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[MSmile]

Hi, I’ve been on hrt for 12 years now.( Early menopause at 43) I was on a cyclical regime until about 2 years ago. Since going to continuous I keep having spotting,  light bleeding. I’m on gel and 200g utrogestan continuously, it was upped from 100g. I’m being sent for another scan, previously had 3 and 2 biopsy’s. My question is what options are there now if all clear with scan. Is it synthetic progesterone or mirena coil? And is there any synthetic progesterone that preferable to others? Just weighing up my options. My gp is lovely but doesn’t know that much about hrt, I’m hopefully being referred to a nhs menopause clinic.

[patti]

Hi MSmile,
I am sitting in my GPs waiting room for exactly the same reason -
The utro worked great for me on sequi - 12 days of 200g & 1x pump gel then bleed  for 5 days -  but at 64 I don’t won’t a bleed anymore -
The breakthrough bleeding is a pain so Im wondering if I need a different progesterone 🤷‍♀️

[sheila99]

The synthetic ones seem to be more effective than utro and a mirena is usually the most effective for problem bleeding. If you don't mind the bleeding you can stay on sequi though. They told me there is a slightly higher risk of endometrial cancer. I stayed on sequi as I don't get on with utro but a month ago I changed to a mirena. Had a week of heavy bleeding but now just the occasional dribble (age 64).

[MSmile]

The bleeding is only very light so not sure if would warrant a mirena coil? When I was on cyclical the bleeds were getting quite heavy so wouldn’t I want to go back to that.
When I first started hrt 12 years ago I was given the old synthetic type, prempack which was cyclical but it stopped all bleeds. I went onto to transdermal and utrogestan as I knew it was safer but tried different patches and gel/ utro combination but still same. Maybe a synthetic progesterone may be the way to go 🤔

[bombsh3ll]

First off you could try taking the utrogestan vaginally, and/or increasing the dose to 300mg if tolerated.

If this fails or is unsuitable then either a mirena IUS or an oral progestin such as desogestrel 150mcg, slynd, norethisterone or provera could be used.

Dydrogesterone is another good option but only available in oral combination.

Unfortunately micronised progesterone is simply not potent enough to maintain amenorrhea in 100% of women.

[Tynkabelle]

…ooh I am having a similar issue albeit a lower amount - 100mg Utrogestan and Sandrena - suddenly started to have a bleed over the past 2 months which should not be happening
(25+ years taking HRT and only in my 50s - ovarian cancer and all that)

I did post a note in this forum but no one responded - I guess for me it will be to up the dose, but not sure what being on 200mg will do …
Just literally booked an appointment with my GP earlier to talk about it.

I would be interested to hear how you get on as by the looks of things I am just a little behind you…

[bombsh3ll]

Hi Tynkabelle,

I just wanted to point out that the advice for you would differ if you have been on your regimen for many years and suddenly started with new bleeding.

MSmile describes having irregular bleeding just since changing from sequential to continuous, which is almost always benign and related to the change in HRT.

You really do need a prompt appointment with your GP with a view to arranging a pelvic scan.

[Tynkabelle]

Many thanks bombsh3ll for your advice, will mention the scan at my appointment 👍

[MSmile]

 

First off you could try taking the utrogestan vaginally, and/or increasing the dose to 300mg if tolerated.

If this fails or is unsuitable then either a mirena IUS or an oral progestin such as desogestrel 150mcg, slynd, norethisterone or provera could be used.

Dydrogesterone is another good option but only available in oral combination.

Unfortunately micronised progesterone is simply not potent enough to maintain amenorrhea in 100% of women.

Thank you for your advice. I shall bear all that in mind for when I get referred. Hopefully the menopause clinic I’m referred to will know their stuff, the last one offered no advice really and my doctor won’t prescribe anything unless it’s in the nice guidelines and certainly nothing off licence unless it’s come from a specialist.

[MSmile]

The synthetic ones seem to be more effective than utro and a mirena is usually the most effective for problem bleeding. If you don't mind the bleeding you can stay on sequi though. They told me there is a slightly higher risk of endometrial cancer. I stayed on sequi as I don't get on with utro but a month ago I changed to a mirena. Had a week of heavy bleeding but now just the occasional dribble (age 64).

You did well to stay on sequi for that long. Hope it settles for you soon.

[MSmile]

Hi MSmile,
I am sitting in my GPs waiting room for exactly the same reason -
The utro worked great for me on sequi - 12 days of 200g & 1x pump gel then bleed  for 5 days -  but at 64 I don’t won’t a bleed anymore -
The breakthrough bleeding is a pain so Im wondering if I need a different progesterone 🤷‍♀️

It’s not great is it 🙁 How did you get on?

[patti]

Hi Msmile
Update …..myGP has recommended 1x pump Oestrogel plus 1x 100mg Utrogestan every night to be reviewed in 3 months - fingers crossed it will work out🤞

[patti]

Oh forgot- I take utro vaginally- always have done - works better for me that way 😊

[MSmile]

Hi Msmile
Update …..myGP has recommended 1x pump Oestrogel plus 1x 100mg Utrogestan every night to be reviewed in 3 months - fingers crossed it will work out🤞

Hope it works for you. My doc won’t prescribe utrogestan for vaginal use as it’s off licence.

[patti]

They’re the same tablets - just don’t put them in your mouth. 😃

I have coeliac disease so the less that goes through my stomach the better.
My GP has never prescribed them for vaginal use - I choose to take them that way - she’s aware of the way I take them and is ok with it .

Try it x