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[Geminilady]

Hi, I’m new to the forum but have been lurking or a few weeks hoping to see if others have had similar experience to me and what the outcome was.

I’ve been on continuous hrt, 2 pumps of oestrogel and 100mg utrogestan plus Estradiol cream, for over 2 years. I’m post menopausal, no periods for about 8 years. All was going well, I felt so much better and nearly all my menopausal symptoms were gone which was great. In May I started noticing when wiping some thin brown what looked like cotton threads for a couple of days, and a small amount of blood which obviously alarmed me a bit. Had a chat with GP who referred for pelvic scan including vaginal scan. Results came back womb was 3.5mm and mentioned some microcalcifications in the endocervical canal and echogenic foci, all most probably age related. Another chat with GP to follow up and they wrote to gynae at local hospital for advice and guidance. This came back I didn’t need to be seen but to try reducing to 1 pump of gel daily. Tried this for 7 weeks but all my menopausal symptoms started coming back and I had 2 episodes of the brown ‘threads’ during this time. The nurse practitioner at surgery said to go back up to 2 pumps and see how things go. I had no spotting or episodes of these brown strands for 5 weeks then I got an unexpected call from surgery saying they wanted me to try upping the nightly utrogestan to 200mg, and if I still had spotting they want to refer me for an urgent biopsy. After 7 nights of 200mg utrogestan and 2 pumps of gel daily I started bleeding, this time a proper bleed which lasted 3 days before becoming brown and containing quite a few strands of what I assume now is endometrial tissue, they are now thicker and longer. Now on day 7 of this and no signed of it stopping yet. I know you can get spotting on hrt but has anyone had similar? Everything was going so well for 2 years and then suddenly it’s all gone haywire, just feeling a bit fed up with it all, and now the worry of probably being sent for a biopsy.

[Sphynx]

Not entirely similar, but I was in HRT for 6 months without any issues. I had a bleed, and then another, so was referred for a TVS which was fine. I then experienced brown spotting which contained stringy bit of lining. This went on for about 10 days. My dr said she’d like me to persevere if I want too, as its helping all my menopause symptoms. She said she didn’t know why some people bleed, but that it does happen a lot. Because my scan was clear, she said it was safe to continue for another 3 months, and see if things settle. It is annoying, and I never know when I might bleed, but I feel more relaxed since the scan.
You can ask to change HRT, or even stop for a while, and ‘reset’ before starting again.

[joziel]

You probably just need the scan to be done to reassure them all is okay, but rest assured for 95% of women it's totally nothing to worry about.

It might be an idea to take a break of 3-5 nights from the utrogestan each month, to schedule the bleed. The thing which seems to freak doctors out is when the bleed is 'unscheduled' (ie happening randomly). IF you take continuous utrogestan, then any bleeding WILL be unscheduled as it's not in relation to starting or stopping utrogestan. If you stop it for 3-5 nights a month, you should schedule a bleed that way and shed any build up so that you don't get bleeding at other times.

Whilst utrogestan keeps the lining so thin for many women they never need to have a bleed in post-meno, I think there are some women who do need to shed anything which has built up over the month.

The 'old' continuous schedule allowed a 3 day break of utrogestan and I think this still suits a lot of women...

[Geminilady]

Thank you both for your replies.

 I’m reassured by the fact that no-one seems concerned with my scan results. It’s all just thrown me, being on the hrt for 2 years with absolutely no issues and now this happening. I’ll see how things go, currently on day 9 of the bleeding and still shedding little bits. My phone consultation with the nurse is in just under 2 weeks so I’ll see what she says and if it looks like this is going to happen often I’ll look more into taking a few days off the utrogestan.

[joziel]

I would stop taking the utrogestan so that you go with the bleed your body wants to have. If you keep taking it, you are preventing your body from properly and fully shedding the lining, only making it more likely to keep breaking through again in future and freaking everyone out.

And then, to prevent that continuing to happen, to schedule a bleed as I said. There's zero reason not to. It is perfectly safe to stop utrogestan for 3 days once a month, it's what everyone used to do on a continuous schedule until just a few years ago.