Print

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

[Clovie]

Hello

Just a quick question to clarify, if you could be so kind. I know a few of you are very knowledgeable about this stuff

If someone was taking continuous HRT daily, so a level playing field of hormones being added in, but was getting bleeds on a predictable and regular (every 20 ish days) for a predictable length (around 5 days, starting light getting heavier and tailing off) with PMS symptoms before each bleed (irritability, sore joints, sometimes spots),

In your opinion -

COULD that regular pattern possibly be caused by continuous HRT?

Is that a sinister pattern of bleeding?  (No spotting in between, no bleeding after sex etc)

If it was sinister bleeding, i.e. the lining of a womb shedding away because of hyperplasia, would a woman get PMS before each episode of shedding?

If there was no natural hormonal activity would a woman get cyclic PMS on continuous HRT?

I am going to see my doctor's surgery and would like advice to be forearmed with information, I've gathered a lot but I can't see answers to these questions anywhere.

Thank you SO much. I appreciate any opinion so much.

[Dierdre]

I'm not knowledgable re full HRT but my own experience on  conti was similar. I was 62 and 8 years post meno so no periods. Started Femiston conti and used for 3 months, no bleeding but had horrible PMT symptoms. Then went onto Femseven patches, PMT stopped but regular periods every 28 days started. Full blown heavy periods with period pains, clots the lot. This went on for 3 months and I gave up, stopped the HRT, had one last period and nothing ever since. It says on the leaflet with conti HRT that with initial first use bleeds can occur up to 6 months. 
I assumed my lining was thickened by the oral femiston and the progesterone had not done its job. The Femseven progesterone was different and worked to thin the lining. I had a scan a few months later and all was well.

[bombsh3ll]

That sounds like a menstrual cycle.

Continuous combined MHT doesn't cause that, but nor does it get rid of it.

It has no sinister characteristics but it is reasonable to get checked out being on the later end of things.

However given that you have been investigated and reassured, unless the bleeding changes in character or you have any new concerning symptoms, I would not keep going to your GP about this as you will keep being referred for "suspected cancer" and worse, may lose your HRT prescription.

If you would prefer not to bleed there are other progestins either oral or IUS that you could choose that would achieve this.

[Clovie]

I'm not knowledgable re full HRT but my own experience on  conti was similar. I was 62 and 8 years post meno so no periods. Started Femiston conti and used for 3 months, no bleeding but had horrible PMT symtons. Then went onto Fenseven patches, PMT stopped but regular periods every 28 days started. Full blown heavy periods with period pains, clots the lot. This went on for 3 months and I gave up, stopped the HRT, had one last periods and nothing ever since. It says on the leaflet with conti HRT that with initial first use bleeds can occur up to 6 months. 
I assumed my lining was thickened by the oral femiston and the progesterone had not done its job. The Femseven progesterone was different and worked to thin the lining. I had a scan a few months later and all was well.

Thanks Dierdre for replying

So you were definitely post menopausal before you started conti?
were you on  any kind of hormonal medication before you went onto conti?

[Clovie]

That sounds like a menstrual cycle.

Continuous combined MHT doesn't cause that, but nor does it get rid of it.

It has no sinister characteristics but it is reasonable to get checked out being on the later end of things.

However given that you have been investigated and reassured, unless the bleeding changes in character or you have any new concerning symptoms, I would not keep going to your GP about this as you will keep being referred for "suspected cancer" and worse, may lose your HRT prescription.

If you would prefer not to bleed there are other progestins either oral or IUS that you could choose that would achieve this.

Thankyou Bombshell, you have so much knowledge on this (and yes, I know I should take my care givers advice... I just wanted opinions)

Yes. You see I THINK, no, I KNOW they are periods.
At my age, 61, my docs will not accept they are.

I was checked out 2 years ago age 59, and  confirmed I was having periods in that I had a  'womb of a menstruating woman, ' and no issues on scan.

Nothing has changed regarding the character of these regular bleeds, still coming along cyclicly despite the conti regime, apart from them lately getting lighter and a bit closer together. Worsening PMS. No other bleeding other than that.

The problem is they want to send me for another scan. Treating me as post menopausal yet I'm not. With all the issues of maybe not having my lining at its thinnest due to my cycle. Tried to reschedule but clinic unhelpful, just have to wait for another appot being sent through (I'm thinking of a private scan at the RIGHT time)
 
I am meeting with my doctors next week to ask instead of a scan for a 6 month trial on the increased (200mg) utrogestan to see if it stops , or Im going to say, even though I am intolerant of synthetic progesterone, that I'm willing to try 6 months of that to see if it stops.
I don't want a scan in case it has to be at the wrong time and it will set of uneccessary investigations that I don't want.

Would you think that might be acceptable, a 6 month trial, and then if still bleeding agree to a scan?

I'm dreading, total understatement.

Thank you for reading! and sorry for bothering you  


P.S. sorry, I did not go to my GP about my bleeding, I wasn't concerned, it was a HRT review that I had to attend .

[Dotty]

Hi Clovie if you are still having natural periods then 200mg of Utrogestan is unlikely to stop the bleeding .

Have you seen the thread on here about late menopause? ( apologies if you have already seen it. ) There are ladies who are still having regular periods into their 60s even though your doctor thinks otherwise. x

[Clovie]

Hi Clovie if you are still having natural periods then 200mg of Utrogestan is unlikely to stop the bleeding .

Have you seen the thread on here about late menopause? ( apologies if you have already seen it. ) There are ladies who are still having regular periods into their 60s even though your doctor thinks otherwise. x

Yes thank you so much Dotty, I have seen it and posted loads , I feel I'm getting annoying, but I don't mean to be. I'm just scared stiff with good reason 2 years ago my GP told me I MUST have womb cancer as I 'thought' I was still having periods at 59 :  it all stems from there, she did a good job on me


Iagree, I have read that 200mg won't likely stop my periods. Im going to ask for a prog that WILL stop them, for a trial period even though I've been highly intolerant of synthetic progs in the past.

I feel I'm on a hiding to nothing...
The Utro won't stop my periods
I'll continue to have these 'unexpected bleeding episodes', as they are calling them.
I can't win.  i will HAVE to have a scan to keep getting HRT, but because I'm having periods my llining might be thicker if scanned at the 'wrong' time in my cycle,
I might be told to have investigations which I don't want. (General anaesthetic, possibilty of perforating womb etc - the risks outweigh the benefits to me   )
Have the investigations or HRT stopped 

[Dotty]

Hi Clovie. You’re not getting annoying….please don’t worry. I think we’ve all been where you are for one reason or another….i certainly have.

Can you ask for a referral to a menopause clinic ?

[Kathleen]

Hello again Clovie

I agree with Dotty, you are not getting annoying, you are just wrestling with a problem and many of us have been there!

I realise that you don't really want a scan but if you could arrange one privately, say with Ultrasound Direct, you could book your appointment for when you have had a bleed, they can then email the results to you and your GP. I did this and my GP was happy to accept their results and my subsequent NHS scan was cancelled.
Your scan is likely to show a normal womb for a menstruating woman and then you can move on. Perhaps then consider booking annual private scans for reassurance and to satisfy the curiosity of NHS!


Wishing you well and take care.

K.

[bombsh3ll]

I agree with that, but I would just check with your GP first that they will accept a private scan, because if not then you have wasted your money.

If this scan is ok then I would simply not mention the bleeding at any further HRT reviews.

It is not on you to educate health professionals at the expense of your physical and mental wellbeing.

To put your mind at ease even further about endometrial cancer, this typically presents with ongoing, irregular NOT CYCLICAL bleeding with no associated "premenstrual" symptoms, which often smells offensive as well.

[Dierdre]

I'm not knowledgable re full HRT but my own experience on  conti was similar. I was 62 and 8 years post meno so no periods. Started Femiston conti and used for 3 months, no bleeding but had horrible PMT symtons. Then went onto Fenseven patches, PMT stopped but regular periods every 28 days started. Full blown heavy periods with period pains, clots the lot. This went on for 3 months and I gave up, stopped the HRT, had one last periods and nothing ever since. It says on the leaflet with conti HRT that with initial first use bleeds can occur up to 6 months. 
I assumed my lining was thickened by the oral femiston and the progesterone had not done its job. The Femseven progesterone was different and worked to thin the lining. I had a scan a few months later and all was well.

Thanks Dierdre for replying

So you were definitely post menopausal before you started conti?
were you on  any kind of hormonal medication before you went onto conti?

Definitely 8 years post menopause with no bleeding at all in that time. I wasn't on any systemic HRT just vagifem, I'd been on that for 3 years at the time with no bleeding.

[Clovie]

Hello again Clovie

I agree with Dotty, you are not getting annoying, you are just wrestling with a problem and many of us have been there!

I realise that you don't really want a scan but if you could arrange one privately, say with Ultrasound Direct, you could book your appointment for when you have had a bleed, they can then email the results to you and your GP. I did this and my GP was happy to accept their results and my subsequent NHS scan was cancelled.
Your scan is likely to show a normal womb for a menstruating woman and then you can move on. Perhaps then consider booking annual private scans for reassurance and to satisfy the curiosity of NHS!


Wishing you well and take care.

K.

Thasnk you Dotty,

I am looking into this, once we have spoken to the surgery next week . Appreciate your reply, and saying about me not being annoying xxx

[Clovie]

I agree with that, but I would just check with your GP first that they will accept a private scan, because if not then you have wasted your money.

If this scan is ok then I would simply not mention the bleeding at any further HRT reviews.

It is not on you to educate health professionals at the expense of your physical and mental wellbeing.

To put your mind at ease even further about endometrial cancer, this typically presents with ongoing, irregular NOT CYCLICAL bleeding with no associated "premenstrual" symptoms, which often smells offensive as well.

Hi Bombshell

Thanks once again. Really appreciate your input.

Good shout about scans, I will enquire , if Ineed to, at my review with the surgery next week.

And regarding the bit in bold - thank you so much. This totally 100% confirms what I thought about unexpected bleeding. It makes total sense, to everyone - well MOST of us 

I have seen the BMS flowsheet for unexpected bleeding on HRT.
I feel that the flowsheet does not apply to women having a cycle of their own.
i feel it refers to more random not cyclic bleeding episodes.
Yet it appears I get funnelled down the urgent route.
I have no minor or major risk factors
I have no PERSISTENT bleeding, as it is only cyclic for the set number of days
but I AM more than 3 months after a change in dose or preparation  (I don't feel this applies as I was on 100mg Utro +gel so was never going to stop my period.

so I am automatically shunted towards scan!

This flowsheet does not apply to women
a) who still having periods on a regular predictable basis and
b) who are on 100mg Utrogestan to try and control it

Thank you again for your valued opinion and input