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[MrsMitch]

Hello lovely ladies. Can I run some things by you and get your thoughts/advice, please?
When I finally saw the NHS Menopause specialist 6 months ago I was up to needing 6 pumps of oestrogel to get my hot flushes and poor sleep under control. But the down side of that was I was bleeding every day. Not loads but enough to wear pads. I'd had a hysteroscopy in December last year after I spoke to GP when the bleeding started and all was OK. So the specialist said its due to the increased dose of oestrogel and it might be easier to take my HRT in a certain way to get one bleed monthly instead of every day.
This really naffed me off because of VA wearing pads just irritates me more and I end up much more sore. So I reduced back to 2 pumps now for past 6 months. But naturally my sleep is getting poorer and hot flushes are back. So I went back to 4 pumps 2 days ago and now I'm bleeding again, like a light period.
So firstly do you think I would bleed within a day of going up to 4 or should I be calling the GP for this to be investigated?
Secondly,  a lady I spoke to was encouraging me to see the private specialist she sees to sort out my HRT because she said my HRT needs looking at so I can be on something that controls my symptoms but without bleeding.
So if you bleed on one form of oestrogen when taking a higher dose, would I bleed no matter what type I was given? I really don't want to waste my money if the issue won't be solved.
I do have a follow-up appointment this month with the specialist but she didn't say I could stop having bleeds by changing my HRT. But I don't know how much of a specialist she is.

[CLKD]

If the body has oestrogen replacement I would think: and I"m sure others will shout if I'm not correct: that any adjustment would trigger a bleed.

Have U thought of adding 3 a few times a week over the 2 you already take nightly?  The body doesn't usually get where it is suddenly and needs time for take up of any differences.

U should be able to check on line what this specialist's qualifications are.  Is she associated to a GP practice or Hospital for example?  Is she mentioned on the MM details above?

There are medications to aid sleep ........ what do you consider 'poor'?  I have in the past used anti-histamine or Kwells - 2/3 nights to readjust my sleeping pattern. 

How debilitating are the flushes on the various doses?

[bombsh3ll]

I'd simply find the dose of estrogen that controls your symptoms and then address your progestogen to control the bleeding.

You may either want to take more micronised progesterone or switch to a more potent synthetic progestin.

Either the mirena IUS, or 150mcg desogestrel daily (2* cerazette pills) can usually achieve amenorrhea.

If you have VA on 6 pumps of estradiol (sorry if I read that wrong) but that suggests very poor absorption - have you had a blood level done?

[MrsMitch]

CLKD: Sounds sensible to do different amounts a few times a week. Poor sleep for me is only being able to stay asleep for 45 mins at a time all through the night, I'm exhausted.  I had over 2 years of it prior to starting HRT out of desperation. With regards to the hot flushes, I have to sleep with the windows wide open (so poor hubby has his electric blanket on all night) even on frosty nights, with only a sheet over me. I wear vest tops & shorts even walking the dog in pouring rain. When we go anywhere at the moment everyone is in sweaters but I'm dressed for summer! Once I'm home I can only wear my nighty in the house as I'm so hot and I often have to sit in the garden. Not fun.
Bombsh3ll: I always find that whoever I see about my HRT doesn't know much, including the supposed specialist, compared to most ladies on here. But when I see her this month I'll talk more about the progesterone now you're saying maybe the bleeding can be stopped. The 6 pumps is oestrogel not estradiol. I'm on daily treatment for the VA (both pessaries and cream) which seems to be improving after just over 6 months on that, but it was untreated for nearly 14 years so I know it will take time.
I wouldn't have the mirena as it would involve GA due to VA and again if it needed removing and having dreadful endometriosis I wouldn't want anything in there!
Aside from the testosterone blood test recently,  I've never been offered a test for all my levels. Maybe I need to be more assertive at my appointment and ask for blood tests and ask for the progesterone to be changed, now you've told me.
Thank you very much, ladies.

[CLKD]

I can't remember    whether you use localised insertion of appropriate vaginal atrophy treatment as sometimes general replacement isn't enough to ease symptoms. 

Let us know how you get on?

[bombsh3ll]

You could get cerazette from your GP - show them the BMS information on using 2*pills daily as the progestogen or just meet them where they are at and say it's for contraception (if you are under 55).

You can also buy it (brand name Hanna) from pharmacies or online.

If you try it yourself you'll know then whether it works and suits, then you aren't wasting appointments and energy on obtaining something that might not be for you.

Just for reference 2* desogestrel shut my endogenous, heavy cycle down completely in my early 40s and I have high ovarian reserve.

[MrsMitch]

Thank you Bombsh3ll,  I'll call the GP next week for some - no point saying it's for contraception as I can't have children so that wouldn't work!!

[MrsMitch]

I was pondering on things today and I'm not sure if this has any bearing on things, but I'll add it in case.
3 years ago my GP changed the HRT I was on. I started on tablets but they became unavailable.  She asked me when my last period was and at the time I hadn't had one for 8 months,  but never been the full 12 months without. However she said she'd prescribe HRT as if I was post menopause and gave me sequential patches. I persevered with these for about 8 months but they didn't get rid of my symptoms sufficiently so she then started my on the gel I now have and utrogestan - again daily utrogestan as if I was post Menopause. 
I had no bleeding until around this time last year when I had the hysteroscopy and all OK. But this time, I had bloating, mild period cramps and the feeling of being out of sorts just like I used to in my days of having regular periods.  Last year my spotting ended with a period and those symptoms.
Do you think it was a mistake to treat me as post when I technically wasn't? I just wonder if my body is trying to have its last few periods as I was still peri?
Just thinking out loud really!
   

[CLKD]

Well it seems that the medic was not au fait with what menopause actually means   

Peri-menopause are those years leading up to the last period = menopause.  No more bleeds.  If there is a show then that needs to be investigated to check for possible problems .

I believe that we are advised to be 12 months without a bleed to consider that we are into menopause .........

[bombsh3ll]

There's nothing harmful about taking continuous HRT even if you haven't gone 12 months.

It just means you MIGHT be more likely to get some irregular bleeding or spotting vs if you were on sequential, which is designed to induce bleeding every 4 weeks.

This is not pathological.

However if you have gone 12 months without bleeding, and there has been no change in treatment or anything else to explain it eg missed doses, and then you have new bleeding, you should check in with your GP.

If you are low risk they are likely to adjust your treatment in the first instance - progestogen should be tweaked rather than reducing a therapeutic dose of estrogen.

[MrsMitch]

No nothing has changed re HRT except, as I said, I decreased to 2 pumps to avoid bleeding and then increased a few days ago and I would have thought it too soon to affect me. That said my hot flushes have decreased and I had a fabulous night's sleep last night. I'll check with the specialist re bleeding when I go in a few weeks.
Maybe I'm just fortunate that the increase in dose has helped really fast!!