Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[rachie]

So…
I’m 56 and have been on HRT for 4.5 years. Previously I Was having 2 pumps estrogen plus 200 utrogestan for the 12 days.
8 months ago, I was told to switch to continuous utrogestan (100) with two pumps of estrogel.
I was constantly bleeding from the start, so had a biopsy and a polyps removed and all good to go.
Discharged immediately and within a few weeks, I started heavy bleeding every 2 weeks for 5-7 days.
As I couldn’t get a doctor’s appointment, I upped it to 200 utrogestan daily.
I finally saw the doctor and mentioned a few things..ie coil..
His response was to stop HRT altogether or a referral back to the gynaecologist.
He could not suggest anything else. When I asked about the 200 utrogestan regime, he told me it was dangerous!
I’ve been told that as they’d discharged me already, I have to go in the waitlist, which is 5 to 6 months.
This sounds like such a cop out and now I really don’t know what to do.
Maybe go back to sequential or just try stopping altogether until I have a referral.
Apart from the bleeds, HRT does seem to suit me.
Is there a regime that could allow just a few days off (someone mentioned that) and if so, should I carry on with the 200 dose?
The doctor was a 30 year old male doctor and I really feel that I’ve been left to sort things out myself.
Any regimes that you’ve all benefited by, would be great to hear of.
Thank you and sorry for the long post.

[sheila99]

Are you definitely meno? Because if you aren't utro isn't going to stop you bleeding. Your age doesn't mean you are, some women aren't meno til their early 60s. He is only gp who isn't trying to force everyone to have far too much progesterone! Personally I'd go back on the sequi regime but you could try 25/28. No reason why you can't have a mirena though, he should be able to refer you and if no-one at the surgery can do them. Definitely no reason to stop hrt.

[rachie]

Thank you for the quick reply.
I have no idea but when I told the doctor that my bleeding doesn’t hurt or come with any mood changes, he agreed that I was probably post.
I was having periods before I started HRT, so it’s hard to know.
I quite like the sound of 25/28 but do you think I should lower the utrogestan to 100 instead or stick to the 200?

[Mary G]

I doubt a 30 year old GP knows much about HRT dosage and it sounds like he was completely out of his depth and effectively took fright and washed his hands if it.

200 mg Utrogestan might not be controlling your bleeds but it's not dangerous, what reason did he give?  I would not stop HRT based on anything he said but I would try using Utrogestan the way Sheila suggested and have a brief bleed break every month.  How long had you been using 200mg Utrogestan continuously when the bleeding started?  Are you using it vaginally?  That would help.  What was the explanation for your not being able to have a Mirena coil?

He should have suggested a different form of progesterone (probably synthetic) but I doubt he's in a position to do that.  My niece is a GP of a similar age and her HRT training was pitiful - she actually said that I know more about HRT than most of the doctors at her surgery which is a damning indictment.  She only got to grips with HRT after enrolling in extra courses connected with women's sexual health. 

[rachie]

He said that only the gynae can do a coil or suggest anything else.
I’ve never spoken with a doctor in all the time taking HRT, only a pharmacist.
I had once taken the utrogestan vaginally and when I mentioned it to the pharmacist, she had a meltdown.
I went continuously mostly due to headaches during the utrogestan break.
I’ve been using the 200 utrogestan for a month now.

[Mary G]

I can't think why the pharmacist had a meltdown over using Utrogestan being used vaginally because the very same capsule can be used both vaginally and orally.  I assume you are in the UK?  Everywhere else, boxes of Utrogestan clearly state vaginal and oral use and they are exactly the same as the UK capsules but for some reason that nobody has ever been able to adequately explain, only the UK will not licence Utrogestan for vaginal use but the private clinics are all happy for their patients to use it vaginally.

Sometimes you get a lot of continuous heavy bleeding when you switch from cyclical progesterone to continuous but it usually settles after a few months.  I bled for weeks when I first switched.  I would try using 100mg vaginally because that way more of it reaches womb and it might help to stabilise the bleeding.  Sometimes, Utrogestan gets partially lost in the digestive system which obviously weakens the dose. 

Ultimately, you might need to change to a stronger synthetic form of progesterone that is better at controlling the bleeding. 

[bombsh3ll]

I would try the hybrid or French regime of taking 100mg progesterone 25 nights out of 28.

This allows for a bleed in the break and can work out better than taking it continuously if that results in erratic bleeding.

The average woman on continuous probably forgets to take one at least 3 times in a month anyway.

You can take this either orally or vaginally. They do not have a camera in either your bedroom.

[rachie]

Thank you both.
I have been having bleeding for 8 months, every other week on the continuous regime (hence a scan and biopsy) I got clear results and was discharged but the bleeding never stopped.
Maybe I will try the 25/28 regime but did find the vaginal way, irritated my bladder a bit but that was a couple of years ago.
I like the fact that I can sleep well with the oral regime.
Thank goodness for this forum as I really feel that you are kind of on your own otherwise.
I looked at private but my local clinic is £300 per consultation, which is quite a lot of money.
So, I think I’ve narrowed it down to the 25/28 regime but with either 100mg vaginally or 200mg orally and will carry on with 2 pumps?

[rachie]

On a positive note, the doctor offered to prescribe something to stop the bleeding.
I did decline as it’s the HRT imbalance that’s causing the bleeding imo.

[bombsh3ll]

I think if you have the actual prescriptions to be able to try out various things and figure out what works for you then there is little point paying for a private consultation.

My approach would always be to first establish the dose, route and type of estrogen that meets your needs, and then titrate the progestogen to control your endometrium.

Do you feel your menopause symptoms are well controlled on 2 pumps?

Just to add the current guidelines recommend using the same progesterone dose vaginally as you would orally. There is evidence that lower doses are effective vaginally but the weight of this evidence is currently insufficient to change recommendations.

There is also no harm in taking 200mg continuous or 25/28 day progesterone if tolerated and needed to control bleeding.

Micronised progesterone is by far not the only option though and there are several oral progestins that can be better at controlling bleeding.

Due to your age and your GPs inexperience, they may be most comfortable prescribing provera. However I would explore all possible regimens with micronised progesterone first, particularly as you mentioned it helping with sleep.

[Clovie]

Are you definitely meno? Because if you aren't utro isn't going to stop you bleeding. Your age doesn't mean you are, some women aren't meno til their early 60s. He is only gp who isn't trying to force everyone to have far too much progesterone! Personally I'd go back on the sequi regime but you could try 25/28. No reason why you can't have a mirena though, he should be able to refer you and if no-one at the surgery can do them. Definitely no reason to stop hrt.

Hello Sheila99, just came across this post (I have been up all night at my absolute wit's end, and have posted a new topic about my problem  )  The bit in bold is especially interesting to me. I think this is me.

I have been given continuous utrogestan (100mg) along with estrogel, been taking it 2 years and it hasn't stopped my bleeding. I have never gone through menopause yet despite my age, I'm 61, still have regular, predictable 'bleeds' every 20 or so days with all the PMT beforehand and no spotting or other red flags in between. The HRT has never supressed my own cycle.
I call them 'bleeds' because the NHS people I see will absolutely NOT rerer to them as periods as apparently I cannot possibly be having periods at my age, despite a scan showing 2 year ago that my womb was still that of a menstruating woman. I am at my wits end. I feel so trapped . Like a lump of flesh. Like I have no say. That I am a neurotic woman. I probably am , I do have outrageous health anxiety made worse by all this to do with my HRT and my age....

Surely if it was sinister bleeding it would not be regular predictable with no other red flags and not be preceded by obvious PMT? I'm at my wits end.

Anyway, sorry to jump on your thread Rachie, I hope you manage to get sorted. 

[rachie]

Clovie, that sounds awful and highlights the fact that most (not all) doctors have no training whatsoever in this field.
Hopefully, things will get sorted for you!

[rachie]

I think if you have the actual prescriptions to be able to try out various things and figure out what works for you then there is little point paying for a private consultation.

My approach would always be to first establish the dose, route and type of estrogen that meets your needs, and then titrate the progestogen to control your endometrium.

Do you feel your menopause symptoms are well controlled on 2 pumps?

Just to add the current guidelines recommend using the same dose vaginally as you would orally. There is evidence that lower doses are effective vaginally but the weight of this evidence is currently insufficient to change recommendations.

There is also no harm in taking 200mg continuous or 25/28 day progesterone if tolerated and needed to control bleeding.

Micronised progesterone is by far not the only option though and there are several oral progestins that can be better at controlling bleeding.

Due to your age and your GPs inexperience, they may be most comfortable prescribing provera. However I would explore all possible regimens with micronised progesterone first, particularly as you mentioned it helping with sleep.

Thank you for this.
I’m not sure whether 2 pumps are sufficient as I still get so thirsty and achy during the night but worry about increasing the dose as I already have a thickened lining.
I’ll take a look and try a few different regimes and see if anything works 🤷‍♀️

[CLKD]

U can continue with the same threads so that responses don't become lost.

GPs simply don't understand enough about HRT ........... many won't admit to understanding enough about .............  some ladies find that keeping a mood/food/symptom diary of use to chart progress.