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[Annalou77]

55 and started on evorel50 and Gepretix continuous 3 months ago… previously on Evorel Conti and mirena for a year +which made me Spot/bleed all the time…I bled all of September and now over the past week I have had such a heavy bleed with painful cramping, bloating ,backache it’s been miserable few days… bleeding has calmed down but still there but now I’m having bloating and intermittent sharp pains in ovary area, and weirdly up vagina … messaged doctor but they won’t get back to me for up to 3 days . I just feel like giving up with this. I have had 2 previous referrals to gyn refused as they think it’s related to hrt … can someone tell me if they’ve had anything similar and what helped  thanx

[bombsh3ll]

I would call your GP tomorrow and ask for a supply of provera to stop the bleeding and to be referred directly for an ultrasound scan to exclude a structural cause for the bleeding.

Referral pathways may differ between health boards but in most cases a GP should be able to refer directly for a pelvic ultrasound.

It is unusual for someone to even be on double progestin ie evorel conti AND the IUS, AND to bleed through that.

I am assuming cervical screening is up to date and your GP has performed a speculum examination including ruling out vaginal atrophy and infections.

Do you have any previous history of heavy menstrual bleeding or personal/family history of bleeding disorders?

[Annalou77]

Hi yes I have previously had extremely heavy, flooding periods in my 40s where I struggled with anemia. Found out I have some fibroids and a polyp. Polyp removed, two resection of fibroid ops , mirena coil inserted to help with bleeding ( never did help) . Had a few months of no period at53/54  ( did not ever have a 12 month period where I had no bleed so unsure whether threw menopause but I think 55 they class that I am anyways)was put on Evorel Conti then because of more bleeds referred twice then changed to Evorel 50 and Gepretix and mirena , which was 7 years old by now was removed…now this is all happening . I am so confused and worried with all this. Years I have been struggling with gyn problems and peri/menopause and just thought hrt would be great for me 🤷🏻‍♀️ will the fibroids be affected by hrt do you think? Thank you for answering.

[Konijntje]

If everything comes back clean and it is the hrt causing the bleeds, you could consider using a stronger progestogen like Slynd (drospirenone) as your progestogen.

(I did not get along with drospirenone, because of the diuretic effect, but other than that it is a pretty kind progestin that a lot of people tolerate well).

[bombsh3ll]

HRT can slow the regression of fibroids but not by much at NHS doses.

You need a gynae review - the fact that all this pre-dates the HRT, plus the fact you have bled through multiple progestins points away from it being all down to the HRT.

You may be a candidate for either an ablation or a hysterectomy.

I would put in a written complaint to your health board and see if there is any kind of patient advocacy service in your area.

Additionally and I hate that I am saying this but if you can afford a private appointment with a menopause literate gynaecologist, this would probably be money well spent to get some progress made because even when you join he NHS list, waits can be long.

You should also have your full blood count and ferritin checked - anaemia is common with heavy or prolonged bleeding and can actually make the bleeding worse if low.

[Annalou77]

Well, spoke with my gp yesterday and just as I thought she says it could be the hrt causing the bleeds and I’ve been told to stop hrt for the next three months to see where I am in regards to still having a period or not.
Now I’m only spotting again but I have been told to inform her if bleeding continues 🤷🏻‍♀️ . So back at the start again … hoping that the hot flashes insomnia and moods don’t crash again as I really did feel I was getting some help using hrt for that.

[bombsh3ll]

This is inappropriate, outdated and harmful advice.

Bleeding such as this should be investigated and treated rather than stripping the patient of necessary treatment.

Even if it were due to the HRT, the HRT should be adjusted by a specialist (if initial tweaks by the GP haven't worked). The answer is never to pull the patient off estrogen, unless a clear contraindication were identified such as endometrial cancer.

Which would only be diagnosed with investigation.

And even if the bleeding stops off treatment, do they just expect you to then suffer a miserable, shortened life with osteoporosis and all the other sequelae of untreated menopause?

I would see someone else and not accept this.

[Ayesha]

And even if the bleeding stops off treatment, do they just expect you to then suffer a miserable, shortened life with osteoporosis and all the other sequelae of untreated menopause?

I would see someone else and not accept this.

This comment is out of order and alarmist, it is not a given that we will all end up with the symptoms you mention because a woman chooses not to be on systemic HRT. Annalou77 has enough going on without any more pressure put on her from comments made by a medically unqualified person on a forum.

[Minusminnie]

Ayesha have you read all of this thread ?

[bombsh3ll]

Whilst hormone therapy is a personal choice, there is published evidence of reduced all -cause mortality, approximate average 3 years greater life expectancy vs non users and reduction in risk of multiple diseases including osteoporosis, in addition to the quality of life benefits that most users derive from treatment.

Therefore if someone has already taken all these factors into account and made an informed decision to use hormone therapy, it is unreasonable and goes against current guidelines to simply disregard all these evidence based indications, withdraw treatment and leave the patient suffering rather than offering appropriate investigation and management of bleeding.

[Annalou77]

Thank you ! I have been reading more and more about the benefits of hrt and I really did feel better on it. My only side effect was the bleeding.  Only been one night and one day since I stopped taking it and can feel a difference already . May just be psychological, I don’t know but I feel a little bit anxious. Anxiety was a big problem for me going through peri and these patches definitely helped my mood. Just read there that you have to gradually come off any hrt and not just stop it, which I specifically asked about and was told to just not take anymore😫. I feel so stupid not knowing what to do but thank you for taking time to answer me .