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[Trish17]

Hi to all, please can anyone advise me.

I am almost 53 have been on hrt for 5 years and after a lot of trial and errors I finally started to feel good, apart from bad pmt, on 4 pumps of oestrogen and 2 utrogestan taken vaginally. 

At the beginning of this year I asked to be put on continuous because of bad pmt,  However, I have been spotting all the way through the 6 months, I even had a full period last month. Because of the spotting I had an ultrasound which found fibroids. The lining is normal and gp not overly concerned, because they are small and not in the 'wrong' place, I can't remember the exact words she said. I was called in to discuss it.  She gave me 3 choices (she wants to see if my spotting is the hrt or fibroids). These were the coil, utrogestan orally or break from hrt for 3 months. All of these scared me to death (not quite but you get the drift). I don't want the coil or utrogestan orally for reasons that I don't need to go into. So, feeling under pressure I went for the 3 month break. This has caused me so much anxiety that I haven't started the break yet (this was 2 weeks ago).

I wasn't happy with the choices I was given and the gp, I believe, didn't seem interested in working with me.
I asked if there was anything she could recommend to help me manage symptoms on the 3 month break, I got a flat '' no''. I also asked if changing from a body identical hrt to non body identical might help. She told me that wasn't available on the NHS, only privately. Reading up on it afterwards she was talking about bio identical. I was talking about synthetic hrt.

I have a appointment with another gp this Friday as I wasn't happy with my last consultation. I felt she wasn't really interested in me that day. I have had a few consultations regarding hrt, with her over the years & not had a problem with her.

I would like to go onto continuous everol as the progesterone part is synthetic, I believe.

Have I been given bad advice or is she correct and the gp on Friday is going to say the same thing?

[bombsh3ll]

It doesn't sound as if she is very knowledgeable.

A synthetic progestin can be a good option for controlling bleeding, in many cases better in this respect than micronised progesterone.

Options orally include Provera, Norethisterone, Desogestrel 150mcg daily or Slynd.

Of these only Provera is licenced for use within HRT and hence likely to be on your GP's formulary, however the others can be purchased from online pharmacies as "birth control" up until age 55. Note that with the exception of Slynd, the dose for endometrial protection is different from the contraceptive dose - you would have to take 2x 75mcg desogestrel (one of which you could obtain from the NHS as "contraception"), or three Noriday tablets

Transdermally you have the combined patch which also contains norethisterone. However this would result in a dose reduction of your estrogen as it only comes in a low fixed dose combination with 50mcg of estradiol. Whilst more than one such patch can be worn, this is often not supported by the NHS.

Another option would be taking an oral combination product with estradiol plus progestin. This would give you access to dydrogesterone (Femoston) however the dose of estradiol in Femoston conti is only 1mg. Again two can be taken however this is often not funded by the NHS. Femoston sequi has 2mg estradiol but you would be back to having withdrawal bleeds.

Alternatively if you feel well on your current regime with benign investigations you could simply choose to accept some nuisance bleeding and spotting which may well disappear in time anyway when you become postmenopausal.

[sheila99]

Oral norethisterone is licensed for hrt now and is likely to be more effective than utro. The drawback is that you only need 1mg a day but they come in 5mg. I used half. Given the choices you had I'd have been tempted to have the oral utro and carry on using it vaginally where more gets to where it's needed. If you're not meno you're likely to have some bleeding on any of them except the mirena which is the most effective option for problem bleeding and stopping your own periods. My hrt can induced bleeds were noticeably shorter and lighter with no PMT so perhaps you still have your own cycle. I also spent many years adamant I wasn't having a mirena either but I've had one since Jan and for me it's great, no bleeding and no side effects (unlike utro).

[Trish17]

Thank you both for your replies.

I struggle to take tablets, always have done. Can take amitryptaline as they are tiny, but can't take paracetamol, even if cut into 4. All phycological, I know. The size of Utrogestan, even cut up, there's no way, lol.
I really suffer having a smear, really hurts. Gp said it's worse than a smear. Plus, when it up there I have no control over it, it scares me.

You've both given me things to think about, but I'm liking your last paragraph Bombsh3ll, about just leaving it as it is. I have read that it can take upto 12 months to settle on continuous, waiting a few more months sounds good.  Lining is normal thickness & the spotting doesn't bother me as it's about 6 days a month and it's gone by lunchtime anyway.

I have 2 lady gp's that I've seen throughout my perimenopause journey, but they tend to disagree with each other. One said I can't switch hrt methods at the same time as starting continuous (wanted to swap to patches), I have to wait a year. When I mentioned it to the other one, she said '' who told you that''

I'm thankful for this site

[sheila99]

If having a smear is painful perhaps you have va? It's just that if you do have it it's better treated sooner rather later as without treatment it will only get worse. Accepting some bleeding is fine as long as you're certain it's hormonal and not anything sinister. I'm not sure if you can be certain?

[CLKD]

My thoughts are vaginal atrophy ........ and mayB it's time to consider getting onto a waiting list for a dedicated menopause clinic.  Why are GPs allowed to contradict each other, mayB because they know very little about how peri-menopause can affect women.

I too had problems with taking tablets, i.e. The Pill would sit in my palm for ages B4 I dared - in case I choked I think.  Then I had life saving medication with little choice and now have no problems at all.  Unless I find 1 sticking = horrid taste.   

[Clovie]

Thank you both for your replies.

I struggle to take tablets, always have done. Can take amitryptaline as they are tiny, but can't take paracetamol, even if cut into 4. All phycological, I know. The size of Utrogestan, even cut up, there's no way, lol.
I really suffer having a smear, really hurts. Gp said it's worse than a smear. Plus, when it up there I have no control over it, it scares me.

You've both given me things to think about, but I'm liking your last paragraph Bombsh3ll, about just leaving it as it is. I have read that it can take upto 12 months to settle on continuous, waiting a few more months sounds good.  Lining is normal thickness & the spotting doesn't bother me as it's about 6 days a month and it's gone by lunchtime anyway.

I have 2 lady gp's that I've seen throughout my perimenopause journey, but they tend to disagree with each other. One said I can't switch hrt methods at the same time as starting continuous (wanted to swap to patches), I have to wait a year. When I mentioned it to the other one, she said '' who told you that''

I'm thankful for this site

Currently I'm going through a LOT of stress with gynae stuff, and one of the reasons I'm cross is that it has brought back my inability to swallow tablets. (Had that ages ago and had conquered it)
Back to using my pill crusher , do you have one of those for suitable solid pills, like paracetamol? They're great.
I split open my omeprazole capsule as I cannot swallow it whole
I bite the utrogestan (yuk - takes horrid) then swill down immediately with something nice tasting - no way could I swallow them, same as you! I would choke.
I know you're probably not supposed to do that but it's the only way right now. So I'm Ok with it.

So, I sympathise.