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[rachelp]

I’m 56 and have been struggling over the past two years with breakthrough bleeding - I have been on HRT for nearly 10 years and the first seven on Evorel conti patches with v few problems or bleeding which was wonderful. About two years ago I seemed to stop absorbing so GP tried oestrogel and a mirena, annoyingly the bleeding never really settled over 6 months so we changed to 2.5 Sandrena gel sachets. Again the bleeding didn’t settle so mirena which was lying too low was removed, and I’m now trying 100 mg progesterone daily plus Evorel 50. After 2 weeks hot flushes returned, bad sleeping and real bleeding not just breakthrough - not used a tampon for nearly ten years🙄 Increased Evorel to a patch and a half as had been suggested if symptoms returned and after 3 weeks am again bleeding after SI, having hot flushes and feeling jittery and fed up - have been on the new regime 7 weeks and don’t understand the full on bleeding and return of symptoms, especially as literally the other day I was finally thinking I may have got it sorted. Due to see the Consultant in July to report back with symptoms diary. Just v fed up with it all, and could do with a magic wand, or just someone else’s take on my system - I have always been a steady weight, generally steady Eddie and don’t get why things won’t settle!
Sorry for moaning, I know a lot far worse things go on in the world.

[bombsh3ll]

I am assuming you have had a normal scan and your cervical screening is up to date.

Estrogen should primarily be titrated to your needs, and then the progestogen adjusted to control the endometrium.

So firstly I would get on a therapeutic dose of estrogen. Additionally low estrogen can also cause an unstable lining, so sometimes increasing this can stabilise things.

Secondly do you have vaginal atrophy? Bleeding after intercourse suggest this, and it can also present as spotting generally.

Coming onto the progestogen, you could try taking your existing dose of micronised progesterone vaginally. This delivers a more concentrated amount to the uterus vs oral, which is largely converted to other metabolites before reaching the circulation.

Alternatively you could increase to 200 mg, or if you previously did well on the combined patch, you could take the same progestin, norethisterone, orally.

[rachelp]

Thank you, Bombshell for your thoughts - all up to date with screening and scans.
 Came off Blissel gel and ovestin in January when had mirena removed and put on 100 utrogestan plus 2.5 mg Sandrena - had had recurrent thrush not helped by awful Blissel stuff (should have stayed with vagirux)
 The Gynae I saw in April said to start again so recommended changing to Evorel 50 with the utrogestan 100 and didn’t think I needed vagirux or ovestin as she said the HRT should be sufficient. I thought I’d try her regime and see, tho, as mentioned upped the 50 Evorel to 75.
 So you literally pop the utrogestan capsule into the vagina rather than swallowing it, and does that have to be at night? Also would you then pop a vagirux up at the same time?
Hope to get another gynae appointment in July to see how things are as maybe I need more oestrogen to stop the bleeding? Quite difficult to know when you keep seeing different Medics!

[rachelp]

Seriously 😳  more bleeding, only stopped on 27 May! Grrrr

[rachelp]

Apologies for venting, it’s just v v annoying especially as I woke up about 6.00 with a definite warm flush! Don’t feel HRT is doing me any favours atm 🙁

[Julie Warner]

I'm weaning off HRT due to the bleeding. Its SO annoying

[bombsh3ll]

It's such a shame and so avoidable that anyone feels like they have to give up hormone therapy due to bleeding - this should be a never event.

Amenorrhea, or almost complete amenorrhea, can be achieved non surgically in upwards of 95% of women in the hands of a skilled clinician.

[rachelp]

I just need to find that elusive skilled clinician!

[Winterangel]

Hi Rachel. I’m sorry to read all this.
I’m in exactly the same boat. I’m 57, have been on HRT (Oestrogel & Utrogestan) for about 7-8 years and having unscheduled, uncontrollable bleeding. Previous scans/hysteroscopies have shown that I have a sub-mucosal fibroid but, as it is quite small, the gynaecologist wasn’t sure that it alone was responsible for my bleeding and advised that I change my HRT regime. I have tried so many different types and doses of HRT but am still here today bleeding again!
Like you, I’m at the end of my tether and am currently taking a break from my HRT to see if it makes a difference.
Unfortunately I don’t have any answers either but please know that you’re not alone in this. We can support each other!

[rachelp]

Thank you, Winterangel, this forum is so helpful and supportive, I just wish I could get this sorted as it was all so good for about 7 years!🙏🏻