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[Bex]

Good afternoon
I have been on an increased dose of oral progesterone since 1st Oct as I was experiencing bleeding on my continuous HRT regime (75mg oestrogel and 100mg progesterone daily, now on 200mg progesterone). For the last 6 weeks, I had some brown spotting, which I assumed was my system adjusting and settling to the new dose, but today, 2 months since starting the new regime, I have had a much heavier withdrawal bleed. Should I go back to GP or wait to see if it settles? I had been on Utrogestan, but for the last 2 months, given Gepretix. Thank you.

[bombsh3ll]

Are you definitely postmenopausal or still having endogenous ovarian activity?

Also you mentioned using continuous HRT, but also having withdrawal bleeding - are you taking the progesterone continuously or intermittently?

Have you had any investigation for the bleeding previously?

Is your cervical screening up to date?

It is not necessarily concerning to bleed within the first 6 months of a new regimen, however if you were already bleeding prior to this it has potentially been going on long enough to warrant assessment.

Micronised progesterone is the least potent of all the progestogens that could be used, and unfortunately doesn't achieve amenorrhea in a significant proportion of women no matter how diligently they take it.

The dose can be increased eg to 300 or 400mg, however tolerability can become an issue. Some people find that it has a more potent effect when taken vaginally.

Alternatively you could look at the synthetic options which generally offer better endometrial control, such as mirena IUS or an oral progestin.

[Bex]

Thank you for your response. I started continual HRT December last year (last period Jan 22). I swapped from patches to the gel in February this year, with increasing the oestrogen to 75mg in March. I had some bleeding in June on and off and when I spoke to GP advised it was due to change in dose. When the bleeding hadn't really stopped in September, I spoke with the HRT nurse who agreed it could be the progesterone being too low so hence increasing it to 200mg. As I say I thought things had settled but a bleed today. All screening upto date.

[bombsh3ll]

I think by this time with bleeding on and off since June that has never really settled, it is now December and if it were me I would want a routine pelvic scan.

This doesn't mean you have to stop your HRT.

The bleeding may well stop if you persist with the current regimen, however you could perhaps speak to your GP and agree a time frame for investigation if it doesn't. This would give you peace of mind.

Also think about how wedded you are to micronised progesterone going forward, because there are much better options for endometrial control if it can't be achieved with micronised progesterone.

[Bex]

Thank you, I'll reach out to my Gp this week.

[Jax]

This was happening to.me. I saw my GP who sent me for a scan where there is slight thickening of the womb due to hrt did a biopsy to.rule everything out and recommended getting a merina coil fitted instead of taking progesterone tabs.

[Bex]

Thank you. Speaking with my GP tomorrow so hopefully will get a referral. Glad all ok with you x