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[MrsMitch]

So I'm learning that progesterone is what seems to stop bleeding whilst on HRT if you're post meno? I'm at my follow-up apt with the menopause specialist next week and last time she said ghat I would bleed if my oestrogen dose was increased and so to decide if I wanted to be spotting every day or have one bleed monthly. I didn't talk to her about that much as I was there for testosterone and only interested in that.
After seeing her I reduced my oestrogel to 2 pumps but kept the Utrogestan at 2 x 100mg partly because my GP had originally said I was borderline between one or two tablets and partly so my sleep wasn't affected.
Eventually I had to give in and go back to 4 pumps due to intolerable flushes about 2 weeks ago and 2 days later, after being really bloated I started a heavy bleed and it's still going now. That was after about 10 months of no bleeding. I did mention this in my thread about testosterone and one lovely lady mentioned a progesterone only contraceptive pill and I read on another thread about mirena.
Another specialist I saw last year prior to my hysteroscopy agreed with me mirena wasn't a good idea as I've a history of bad endometriosis and should it need to be removed etc it would mean another GA due to VA. 
So I'm guessing this specialist doesn't know that bleeding can/could be prevented.  Obviously I don't want to bleed! I've waited till I see her to mention bleeding rather than go to GP. 
Should I be firm that it can potentially be stopped or just accept if she says it can't? I'd like to sort this but do fear she might not be prepared to sort it out.

[bombsh3ll]

I would definitely bring up that you are interested in other progestogen options if you are.

Micronised progesterone has been pushed as the holy grail in recent years and synthetic progestins have been really demonised, so either she believes everyone should be on micronised, or she thinks this is all her patients will accept. She has probably had a ton of women saying they will only have body identical, because they have watched Louise Newson on YouTube (who I am a big fan of, but don't align with on all issues)

This is one of them - micronised progesterone is slightly better regarding clot, breast and cardiovascular risks, however the absolute difference is minuscule, and it doesn't control bleeding or prevent endometrial thickening in a significant proportion of women, and at high doses tolerability becomes a problem.

When safety vs harm is being considered, nobody is factoring in the suffering and distress of many women undergoing painful and invasive investigations for bleeding, often repeatedly, nor all those who give up HRT altogether due to bleeding, having only ever tried one progesterone option.

Synthetics on the other hand have been engineered to achieve endometrial control at very low doses. They are associated with much lower bleeding rates and lower risk of endometrial hyperplasia and cancer than women on no HRT. The WHI also reported a significant reduction in bowel cancer on the combination with provera. That never gets mentioned, because who cares if women get any other type of cancer as long as it doesn't impact the male gaze like treatment for breast cancer potentially can.

So if you are willing to look at the synthetic options, and have said that mirena isn't for you, then there are several oral progestins that you can take daily.

The BMS has a list of these on their website if you wanted to take something to show your provider.

My first option would be 150mg desogestrel daily ie 2*cerazette pills. This has excellent safety data, potent endometrial control and is easily obtained. Many women have also used it previously in birth control.

Secondly there is Slynd, a newcomer which is 4mg drospirenone and can be taken daily as the progestin in HRT. It is increasingly popular but no data on how good it is on bleed control Vs others.

Norethisterone is another - requires taking 3 * Noriday pills a day unless in an oral combination product. Some find mood and bloating and issue on this.

Then you have Provera (medroxyprogesterone acetate) which was used in the WHI but is also available as a standalone progestin. This is the least metabolically favourable but still a really good treatment if no other option suits, and at a high enough dose could stop an elephant bleeding. Suggested dose on a moderate estrogen dose eg 4 pumps would be 5mg. This can be increased to 10mg daily if needed.

I would absolutely take provera if it were the only option that suited me, rather than no estrogen.

[MrsMitch]

Thank you so much Bombsh3ll,  I was hoping to hear your advice and the above is fantastic advice, I really do appreciate you taking the time to reply. I think I'd be better having consultations with you!
I will make a list to take with me to the apt. I'm ready to see her pull a face again as she did when I told her I had corresponded with Dr Currie about Estradiol daily. But I'm past caring about the sensitivities of health professionals- I just need to try and get this bleeding to stop. You mentioned stopping an elephant bleeding, that's me currently. 
Again, massive thanks dear lady.

[MrsMitch]

So just to update: had my follow up with the specialist yesterday. I'm still bleeding but it is slowing a little. She was happy with my testosterone levels in spite of my GP saying it was too high (no surprise there then) and so I'll re test for that in 3 months.
With regards to the bleeding, she did say it can be normal due to an increased dose of oestrogel.  She said if it didn't stop in 3 months then it would mean a scan and potential hysteroscopy again but she says it likely will stop.
Once it has, she says I would be much better inducing a bleed every month.  Because I'm higher risk of endometrial cancer due to no children,  she says this will keep the lining of my womb thinner and eliminate any thickening.
With regards to Utrogestan,  she says it is very safe but it isn't good at preventing bleeding. I did discuss the other progesterones you mentioned, Bombsh3ll,  and she would be happy to try others but again would prefer a monthly induced bleed, for me.
So whilst I don't want to bleed, I think in the long run it's the safer option for me, unless I bleed mid month, in which case she will try different forms of progesterone.
Thanks again for the advice.