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[EllieJ]

I'm feeling a bit confused about when I should go back to the GP.

I had a hysteroscopy and biopsy on 10th December 2024 after experiencing regular bleeding while on Evorel Conti. Thankfully, both tests came back clear. My HRT was then changed on 29th April 2025 to Evorel 50 patches, Vagifem twice a week, and 200mg of micronised progesterone daily in an attempt to control the bleeding.

After an intial few days of bleeding all seemed to settle, but now I’m getting what seems like a proper period bleed — I need to wear a pad, have sore boobs, and period-type pains. I remember being told that if bleeding continues for 6 months after a clear hysteroscopy and biopsy, I should be referred again for further checks. That really worries me, as the hysteroscopy was traumatic.

At the same time, I’ve read (Dr Louise Newson) that it can take the body up to 6 months to adjust to a change in HRT, and that bleeding during this time isn’t unusual. However I've also been told that these side effects should only last for THREE months after switching HRT types.

So now I don’t know what’s normal or when I should be concerned. My anxiety is building again, and we’re going on holiday next week — I really don’t want this to overshadow it for my family. After ten weeks on a new HRT regime is it too early for going back to the GP? Sorry to be a pain, but I would appreciate some advice.

[Zara24]

Just wanted to say you can request a hysteroscopy to be done under a general anaesthetic. I’ve had similar experience but the other way round. I was on Evorel Conti with no problems then switched to Evorel 50 plus 100g Utrogestan. I had vaginal bleeding six months later, a traumatic hysteroscopy then a GA to take biopsy and remove polyp. All clear but now a year later, it’s happened again. I’ve had the scan and am booked to have the hysteoscopy under GA , biopsy and possible polyp removal. I’ve now changed this weekend back to Evorel Conti.
I guess everyone reacts differently. It might well be worth going back to the GP and getting a referral to a specialist.  Know it’s horrible having to be tested again but insist that the hysteroscopy needs to be done under GA. The hospital were absolutely fine with me when I asked for it because of my experiences last year.

[EllieJ]

Just wanted to say you can request a hysteroscopy to be done under a general anaesthetic. I’ve had similar experience but the other way round. I was on Evorel Conti with no problems then switched to Evorel 50 plus 100g Utrogestan. I had vaginal bleeding six months later, a traumatic hysteroscopy then a GA to take biopsy and remove polyp. All clear but now a year later, it’s happened again. I’ve had the scan and am booked to have the hysteoscopy under GA , biopsy and possible polyp removal. I’ve now changed this weekend back to Evorel Conti.
I guess everyone reacts differently. It might well be worth going back to the GP and getting a referral to a specialist.  Know it’s horrible having to be tested again but insist that the hysteroscopy needs to be done under GA. The hospital were absolutely fine with me when I asked for it because of my experiences last year.

Thank you for commenting. I am hoping the bleeding will settle soon - to be honest I am getting so fed up with all the worrying I've done over the past year or so with bleeding on and off - I resisted HRT but went on it finally due to the very negative effects menopause was having on my mental health.  I am now seriously considering coming off it altogether and taking my chance.

[Zara24]

I know how you feel. If it happens again to me then I will stop it too. I can’t be going for a GA each year. This time around I let him try to take a cervical biopsy but wish I hadn’t as it was extremely painful and he had to give up. I am wondering about going privately in 3-6 months to get the lining scanned to see if it’s behaving or not. Maybe there’s other ways to address your mental health if HRT isn’t for you. I have a friend who can’t take HRT because she had breast cancer, but she was given Prozac to deal with menopause instead. I hope your bleeding stops soon. Today I saw the nurse for my preop assessment and she recognised me from last year. She said to me are you still on HRT, it’s probably that. Just hoping changing the regime sorts it out.

[CLKD]

No lady should be expected to undergo any invasive procedures without a GA or sedation.  Our bodies.  Our choice!

[Dandelion]

I'm feeling a bit confused about when I should go back to the GP.

I had a hysteroscopy and biopsy on 10th December 2024 after experiencing regular bleeding while on Evorel Conti. Thankfully, both tests came back clear. My HRT was then changed on 29th April 2025 to Evorel 50 patches, Vagifem twice a week, and 200mg of micronised progesterone daily in an attempt to control the bleeding.

After an intial few days of bleeding all seemed to settle, but now I’m getting what seems like a proper period bleed — I need to wear a pad, have sore boobs, and period-type pains. I remember being told that if bleeding continues for 6 months after a clear hysteroscopy and biopsy, I should be referred again for further checks. That really worries me, as the hysteroscopy was traumatic.

At the same time, I’ve read (Dr Louise Newson) that it can take the body up to 6 months to adjust to a change in HRT, and that bleeding during this time isn’t unusual. However I've also been told that these side effects should only last for THREE months after switching HRT types.

So now I don’t know what’s normal or when I should be concerned. My anxiety is building again, and we’re going on holiday next week — I really don’t want this to overshadow it for my family. After ten weeks on a new HRT regime is it too early for going back to the GP? Sorry to be a pain, but I would appreciate some advice.

Hello, sorry you are going through this and hope your holiday is not disrupted by this.
I am a bleeder and it turns out mine was due to low oestrogen.
I didn't know low oestrogen could cause bleeding.
Bleeding was the reason I lowered it, three times.
I bled on higher doses, but not as much.
Dr Louise Newson has a website now with a search engine, it's well handy.
I would explore higher dose oestrogen.

[sheila99]

The oral synthetic progestogens are usually more effective at stopping bleeding than utro and a mirena is usually the most effective way.

[EllieJ]

Just got back from GP. She had a look at my cervix and said that looked fine - but she said 'oh yes, you are bleeding' lol - I did warn her! She wanted me to have the Mirena but after my horrific experience with hysteroscopy last year I feel too traumatised to have anything like that done. Her next preference was to prescribe Medroxyprogesterone 5mg tablets, which is another synthetic progesterone. I haven't filled the prescription because I really like the thought of micronised, body identical progesterone and until this damn bleeding started was feeling good on it.

I have only been taking the new micronised progesterone for ten weeks, so surely I'm still in the 'bedding in' period (3-6 months to settle after starting or changing HRT)?  She's booking me in for yet another 'urgent' scan to check the thickness of my womb. If they want do another biopsy they'll have to sedate me, I'm still traumatised after the last one.

Has anyone here been on Medroxyprogesterone? I don't like the sound of it - causes weight gain apparently and potential for liver problems - I've already been told I have a fatty liver but GP didn't seem too worried about that.

[bombsh3ll]

I don't love medroxyprogesterone acetate being used long term because it is the least favourable progestin metabolically speaking.

That said it is still incredibly safe and well tolerated by the majority, and can be a useful tool for controlling problem bleeding.

You don't have to marry it, but it might be worth a try for a few months to get your endometrium nice and stable and atrophic, if being bleed free is an important outcome.

You could always then revisit micronised progesterone, and you may find you have no further problems and have potentially avoided invasive investigation.

[EllieJ]

I don't love medroxyprogesterone acetate being used long term because it is the least favourable progestin metabolically speaking.

That said it is still incredibly safe and well tolerated by the majority, and can be a useful tool for controlling problem bleeding.

You don't have to marry it, but it might be worth a try for a few months to get your endometrium nice and stable and atrophic, if being bleed free is an important outcome.

You could always then revisit micronised progesterone, and you may find you have no further problems and have potentially avoided invasive investigation.

Thank you so much you are always very helpful. Excuse my ignorance but are you in the medical field yourself? You always seem very knowledgeable. Thank you so much again for responding.