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[Ebonybones]

To update the sweating is very minimal now and I’m finding 5mg is the perfect dose for me now it’s settled down

I haven’t had a bleed for 34 days ! Which is a long time for me

[mmm]

So to update. 

Have had some bleeding (less than on prevous HRT) on the Evorel Conti patches.  Had my call from The Menopause Clinic (this was originally scheduled for well into the new year but has been brought forward on a couple of occassions, presumably due to cancellations :-).  I will need to have another TVUS (hopefully not another Hysteroscopy).  Suggestions for HRT going forward are as follows:

Oestrogen only patch, Oestrogel, Sandrina or Lenzetto Spray -  suggested Lenzetto or Patch with Dydrogesterone, Medroxyprogesterone or Myrena IUD.  Will not offer oral options due to age/weight.

Suggested possiblytrying Lenzetto and Dydrogesterone (if available) or Myrena if I am happy to have a coil fitted.  Any suggestions/experiences/recommendations of these combinations?

I think posts are getting a bit lost on this thread now so may also re-post seperately but as I started the thread I wanted to update.

[bombsh3ll]

That's great your consultation was brought forward.

As you have relative contraindications to oral estradiol I would go for the patches rather than the gel.

They provide a more stable and reliable delivery, you don't have to wait for it to dry, it doesn't rub off onto clothes bedding pets etc and it is less restrictive in terms of planning activities around it although I didn't love the twice weekly showers, the adhesive dressings I had to buy to stick over the top or the dirty square marks they left when I used them for IVF.

Patches also permit plasma estradiol to be measured if this is important to you whereas the pharmacokinetics of gel make blood tests for estradiol meaningless.

I would take dydrogesterone over medroxyprogesterone acetate even if I had to self fund it because it is less metabolically unfavorable, however both are good safe treatments that provide effective endometrial protection.

[mmm]

Many thanks for your reply anything you are able to add on below would be very useful!

I have found the Evorel Conti patches very convienient (apart from the horrible black marks they leave behind) however, my GP tested my blood levels and they were below 80, so she tested again a few weeks later with the same result.  I dont know whether I had higher levels when I was on the Oestrogel/Utrogesterone as this was never tested and bleeding was always assumed to be a result of the Oestrogen.  GP then suggested using 1 pump of the Oestrogel to supplement the Evorel but I bled again after around 3 weeks (which may or may not be related) so stopped adding the Oestrogel.  I did also post blood test start to put patches on abdomen rather than buttocks.  I now cannot be sure if the Oestrogen in the patches is absorbing or not and whether any other patch would be any better. 

The other thing that I had started to use after I tried and stopped adding 1 pump of Oestrogel to the Evorel was Vagirux but completed the two weeks of one a day and got maybe a week further and started to bleed again and so discontinued this but again it may have been completely coincidental!

The Menopause Clinic stated that bloods were not useful and they go on symptoms so I dont think I will be offered another blood test but they do want me to have another TV Scan.  The last one I had didnt really tell anything about the lining as I had what turned out to be a reasonable sized polyp so maybe I will get more information this time.  I also had a hysteroscopy and then seperate procedure to remove polyp all at the beginning of the year.  Both biopsies of polyp and endometrium came back clear but I can find no comment on the thickness of the lining.   

I dont know what to do or in which order.  Thinking possibly continue on the Evorel Conti until I get TVS.  At least hopefully we can rule in or out a thickened lining and it may give a better idea of the way forwards.  However, if not thickened and I then change HRT afterwards and bleed again I will not know if the new HRT has thickened it subsequently.  Also wonder if I should be considering a Myrena Coil (not something I wanted but all the heathcare professionals seem to love them and feel that they solve bleeding well).

I guess my choices are stop HRT, give it a few months and see what happens, if I dont bleed then it's definately the HRT that is making me bleed
Stay on the Evorel Conti until I have TVS and then decide on which HRT to change to of options below
Change to Oestrogel, Sandrina, Lenzetto or Patches and Dydrogesterone now or after TVS
Change to Oestrogel, Sandrina or Lenzetto or Patches and have a coil fitted now or after TVS

Sorry this is such a long post, any further thoughts/considerations appreciated on Mirena vs Dydrogesterone, absorption of gels, sprays, patches and what the best order of events might be?  I am so frustrated as it has been best part of a year and a half and I don't seem to have made much positive progress in this time!