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[Bungo]

Had been spotting even before started hrt, am sure am post menopause. Sonce increased patches, bleeding more and heavier. Ultrasound showed womb lining of 5mm. I increased utrogestan myself last week to 200mg continuously and I'm happy with this . But still spotting.  Should i stop utrogestan entirely for a week just to shed whatever lining is there and then cross fingers that the 200mg will stop lining from growing again? I really dont want to decrease my patch from 75mg as want the most oestrogen i can get for my bones, and im mostly feeling better on it. My GP doesnt have a clue,shes just going to push the coil

[sheila99]

Did the scan show any other cause for the spotting such as polyps or fibroids? Are you up to date with smears? Are they sending you for a hysteroscopy? What was the pre hrt spotting like? Pale pink or bright red? Sorry for all the questions it's that I think it's a bit worrying particularly as you were spotting before hrt. I don't think your lining is thick enough to be too concerning, some say 4mm, others say 5mm is fine on hrt.
Stopping utro should trigger a bleed so would be worth doing anyway but I'm not completely convinced the thickness of the lining is the problem. How certain are you you're post meno? Being peri on a conti regime could be an explanation for it.

[Bungo]

I had hysteroscopy almost 2 years ago as had been spotting  for a few years at that stage even pre hrt. I have multiple small fibroids,largest is 4.5cm and gynae wasnt inclined to do anything  with them as the spotting didnt bother me. Lining was thin in that hysterscopy as I wasnt absorbing the gel. Bleeding is definitely heavier since i increased patch 5 months ago.  Blood is red and very occasionally some brown discharge at the end of the bleeding. Im 55 so assuming am post. Im thinking of asking GP for another ultrasound to check lining and then if  over 5mm, get a hysteroscopy . Id like to stay on the 200mg utrogestan and feel my sleep is deeper and its early days but i think im better on it. Thanks Sheila

[bombsh3ll]

Sometimes micronised progesterone is simply not strong enough to control the endometrium and a synthetic progestin is required - these can be taken orally, you don't have to have the IUS.

However if you only increased to 200mg utrogestan last week I would give it at least 3 months.

You could also try having a 3-5 day break every month for a withdrawal bleed.

Oral micronised progesterone can help with sleep but for bleed control some find taking it vaginally more effective, or with 200mg you could even do one of each.

I would give the increased progesterone chance to work before rushing to get another scan as this could lead to unnecessary invasive investigation and/or pressure to come off treatment.

[Taz2]

Hi Bungo. Some women are not post meno by 55 so you might not be. When was your last natural period?

Taz.

[Bungo]

My GP said to try the 200mg utrogestan and then follow up hysteroscopy in January. Am just hoping that the lining is thinner at that stage. I dont hold out much hope of the spotting stopping as thats happened even before the hrt. Maybe ill need to get the fibroids sorted to avoid unnecessary scans down the line.
Ive no idea if am post meno as periods went straight into continuouse hrt ( my choice) 3 years ago and have been having irregular spotting, days with heavier bleeding etc but no pattern. My own oestrogen level was 275 in May 2022 before i started hrt so i was peri then

[sheila99]

Can you get them to remove the fibroids at the same time as that might cure it? The other thing you might try is the 25/28 routine. It allows a bleed if there's been a build up and would be easier to manage if you know when you'll bleed.

[Bungo]

I dont know why they didnt dp anything about the fibroids at previous hysteroscopy 2 years ago, maybe theyre  in a place where not easy to remove.  The bleeding doesnt bother me really. Id live with it as side effect for rest of my life except for the fact it might be due to thickened lining and the fact that need investigated

[Mary G]

Bungo, you could try adding in some Cerazette.  It's a synthetic progesterone but it's very safe, side effect free (in my case at least) and It's very good at controlling bleeding and keeping the womb lining thin.

You can buy it over the counter without a prescription.  You could add one 75mcg tablet with 100mg Utrogestan or ditch the Utrogestan altogether in which case you would probably need 2 x 75mcg Cerazette although I don't personally need that high a dose, probably because my progesterone gel is very good.

Thanks to helpful information on here, I've been using 75mcg Cerazette every day myself alongside my progesterone gel for several months now and I really like it.  I think Utrogestan has too many side effects and a lot of women struggle to control their bleeds with it.  I was using progesterone gel and Cyclogest but I'm finding Cerazette more user friendly than Cyclogest.

I'm always prepared to try new things!

[Taz2]

I didn't realise you could buy cerazette without a prescription now?

Taz x

[Mary G]

I'm pretty sure you can buy Cerazette over the counter in the UK because it's a conceptive pill so presumably medics don't want to discourage people from taking it.  I can certainly buy it very easily in Spain.

[joziel]

I would first try stopping the utrogestan for about 5+ days to start a shed. You may find it takes a few days to get going (it takes me 5 days after stopping it, before I start to bleed and then I stay off it for another 4-5 days until it's done - to let it all come out).

The thing is (I keep trying to explain this)... HRT was designed with tiny pathetic doses of estrogen to offset the worst symptoms. That kind of dose, is unlikely to give you the best health benefits with bone and cardio protection, dementia reduction and all the rest. It just keeps hot flushes away. When you take a tiny low dose of estrogen and a generous whack of progesterone (which is the standard HRT deal), you won't get much uterine lining build up at all and can go onto continuous progesterone and never bleed in post-menopause.

But if you take enough estrogen to see all the health benefits from it (serum levels around 500-600pmol), you are unlikely to not be bleeding. Because estrogen acts throughout the body to cause (for eg) bone to build up, skin cells to turn over and renew - it is growth proliferative, in other words - and it's not going to only do that to your bones and your skin and brain and heart - it's going to do it to you endometrium as well. And what builds up, must come out.

So if you take sufficient E, you are likely to need to have an outlet for the build up even in post-menopause. If you don't schedule a bleed, it will happen randomly and unpredictably and alarm doctors and see you referred for hysteroscopies and biopsies. If you schedule it and it only happens when you stop P, then no one minds.

Unfortunately mainstream health care hasn't quite caught onto this yet and seems to be caught up in the fantasy that women should be able to take decent doses of estrogen in post-menopause and expect not to bleed if they take P continuously. That doesn't make biological sense.

[Bungo]

Thanks joziel, that makes sense re doctors not being worried if bleed when take a break from utrogestan( even if post menopausal).  I like the utrogestan though and the sleep benefits, not too happy about having to take a break of 10 days every month to allow the shedding to occur. Its an option for a years time though if find the lining is growing and gp is trying to get me to reduce oestrogen.  I was on cerazette for years and am reluctant to take it for the rest of my life, especially without knowledge of my gp but again its an option for down the line

[Mary G]

Excellent post joziel.

What you say makes complete sense and it was borne out by a menopause specialist I consulted and a gynaecologist.  The general consensus is that it you don't take enough progesterone on a continuous regime, you will simply bleed out at unscheduled times when your womb living gets to 8mm or more. This is not dangerous bleeding that needs investigating via a hysteroscopy, it's womb lining build up that will shed properly because you have been taking progesterone continuously.  Basically it's the progesterone doing its job of regulating the womb lining and keeping it thin.  Obviously it's a good idea to have a yearly transvaginal scan.

If you never take progesterone that is a problem and you will have watery breakthrough bleeding or extensive womb lining build up.

I don't quite understand why the NHS can't get their heads around this straightforward concept.

[Zara24]

I’m post menopausal, 67. My womb lining is 5mm and they are doing a hysterostomy to get an endometrial biopsy and check for polyps. Gynaecologist said 5mm was criteria for biopsy. Very interesting to read of people finding Utrogestan not controlling bleeds. Previously I was on Evorel Conti for ten years, never bled. Then changed to Evorel 50 and 100g Utrogestan. Had bleeding last year after six months on new regime so had, hysterostomy , lining 5.7 mm and polyp removed. Now it’s happened again. Think I’ll try and go back to the synthetic in Evorel Conti as that suited. They offered me a Mirena coil but I have to have hysterostomy under GA and couldn’t tolerate cervical Pipette biopsy so I can’t see my getting on with coils insertion and removal.