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[sadielouise78]

Hi. I first went on HRT in early 40's due to brain fog and night sweats but had to come off it as my blood pressure went through the roof at age 43. Strangely symptoms stopped but periods carried on. Now age 50 I've recently gone back on HRT 6 weeks ago (Estrogen 2 pumps & Utrogestan 25mg (corrected to 100mg) continuous) due to excessive hair loss and it's really helped with my mood and anxiety. I've not had a period for going on for a year prior to starting HRT. The first two weeks I had period pains, then by week 3 I started with dark gunge/blood. By week 5 it's a full on heavy bleed. So I've been bleeding now for 4 weeks and the doctor has made me stop HRT. I've got a follow up appointment with the doctor on the 14th January but as yet there's no sign of the bleeding easing up. Why after no bleeding for nearly 12 months has it all started again and what's the next step with HRT now? I've had the mirena coil before and had a terrible experience so not willing to go down that route again.

[bombsh3ll]

Your GP is not correct in making you stop the HRT - investigation should be arranged as it sounds like it is beyond the light bleeding/spotting that can occur in the first months of starting or changing HRT - however recent guidance doesn't recommend withdrawing HRT prescription pending investigation for bleeding.

Regarding the progestogen component - there are multiple other options than utrogestan or the IUS.

However your utrogestan dose is a little confusing, are you sure it is 25mg? The capsules are 100mg and can't be split. You would normally be on 100mg every day.

An alternative progestin to consider would be 2* cerazette pills every day. That's 150micrograms of desogestrel. This is off label but supported by the BMS. It would generally stop an elephant bleeding and is well tolerated and easy to obtain.

[sadielouise78]

Sorry 100mg Utrogestan. I came back on to correct that. I also take the mini pill, desogestrel. The complication with the mini pill is that it doesn't work as a contraceptive for me as I take Topiramate for migraine so does it work for HRT??

[CLKD]

Your GP could of course prescribe medication to stop the bleeding.

How were your periods over the years?  I had excruciating pains with heavy clots for 2 days every month  - until I went on the contraceptive Pill.

[bombsh3ll]

It is still worth trying 2*desogestrel to see if you can achieve amenorrhea.

Unfortunately if you are on medication that can hasten the metabolism of oral agents, specialist advice may be required, even around oral micronised progesterone, to ensure that what you are using for endometrial protection is actually going to do that.

Another possible option is trying the utrogestan vaginally (I would maybe increase the dose to 200mg every night), or looking into the combined patch.

[sadielouise78]

I'm sorry I don't understand what you mean by 'medication that can hasten the metabolism of oral agents'. Can you explain what you mean by that please?

[sadielouise78]

Over the years my periods have been awful. I had ablation done probably 4 years ago as I was just flooding all the time. It worked for a while but then it all started again. The mini pill has stopped the bleeding until now. I never had excoriating pain but definitely felt unwell.

[bombsh3ll]

Hi, sorry, I meant because you are on topiramate and have been told not to rely on oral contraception.

Basically some drugs can cause others to be eliminated from the body more quickly.

A well known example is some anti-epileptics which makes oral birth control unreliable.

Neurology drugs are not my area of expertise however if your consultant has said don't rely on desogestrel for contraception whilst taking topiramate I would want to get specialist advice regarding the use of any oral progestogen for endometrial protection.

There is a potential safety issue if you are taking progesterone to protect the endometrium, and it is not working as effectively as it should due to the concurrent use of topiramate.

Please highlight this issue with your medical team.

[sadielouise78]

Yes thank you. I will do that in my call with the doctor next week. Topiramate is an anti epilepsy drug used for migraine and it does stop the effectiveness of the mini pill. It's so complicated.  The doctors are trying to get me to come off Topiramate now I don't have migraines but I fought for so long to get on it and he pretty much migraine free I'm very reluctant.