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[Wania]

Hi ladies,

I have started HRT in March last year so taking it for a fair amount of time now. Recently, just before Christmas I had terrible abdominal  pains and shortly after I started bleeding (it was bleeding, not staining etc). Lasted about 4 days, came back on new years eve with pain again, lasted about 3 days and now back at it since yesterday (passing big clots - apologies for tmi).

I was taking 2 pumps of estrogel and 100mg of utrogestan. The last bleed came on about the time when I would have break from urtogestan and started back up when I took progesterone. I kind of panicked and didn't take progesterone last night and skipped estrogel too this morning.

I went to GP the first time this happened and she put me on fast track referral to clinic, instead I received letter through post about colposcopy for 7th Jan which then was postponed till next Wednesday.

I am usual worrier type, tried not to panick but because it came back again and i hurt all over I just don't know what to do in the meantime.
I don't know if withdrawing HRT will change anything and I know it should be done gradually, but I'm scared.

I'm also most likely post menopausal already @43 as confirmed by bloods several times. I was on minipill for years and didn't have periods so can't say for certain.

Many thanks for reading and any advice greatly appreciated!

[CLKD]

When on HRT 1 cannot know when our last period was.  Menopause = last bleed. Ever.

Could your hormones have over-ridden the regime?

[joziel]

It might just be that you had/have adenomyosis or endometriosis which has been re-activated by the estrogen in the HRT. Sufficient opposing progesterone should stop that. You can also take the mini-pill as well as HRT if you need to keep it suppressed. (The progestin in the mini pill will suppress it.)

By the way, with an early menopause at 43, you really should be on HRT until at least the age of 52 (average age of menopause) to prevent osteoporosis and other health conditions, so don't stop the HRT.

[Wania]

Thank you!

@Joziel - I had a private scan last January and everything was fine so doubt I had anything wrong down there.

[joziel]

You can't see adenomyosis or endometriosis on any scan.

They are very common, with over 10% of all women having endo. Not sure about adeno. Many women have both.

[Katie1980B]

Peri has periods going all over the place, and the utro can also cause sporadic periods.

I’ve been on patches and utro for 2.5 years now, and have entered the stage where mine come more frequently (every 2 weeks give or take). It’s frustratingly normal.

I track all bleeds on my iPhone health app, including spotting, and am starting to see some patterns in the madness of peri, so I just try and go with the flow (no pun intended lol).

But as always, if you’re worried, you’re right to get checked over.

[GraceM]

Are you taking the utrogestan every day - you mention having a break from utrogestan.  If you take utrogestan daily then 100mg would be the recommended dose.  However, if you are on a regime where you take utrogestan for 12 or 14 days of the month, then the recommended dose is 200mg for those days.  It could be that you are not on enough progesterone to balance your level of oestrogen, hence the bleeding. 

[flo69]

Wania, I'm 12 years older than you and I still get unexpected bleeding with HRT. The longer the gap before bleeding, the more clots and really thick blood I'll get. I'm on the continuous "no bleed" treatment called tibolone.

I've been seen once by Gynae for a normal scan, but the GP wasn't happy to get me discharged back immediately with no answers or suggestions, so she put me back on the Gynae waiting list immediately, in 2023, and I've been waiting ever since, I occasionally phone to check my progress on the list.

I'm just trying to reassure you it's very common. I just googled colposcopy and is it a smear test? Maybe the "fast track referral to clinic" is for a different appointment with a hospital consultant who looks at more than just your cervix?

When bleeding occurs unexpectedly, it seems to worry the GPs, but not the consultants. I was told by the gynae consultant who runs the menopause clinic around here that their most common complaint is women bleeding when they aren't supposed to.
The real problem is the lack of research, but that's another thread, lol.

I'd really emphasise to them that you think you are past menopause, they might not have been listening and assume a 43 yo won't be past menopause yet.