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[Hello101]

I’m on Estradot 100mcg patches and I take 2 Utrogestan vaginally every night as orally makes me super depressed and flat. I was on Oestrogel (4 pumps) for years but switched to patches about 18 months ago as I felt the packaging change of Oestrogel caused my meno symptoms to return. Plus the patches are more convenient!
Anyway I had some bleeding about 3 months after switching to the patches. My GP referred me for an ultrasound and all was fine. The gynaecologist who reviewed my scan said if the bleeding continued I could switch to a Mirena coil which may be better than Utrogestan at controlling bleeding.
I’ve since had another two episodes of bleeding which has been so light it was barely noticeable. I’ve not needed a pad or anything, I just noticed on wiping after I went to the toilet.
I’ve not gone back to my GP but I will soon. My question is-is my only option to switch to the coil? I’m wary as I’ve heard lots of posters say the coil made them really flat, depressed etc so I’m worried about that. I also had the coil years ago for contraception and I had really heavy periods for months on it before I gave up.
Is there any other options? The bleeding I have at the moment is very manageable and not a problem. Thanks!

[joziel]

How old are you? You're on continuous HRT but that doesn't really tell us if you might still be cycling and producing your own estrogen, which will cause unscheduled bleeding.

And no, the coil is not your only option.

If I were you, I would schedule a bleed. Simply stop taking the P for 3-5 nights every month. Usually a bleed will start about 48hrs after you stop it, so give it a few days to empty out. Then restart the P.

Doctors freak out about 'unscheduled' bleeding. If you schedule it so it only happens when you stop P, they won't worry. If you have any building up, eventually it is going to break through at some point. If you schedule it, you will control when that happens and let the pressure off, so to speak...

And this used to be the old 'continuous' schedule, taking it for 25 days out of 28 - so it's perfectly safe. It's just that someone (probably someone running a pharma company with a penis) decided that women didn't need to bleed and should just take it continuously. The problem with that is, if you still make any of your own, you are likely to bleed randomly and 'unscheduled' if you take continuous P - OR if you take a decent amount of E.

The other thing you can do, is to increase the P as well. I take 300mg P from day 7-14 and 400mg P from day 14-26. I am on a high E dose. I get this privately as my NHS GP probably wouldn't prescribe it without a letter from the private clinic. I stop taking P on day 26 and usually bleed by day 28-29. I start it again on day 7.

And lastly, you can also experiment with taking some P rectally rather than all vaginally. Some women absorb it better rectally than vaginally. Don't put it too far in, or it will get absorbed by the liver and have the same effects on you as taking it orally does. Just past the sphincter. This is v common way of taking it in the US.

It's really about experimenting until you've tried all options....

[bombsh3ll]

No, there are multiple oral progestins that provide better bleed control than micronised progesterone.

These include desogestrel, drospirenone, norethisterone, medroxyprogesterone acetate as standalone progestins.

In oral combination products there is also dydrogesterone.

Alternatively if no progestogen suits there is tibolone.

Also the mirena IUS typically stops periods - the "coil" you had may have been the hormone free copper T if it gave you heavy periods.

[Hello101]

Thanks! I’m 50. Started HRT at 43 and moved to continuous about 4 years ago I think (can’t remember exactly).
So missing a few days of Utrogestan may work-good to know.
I honestly don’t think I could increase my dose of P. I think I would feel depressed if I increased the dose and my bleeding is so light that it might not be worth it.

[joziel]

If you're 50, it's very likely that you are still producing estrogen yourself. The average age of menopause is 52, so you are very likely producing spikes of estrogen which are going to lead to build up and bleeding.

Try stopping P for 3-5 days each cycle to schedule a bleed.

If that doesn't work and you don't want to increase the P, then you can take one of those progestins bomb lists. The desogestrel (for eg) is approved for contraception for women on HRT. So you could add that in *as well* as the utrogestan and it will almost certainly stop all bleeding. When you are into post-menopause you can probably stop it and be fine with just utrogestan because your own body won't be producing these spikes of estrogen anymore.