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[NickyK]

Hi everyone, I'm 55 and recently (just over 2 months ago) started HRT.  I'm taking Oestrogel (2 pumps daily) and Ultrogestan 100mg capsules (1 daily).  I havent had a period or any bleeding whatsoever for over 3 years. 

I was on combi HRT perimenopausal around 7 years ago due to hot flushes and extreme anxiety and took it for a couple of years but at the time there generally was a lot of fear surrounding taking it long term and so I stopped taking it.  Fortunately the hot flushes and anxiety didnt return.

This time, I requested to go on HRT after becoming more informed and aware of the benefits of taking HRT as I age, as well as recognising that I had some long standing menopausal symptoms which had crept in to become normal (low mood, poor motivation and lack of energy being the main ones).

After about three weeks after starting HRT I started a very light period but after about 4 days it progressed to heavy and then the flow became distressingly heavy, never experienced that when I did have periods, almost gushing!  This happened two days in a row for probably a couple of hours each day.  It then progressed to normal heavy, tailing off to light and lasted for around two weeks.  At the time I managed to speak to one of the doctors at my GP practice who said that they could send me for an ultrasound if it persisted, but it didnt so I didnt go down that route.  I really felt like it must be due to the HRT as I had never had any bleeding since stopping periods 3 + years ago so I didnt think it was necessary.  I should also mention that I have a pathological fear of smears after some horrible experiences in the past so perhaps was less open to the idea of going for an ultrasound than I should have been.

Less than two weeks after the last one, I got another period!  Again it started off very light and progressed to heavy after about 10 days and then after about 13 days I had the distressing extremely heavy gushing again for a couple of days.  Its so random though - it could be 8 hours with virtually nothing and then it gets really heavy again which is very different to when I did have periods pre menopause.

I am generally feeling exhausted all the time, weeks of sore boobs and no matter what time I take the Ultrogestan, I feel groggy in the morning, sometimes after sleeping for 9-10 hours!  I am not a high energy person but this is another level of tiredness.  I know that guidance says it can take up to 6 months for your body to adjust to HRT but I honestly am not sure I can persist, even being aware of the apparent benefits of HRT as I get older.

I will be having a three month follow up with my GP so will discuss this with her then but wanted to see if anyone else had the same symptoms?  Did they pass or am I going to have to have horrible periods that last for weeks forever!?  Should I go for an ultrasound or not?  Dreadfully confused and not sure what to do so any guidance or help would be much appreciated.

I guess what worries me the most is going off of HRT and facing the prospect of being a shrivelled old hag with osteoporisis (yes the media has a lot to answer for!)

[bombsh3ll]

Nobody needs to put up with ongoing or repeated vaginal bleeding of any etiology and nor should this be a reason anyone has to give up hormone therapy.

There are multiple other progestogens that can be used which provide better endometrial control than utrogestan and do not make you groggy.

These include the IUS and multiple oral progestins.

In the first instance whilst waiting to see your GP why not try the progesterone you have vaginally.

This should bypass the grogginess by avoiding first pass metabolism, and this route also delivers a higher concentration to the uterus, which may help lessen bleeding.

I would encourage you to get an ultrasound though just for your peace of mind given how heavy the bleeding has been - this can be done externally which is almost as good as a transvaginal scan unless the patient has severe obesity.

I have vaginal stenosis so cannot get an internal scan at all, and my external pelvic scans show everything just fine.

[NickyK]

Thanks so much bombsh3ll, really helpful advice. I will give the progesterone a try vaginally as well as book in for an external ultrasound. Thank you for responding, as always these are things that are just not discussed enough and really you don't know what you dont know until you listen to others xxx

[sheila99]

I have the same side effects from utro as well as interrupted sleep. It's worth trying vaginally though it made no difference to me but I found 10am was better than in the evening. If you're not certain it's the utro causing problems you could trial a couple of cycles of sequi (200mg x 12 days) and see how you feel on estrogen only. The synthetics are normally more effective at keeping your lining thin and don't usually cause grogginess. I have no side effects and no bleeding with a mirena.

[Becr]

I could have written your post myself. I’m 53, 5 years since last period. HRT before (stopped in 2020). Restarted HRT 8 weeks ago, 2 X oestrogen, 100mg utrogestan but I switched to vaginally as I couldn’t tolerate oral due to it giving me depression and feeling exhausted. I also have had two heavy periods that were a couple of weeks apart. Currently I have a bit of spotting. I just put it down to my uterus waking up again but like you I have been a bit worried and almost posted about it here yesterday! My doctor said I should expect some bleeding  so I haven’t mentioned it. I also have a fear of smears due to an awful colposcopy years ago so tend to avoid any internal examination. I do think vaginal utrogestan works for avoidance of side effects and wonder if it all just takes time to settle? I did start on oral but quickly remembered that last time it had made me feel rubbish so asked to use it vaginal. Not sure if any of the above helps but you are not alone in the bleeds. I too find them exhausting.

[CLKD]

Do keep up with smear tests on an in-case basis, have a chat with the Nurse Practitioner to find out how methods have improved in recent years.