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[Winterangel]

Hi everyone, I’m new here and am hoping to share experiences with other ladies who understand.

I’m 57 and have been on continuous combined HRT (Estrogel and Utrogestan) for 7 years now. In that time I have had many episodes of unscheduled spotting or light bleeding. I have had three hysteroscopies, which have all been normal apart from the fact that I have a 15mm sub mucosal fibroid. The gynaecologist thinks that my fibroid and HRT are responsible for the bleeding but they offer no solution. I have seen doctors at Newson Health but they just seem to want to increase my estrogen. My GP just keeps referring me for ultrasounds, which show a ‘mass’ (fibroid) and a thickened womb lining, which then necessitates another hysteroscopy and I don’t want to keep having them.

I’m considering stopping my HRT as this is all so draining. Has anyone else taken HRT with fibroids at all?

Many thanks for reading!

[elle]

Hi Winterangel, sorry to hear of the loop you seem to be in with no solutions. I'm in a similar position so although I can't offer much in the way of advice I'm happy to share experience in case anything resonates or you can look into further with your healthcare team. I'm also 57 on continuous HRT for 2 years now (for chronic pain rather than typical meno symptoms) I have a number of fibroids, some 6cm and I bleed almost daily. Hyperplasia of 6.3cm. Had a hysteroscopy last week, lining smooth but they want to do a biopsy of fibroids which I wasn't able to do due to the pain. I had another biopsy done the previous month, again very painful where they removed polyps, all clear. After chatting to people here on the forum I have some very helpful suggestions to look into. I'm also thinking of reducing/stopping HRT but other options are trying sequential HRT as well as looking at alternatives to your current progesterone. You might want to discuss Tibolone, testosterone, DHEA and provera.  I can't have the coil fitted but that's maybe another possibility. I think for me the thinking is the same as you, that HRT and fibroids are causing the bleeding. It's frustrating that we can't do bloods that might indicate where the imbalance lies. I'll share any info I get along my journey and wish you well on yours!

[Winterangel]

Hi Elle, many thanks for your reply.
It’s a vicious cycle isn’t it? I can’t have the Mirena coil either as it wouldn’t fit. I will definitely look into those alternatives, thank you. Newson Health put me on Cyclogest for the progesterone part of my HRT but I didn’t get on well with it. The first time I had a hysteroscopy (2019) the gynaecologist advise me to change to sequential HRT, which I did for a while but the bleeding just got more out of control. I think that it will be a case of eventually having to stop the HRT but I really don’t want to. Thanks again. I’ll share any info with you too. Best of luck!

[joziel]

Winterangel, have you tried the version of things which is the 'old' continuous regime - where you stop the progesterone to allow a bleed? You don't stop it for as long as on sequential...

So for eg, whenever you next start to bleed, stop taking the utrogestan for 5-7 days to allow the bleed to happen. Count that first day of the bleed as day 1. On day 26, stop taking it again - for 5-7 days. So basically, you work with your body rather than against it. If your body has lining to shed but you are taking utrogestan, it can't do that properly or fully - so it doesn't shed it all and you get breakthrough random bleeding that worries everyone.

As well as that, you could increase the utrogestan if you tolerate it ok. In the UK, many women are not taking enough progesterone (this is all down to absorption). The progesterone tests available in the UK are not reliable when women take progesterone orally because they 'count' all the metabolites of progesterone as actual progesterone and come back with a falsely high reading. So doctors in the UK don't test progesterone or take it into account. Doctors in the US have the PC MS test for progesterone which IS reliable when you take it orally. We don't have that....

BUT - you can test reliably for progesterone if you take it vaginally or rectally. It's only if you take it orally that UK tests are not reliable.

As I'm on a high dose of estrogen, I wanted to be sure I was getting enough progesterone. So I switched to taking it vaginally. At first I took 300mg at night (sequentially) and then did bloods the next morning. My levels were pretty low. Only just creeping into the bottom of the range. Progesterone has a short half life, only 12 hours, so often levels will dip if you only take it once a day. So I added in 200mg in the mornings as well. That got my levels properly up into a decent luteal range. (Tested about 2 hours after my morning dose.)

So if I were you, I would try switching to taking it vaginally (which is also better absorbed than orally - you are getting it right where it needs to be, by the uterus, for maximum effect down there) and get some Randox home 'Tasso' tests (the Female Hormones test which you can take at home from your shoulder - not finger prick). The test is about £45. See what your levels are with it at night only and try to get an increase in dose if you can. As well as taking a break from it to allow the bleed to happen unopposed (which should also 'save' you some capsules to use the rest of the month at higher dose).

[Winterangel]

Many thanks for that very helpful reply Joziel. I really appreciate it.

When this first happened back in 2019 the gynaecologist told me to change to sequential to allow my womb lining to shed for ‘at least a year’. It was fine for about 8 months then the bleeding was just continuous so my GP put me back on continuous combined.

I’ve asked the specialist at Newson about going back on sequential but she didn’t seem keen and described it as pushing the problem further down the road rather than dealing with it. However, she’s been unable to ‘deal with it’.

I’ve tried upping my Utrogestan to 200mg and it just makes me bloated, depressed and miserable. I need a break! The doctors keep making me anxious about it all when it’s no different than it was the other 3 times they’ve investigated.

So, let me get it right; Oestrogel as normal daily then Utrogestan vaginally (I’ll try the 2 capsules and see if I can tolerate it better via that route) for 26 days a month with 5-7 days off. Is that right?! I’m spotting now (have been for the last 4 weeks 😩) so should I take the break from the Utrogestan now?

I’ll start straight away and will look for the tests you mentioned too. Thanks again, so much!

[joziel]

Newson are in favour of moving people to continuous as they stay on HRT longer. Personally, I'm not in favour of that - but seeing they don't know whether I'm taking the utrogestan at higher dose for half the month or lower dose over the full month, it doesn't really matter.

You might want to check out the YouTube videos of Dr Felice Gersh - specifically on 'estrogen dosing'. She is very much in favour of everyone staying on sequential and taking a good/decent dose of estrogen.

Yes, try taking the utrogestan vaginally and see if you can tolerate higher doses that way. If you can, you can dose twice a day as well. It doesn't get absorbed in the way which makes you sleepy when used vaginally, so it can be dosed in the morning to keep levels up as well.

It looks like: Day 1 is first day of bleed. Stop taking P and wait for bleed to finish (hopefully this is within a week). Day 7 resume P until day 26. Then stop taking P again and wait for bleed to start. (It can take about 5 days for the drop in P to trigger the bleed.) You might need to adjust that if you get random bleeding.

The other thought is whether your estrogen dose is actually high enough. Have you had bloods done? Everyone assumes that bleeding is due to too much estrogen or too little progesterone but actually too little estrogen can cause bleeding/spotting as well. It's as if there isn't enough estrogen to 'keep' the lining there or sustain things, so it keeps breaking down. If your bloods show a decent level, like 400+ then I doubt this is the cause. But if your bloods come back low, I would try increasing as you've tried everything else.

Lastly, do make sure to take iron as well if you are bleeding this much. Join The Iron Protocol group on Facebook and get your ferritin tested - make sure it's over 100. This can affect bleeding as well - many women who are iron deficient have heavy periods or bleed a lot and it's always been assumed they are losing blood, therefore they get low iron. But actually it can work the other way - low iron can cause you to bleed heavily as well. I know this because of the number of us who have had infusions or got ferritin up, and found they stop bleeding half as much as before....