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[saz42]

I'm hoping someone can help me with this before I go to my doctor as I want to go into the appointment with a better knowledge of what's possible.

I've been on HRT for about 4 years now.  I've bled heavily on every version I've tried so far (ferritin down to 5 last year) & have finally settled through experimentation on 25 Evorel & 200mg Utrogestan for 14 days out of 28.  This gives me a light bleed for about 1 week out of 4 which is far better than the heavy flooding I get on a higher estrogen dose.  This regime gets rid of my main symptom of night sweats & has helped to a certain extent with my disrupted sleep.  However, other symptoms are still there - itchy skin, brain fog, low moods, cramps in my legs and very sore joints. 

I'm going to see my doctor to see if I can go on a continuous regime yet (last had regular (non HRT) periods in 2019) and to see if I could try a different balance of HRT which would keep my bleeding down AND reduce all my symptoms. 

Any ideas of what I could suggest?

Thanks in advance.

[bombsh3ll]

I would opt for either a mirena IUS or 150mcg desogestrel daily (2*75mcg cerazette pills) alongside your estrogen of choice.

Nobody has to put up with unwanted vaginal bleeding whether menstruation or iatrogenic.

We have had the tools to eradicate this for decades and over 95% of women can achieve complete or almost complete amenorrhea with non-surgical treatment.

[saz42]

Thanks for your quick reply!  I've never even heard of desogestrel - so I wouldn't have even known to ask for it.  I'll do some reading up.

Sadly I don't think a mirena would be a good option for me.  I've had several hysteroscopies over the last few years that have been pretty horrific.  Two have totally failed to even get into my uterus to get a biopsy and the last successful one took 2 hours (under GA thankfully).  One consultant gynae described my uterus as 'awkward'.  The idea of getting a mirena inserted just fills me with horror! 

[bombsh3ll]

Then definitely look into double dose desogestrel every day.

This can even be bought over the counter if you say it's for contraception.

It's use within HRT is off licence but supported by the BMS.

If your GP won't prescribe this and you can't source it yourself, provera 5mg daily is also likely to get you bleed free - this can be increased to 10mg if needed.

This is an older progestin, slightly less metabolically favourable than newer options but still extremely safe and useful.

[saz42]

Thanks again for your help.  I finally got an appointment with the nurse earlier this month - she spent ages with me and agreed that utrogestran wasn't working for me and was really sympathetic about my bleeding problems.  However, we left the appointment with her saying she would consult with a doctor & would get back to me.  When she rang back, the doctor had decided that I should just switch to continuous utrogestran (one tablet daily) & I should stay on the 25 evorel patch for now until the bleeding is sorted.  I'm pretty sure this won't work as I seem to be resistant to the utrogestran.  If I'm bleeding on 2 tablets for several days of the month, then dropping to one, even continuous isn't going to work either.  I mentioned the mini pill to her, but she didn't seem keen.

I've said I will give it a go, but I'm already bleeding after just a week.  I know I need to give it time to settle down, but wondering how long I'm going to have to bleed for before they switch me to something else!  I'm determined to get this sorted now!

[sheila99]

Perhaps make an appointment with the gp so you can explain the issues a bit more forcefully than the nurse? Norethisterone is licensed for hrt now so the gp can prescribe it, it's more effective than utro for preventing bleeding. Might also be worth asking if they can refer you to a specialist for a mirena. Gp couldn't get mine in because the cervix wouldn't open but the specialist could. No bleeding after the first 6weeks and it's sorted now for 4 years. A mirena is usually the most effective option for problem bleeding.

[saz42]

Thanks @sheila99 - sadly, as you can see up thread, I don't think that a mirena would work for me.  Also, I'm not sure norethisterone would work either as I think it is in Evorel Sequi?  I bled so much on that my ferritin ended up at 5.3 & I was barely functioning.  I'm just going to keep on at them I think.

[bombsh3ll]

You can buy desogestrel from pharmacies if you are up to age 55 and say it is for contraception.

I would ask for a referral to your local NHS menopause clinic as well on the grounds of both uncontrolled bleeding and a subtherapeutic dose of estrogen.

Alternatively if you have the resources it might be worth going private to get the help you need.

mymenopausecentre.com are supportive of using desogestrel 150mcg as the progestin and can also increase your estrogen above 25mcg, which should more effectively treat your symptoms.

[Mary G]

saz42, that doesn't sound terribly helpful because it's not really addressing your bleeding problem or the fact that your oestrogen dose is only doing the barest minimum in terms of symptom control.

It sounds like you need a higher dose of oestrogen and a different progesterone.  I agree with bomb about trying desogestrel.  Based on information I helpfully got on here, I've been using it myself for some time now and I have found it to be free of side effects unlike other forms of progesterone I have tried in the past, Utrogestan being one of them.  I'm on two pumps of Oestrogel and I only take 75mcg Cerazette (desogestrel) every day alongside progesterone gel and it's worked extremely well with no breakthrough bleeding.  This might not work for everyone but it does suggest that desogestrel is good at controlling the womb lining and bleeding. 

With your history of problem bleeding the double dose of 150mcg every day would probably work well.  It might be worth getting hold of some Cerazette from the pharmacy and if the bleeding stops, doubling up on patches.

[saz42]

Thanks guys, this is all so helpful and confirms my suspicions that this isn't the right course of action for me. The nurse was keen to refer me on to a specialist, but the GP must have shot her down unfortunately. I don't know if I'll be able to get hold of some desogestrel as I'm 55, but I'll do some research. At least I'm better armed with some options when I go back to say it isn't working. Thanks souch - I'll let you know how I get on.