Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[mmm]

I have been taking continuous HRT for around 11 months now (approx 4 years post menopausal started on HRT last year)- 1 pump Oestrogel and 100mg Utrogestan.  Took for 1 month and then had spotting and a couple of episodes of heavier bleeding.  I had not had any episodes of bleeding before taking HRT.   :-\After 6 months had referal by GP for TVS and as this was inconclusive due to either a clot or a Polyp then had Hysteroscopy.  Biopsy of both endometrium and polyp came back as clear and I went on to have the Medium Polyp removed 10 weeks ago again with a clear Biopsy.  I am still bleeding on and off.  Was advised after Polyp removal that if bleeding persisted then to either increase progesterone to 200mg daily or to have a Myrena Coil fitted.  I have upped my Utrogestan to 2 pills but kept my Oestrogel at 1 pump but am still bleeding after a couple of weeks of increase.  I really do not know what to do now and how long I should be giving things in the hope that they may settle down.  I would really prefer not to have a Myrena Coil fitted, especially as upping the Utrogestan has not helped thus far and I am bleeding more heavily atm.  I dont really want to take synthetic Progesterone either if at all possible.  All logic tells me that 200mg should be more than enough for the low dose of Oestrogel having looked at the recommendations.  Could it be possible that I am not absorbing either the Oestrogen or Progesterone component and this is throwing things off.  No-one has checked my levels of either so far.  I did ask when I had my Polyp removed whether it was possible that I needed less Progesterone and it might be thining my lining too much and that was why I was bleeding but this was dismissed and told that the BMS guidelines do not consider this.  I do also have some Vagirux that my GP initially gave me when I went to see her initially about HRT but havent tried as yet as wanted to know what might work and what doesnt and try things in a logical order - could this help?  My feeling is the bleeding is uterine and not vaginal.  I am feeling that the only other option is to cease HRT because I am fed up of bleeding!!!  Has anyone else had this experience and found a solution or can offer any advice please?  Not sure that my GP will be able to help much more.  I did try ringing the Gynae department at hospital that did all the investigation/Polyp removal to see if I hadnt given it long enough to recover from the removal and that was why i was bleeding.  Was told I needed to go to GP as more than 48 hours after procedure.  Only other option I can see is to have a private consultation but dont really feel like paying for consultation and tests again only to be told the same thing.

[bombsh3ll]

Do you know what your lining measured?

If it was very thin, it could be the case that more estrogen would help stabilise things.

You are on a very low dose of estrogen.

Whilst there is no such thing as too much progesterone over- thinning the lining (many women are routinely over treated with progesterone in order to make sure nobody gets endometrial cancer) there can be bleeding issues when very low doses of estrogen are used.

You have nothing to lose by experimenting, and a negative hysteroscopy is good for at least 6 months.

An alternative would be trying a cyclical regime so that whilst you may still bleed, this could be in a more predictable pattern.

There is also the option of tibolone which can work really well where traditional hormone therapy hasn't suited.

[mmm]

In the notes from the OPH (Out Patients Hysteroscopy???) appointment the comments were USS (Ultra Sound Scan???) 21 x 14mm ?clot or polyp, unable to assesss ET (endometrial thickness???).  This is the only reference I can find to endometrial thickness.  Possibly they were unable to assess this while the Polyp was present at the later appointments.  I got the impression that the Polyp as possibly larger than they had thought.  The follow up letter after the Myosure procedure certainly seems to suggest that they felt that the bleeding was due to the Polyp.

It also says that "it is important that you continue with vaginal estriol pesseries and/or cream regularly, even if you are not using systemic HRT".  My GP prescribed a small amount of this when I initially saw her about HRT "in the event that PO options did not improve vaginal symptoms adequately".  I have not used this as yet, maybe I should also give this a try in case this might improve the bleeding.  I was trying to be methodical and do things one at a time so that I knew what worked and what didn't.

So have only increased my progesterone for a few weeks now, how long should it take to take effect?  I dont want to leave it too long to try anything else as have six months and I had the Polyp removed on 25th February.  I waited before upping the Utrogestan as initially I was hopeful that this would solve the bleeding issue and put the bleeding down to the removal (I had read in another health authority's leaflet that with removal of a larger polyp you could bleed up to 6 weeks after).  The bleeding stopped for a couple of weeks so hoped that was that!

[Ebonybones]

This is exactly what has happened to me

Next step for me is to increase the Utro to 200mg but after you saying it didn’t work I’m not holding out much hope

So sick of bleeding

[mmm]

So sorry to hear you are struggling too.

I am not too sure how long it takes for any changes made to take effect, I may just not be giving it long enough.  I was really hoping that there would be someone here who has had a similar issue but that had found a solution.

Because bleeding comes and goes a bit keep hoping that it has stopped only to find it starts again.  Will give it a little while longer and then try upping the Oestrogel and/or using the Vagifem to see if that settles things any.

Please let me know how you are getting on and if you find something that works for you.

[bombsh3ll]

If you have vaginal atrophy, which is highly likely given the low dose of estrogen, then using the vaginal estrogen is a good idea.

Vaginal estrogen has negligible systemic absorption and generally has no bearing on uterine bleeding either way.

If you haven't already tried using the progesterone vaginally, this could also be tried as it provides more localised delivery to the uterus and can be more effective against bleeding.

[mmm]

Many thanks for your reply - that clears up something else - I wasn't sure if the Gynae at the hospital was suggesting that Vagifem etc might help with the Uterine bleeding in my case but sounds like she was suggesting that I used it for other symptoms.

Do you have any idea how quickly adding the extra 100mg of Utrogestan is likely to take effect with bleeding (if it does actually make any difference that is)?  I would like to give it a fair shot to see if it stops it before trying to add another pump of Oestrogel, otherwise, I am not likely to know what has solved the issue. 

I am not sure that I am comfortable with taking the higher dose of Utrogesten on a long term basis, if things stabilise/bleeding stops, would it be worth trying to reduce this to 100mg again after a couple of months to see what happens?

I haven't tried using the Utrogestan vaginally so that could be another option.  Wish it wasn't all so hit and miss and there was more follow-up by Gynaes rather than having to try to rely on GPs knowledge or try to research everything yourself!

[CLKD]

Vagifem or other atrophy products should not affect bleeding.  If the vaginal walls are very thin and fragile, one might notice blood when we wipe which will improve with appropriate treatment.

[Ebonybones]

I will do, I had my hysteroscopy last November 24 and they removed a 1cm poly, I still bled so thought my Evorel 25mg patch may have been too low causing me breakthrough bleeding so in December 24 I changed to the 50mg patch and stayed on the same Utrogestan dosage of 100

Still bleeding once a month for 7-9 days so I was going to give it until June as they say it can take 6 months after starting hrt or changing the regime but I’ve had enough the hospital won’t speak to me as it’s been more than 3 months since I’ve seen them, they need my dr to refer me back just to discuss increasing progesterone

So sorry to hear you are struggling too.

I am not too sure how long it takes for any changes made to take effect, I may just not be giving it long enough.  I was really hoping that there would be someone here who has had a similar issue but that had found a solution.

Because bleeding comes and goes a bit keep hoping that it has stopped only to find it starts again.  Will give it a little while longer and then try upping the Oestrogel and/or using the Vagifem to see if that settles things any.

Please let me know how you are getting on and if you find something that works for you.

[mmm]

Thought I would update and see if there is any further input.

Upped the Utrogestan to 2x tablets (200mg total) around end of April as per suggestion (by hospital) if still bleeding after Polyp removal and I still have bleeding, have tried going from 1 pump to 2 pumps of Oestrogel, still bleeding.  Keep thinking it has settled but then it returns!  TBH not sure that it has improved things at all.

I haven't tried taking the Utrogestan vaginally yet, this may be my next "experiment".  If I do am wondering whether to do this with 2x tablets or just one?

Spoke to someone via video at Peppy Health through service at health insurance company (think this is the only service they offer for menopause though).  She suggested Myrena Coil, Provara or Evorel Conti Patch as other things that I could ask the doctor to try.  I have been really trying to make the non-synthetic plrogesterone work for me but think I am fighting a losing battle.  I may just have to stop HRT full stop as I am at the end of my tether with it.  It just seems that whatever I try with Oestrogel /Utrogestan I cannot get them to balance.  I really do not want to have to go back and have all the investigations again and would prefer not to have to use synthetic progesterone.  I would be more likely to consider it if none-oral but don't want really want a Mirena as will find the insertion/removal tricky and if I react badly to it I will be stuck with it for a while.  I am running out of my 6 months time period as had Polyp procedure in February.

Can anyone offer any further advice or experience of having bleeding issues with HRT and how they have resolved them?  I see lots of posts on these forums of people who seem to also have bleeding issues with the Evorel Conti Patch.

Ebonybones have you managed to resolve your isssues or are you still in a similar situation?

[Violetta808]

I have experienced similar. The constant bleeding is really miserable, I know, but don’t give up - there are other options you can try. It’s not one size fits all.

I understand your reluctance to try synthetic progestogen (I was the same) but a gynaecologist explained to me that although utrogestan is body identical it’s not very stable so the levels in the body really fluctuate - and technically it’s still synthetic as the only natural hormones are the ones produced in our bodies. That made sense!

First I would try some different combinations of oestrogen/progestogen and consider the Mirena iud which works very well for a lot of women.

That said, I tried the various combos myself and was still bleeding (and they couldn’t fit a Mirena due to fibroids) so I have ended up on Tibolone (prescribed by a hospital gynaecologist) which is an entirely synthetic steroid taken as a daily pill. And it’s been brilliant for me - I’ve been on it 15 months with no side effects and no bleeding and I feel ‘normal’ again.

GPs see it as old fashioned and don’t prescribe it often but from my personal experience it’s been exactly what I need.

[Ebonybones]

I didn’t bleed for 45 days and thought great it’s gone, then 2 days ago bleeding again, the dr has spoken to the consultant who said I can increase the Utrogestan to 200mg but If I’m still bleeding on that after 6 months it’s back to gynaecology

I can’t even be bothered to increase it I shouldn’t need 200mg with a 50mg Evorel patch

Thought I would update and see if there is any further input.

Upped the Utrogestan to 2x tablets (200mg total) around end of April as per suggestion (by hospital) if still bleeding after Polyp removal and I still have bleeding, have tried going from 1 pump to 2 pumps of Oestrogel, still bleeding.  Keep thinking it has settled but then it returns!  TBH not sure that it has improved things at all.

I haven't tried taking the Utrogestan vaginally yet, this may be my next "experiment".  If I do am wondering whether to do this with 2x tablets or just one?

Spoke to someone via video at Peppy Health through service at health insurance company (think this is the only service they offer for menopause though).  She suggested Myrena Coil, Provara or Evorel Conti Patch as other things that I could ask the doctor to try.  I have been really trying to make the non-synthetic plrogesterone work for me but think I am fighting a losing battle.  I may just have to stop HRT full stop as I am at the end of my tether with it.  It just seems that whatever I try with Oestrogel /Utrogestan I cannot get them to balance.  I really do not want to have to go back and have all the investigations again and would prefer not to have to use synthetic progesterone.  I would be more likely to consider it if none-oral but don't want really want a Mirena as will find the insertion/removal tricky and if I react badly to it I will be stuck with it for a while.  I am running out of my 6 months time period as had Polyp procedure in February.

Can anyone offer any further advice or experience of having bleeding issues with HRT and how they have resolved them?  I see lots of posts on these forums of people who seem to also have bleeding issues with the Evorel Conti Patch.

Ebonybones have you managed to resolve your isssues or are you still in a similar situation?

[mmm]

Thats kinda how I feel, 2x Utrogestan tablets seems a lot for 1 measly squirt of Oestrogel when I have been menopausal for quite some time!  Going to give the increased amount a little longer to work but if I get another lot of bleeding then it will be back to doctors for a change as I can only assume that for one reason or another, Utrogestan will never work for me.  Will see if they will check my blood levels to see what I am absorbing, although I dont think they like doing this.  Think I will ask to try the patches, at least then I will have given a synthetic version of progesterone a try, they do think that it is better at controlling bleeding.  I know that the Mirena Coil is the prefered route (probably as it is long term and done and dusted in one hit and there may be some financial incentive also).  I am still not keen on the Mirena for various reasons (pretty sure that insertion will be painful as have never had children, have a tilted uterus and find smears difficult, if I dont get on with it I will probably have to wait to have it removed and I dont really like the idea of the more synthetic Progesterone and heard horror stories of them migrating).  Unfortunately I think that this (or a hysterectomy) is probably the only way I am going to be able to take HRT.  If I end up having to have another lot of investigations then it would seem like a more logical time to have a coil fitted anyway, at least I only have the discomfort once!  If it comes to that I may just go "cold turkey" stop everything and see what happens - if I still bleed then I know that it is not the HRT.  Hopefully I would be past the hot flushes etc but I would like to continue if at all possible for all the other health benefits that HRT potentially brings.

[che]

Thought I would update and see if there is any further input.

Upped the Utrogestan to 2x tablets (200mg total) around end of April as per suggestion (by hospital) if still bleeding after Polyp removal and I still have bleeding, have tried going from 1 pump to 2 pumps of Oestrogel, still bleeding.  Keep thinking it has settled but then it returns!  TBH not sure that it has improved things at all.

I haven't tried taking the Utrogestan vaginally yet, this may be my next "experiment".  If I do am wondering whether to do this with 2x tablets or just one?

Spoke to someone via video at Peppy Health through service at health insurance company (think this is the only service they offer for menopause though).  She suggested Myrena Coil, Provara or Evorel Conti Patch as other things that I could ask the doctor to try.  I have been really trying to make the non-synthetic plrogesterone work for me but think I am fighting a losing battle.  I may just have to stop HRT full stop as I am at the end of my tether with it.  It just seems that whatever I try with Oestrogel /Utrogestan I cannot get them to balance.  I really do not want to have to go back and have all the investigations again and would prefer not to have to use synthetic progesterone.  I would be more likely to consider it if none-oral but don't want really want a Mirena as will find the insertion/removal tricky and if I react badly to it I will be stuck with it for a while.  I am running out of my 6 months time period as had Polyp procedure in February.

Can anyone offer any further advice or experience of having bleeding issues with HRT and how they have resolved them?  I see lots of posts on these forums of people who seem to also have bleeding issues with the Evorel Conti Patch.

Ebonybones have you managed to resolve your isssues or are you still in a similar situation?

I have been on EC patches for just over 2 years, i bleed after about 8 months and was sent for a hyso, the gp never ollowed the hospital advice and around 14 month  later bleed again ( on wipe only ) took my patch off for 5 days, as gp has told me prior ( hospital said never do that. Sent for another hysto and they have again recommended extra progestrone and gp has said see if you bleeed again, so i said seep you in  around 14 months as i predict it will happen again.   ( prob time for a new gp i know )

[Ebonybones]

Bleeding yet again starts off brown then goes to light red after 2 days it’s like a period lasts 5-7 days and I’m having this happen monthly apart from the 45 days I had with no bleeding

I have trouble swallowing capsules as it is so don’t want to change to 2

I don’t want to ask the dr to change me to provera as that gave me bad headaches

I think I’ll just put up with it

The hysteroscopy was clear apart from the poly they removed

Maybe I’m still having periods 🤷‍♀️