bleeding every X days if you allow your cycle to happen. Usually cycles get shorter and closer together at first (mine are now every 23 days) and then longer and further apart before they stop totally.

It sounds to me like you have been put on continuous too soon and your own cycle is still happening.

Secondly, if you are on a 75 patch, 100 utrogestan continuously is on the low side. It would make better sense to take 200mg continuously (with that 5 day break). If you get progesterone side effects at that dosage, try 100 orally and the other 100 vaginally to avoid absorbing too much systemically.

If even that doesn't work for you, you might want to consider a Mirena coil which will completely stop all bleeding so you can forget about all this and you can even increase estrogen further if needed without worrying about it - it will protect even then. You don't want to stop HRT for so many reasons... But there are loads of options.

If the Mirena coil isn't an option, there are synthetic progestins which have a better effect on stopping bleeding than utrogestan does. You could add in desogestrel POP for eg, which is used as a contraceptive alongside HRT if women want to prevent pregnancy. It's fully approved and kosher to use it as well as utrogestan and it will stop the bleeding. (Sometimes there is some brown sludge for a while but then it will all stop.) Basically there are loads of options...

Have a read of this link for all the licensed options and tell your GP what you want to try (don't ask): https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf