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[Bellacake]

Hi

Newby here.  Could really do with some helpful input please? 

History - problem periods since early 20's, went on combined pill, as told had got a hormonal imbalance, was constantly bleeding. Anxiety & depression problems started around same time, told possibly PMDD but never officially diagnosed.  Pill helped, regular periods on it & for several years after coming off it.

Now aged 50, when I turned 47, I'm sure that my hormones shifted again.  Despite still dealing with PMDD?, anxiety & depression, I hit an all time low, didn't know my own mind & felt suicidal, went onto sequential HRT,  bleeding was as expected, now on continuous HRT after roughly 2 years on sequential HRT.  Had 2 or 3 months, not in a row of no bleeding on sequential earlier this year & a couple of months spotting, GP said to try continuous. Last few months have hardly stopped bleeding, had ultrasounds & hysteroscopy, told got coarse uterus, fibroid (posterior suberosal), results of hysteroscopy given to me by phone, just told nothing sinister, which I'm obviously thankful for but also told that if I continue with HRT, I'll carry on bleeding.  Coil keeps being pushed but not really wanting it, it took 4/5 attempts to carry out hysteroscopy, smears always uncomfortable, not sure about the coil & my mental health, options given to me, coil or hysterectomy, seems 1 extreme to the other?  Bled for 3 weeks after hysteroscopy, stopped 2 days, now started again.  Pelvic pain, constipation, clotting like I've never had before, back to bleeding through clothes, sleeping on a towel, blood going through bed sheets.  Currently on 2 pumps of Oestrogel & 1 100mg Utrogestan at night.

I'm sorry if this post is long & I'm not after sympathy, just help, lost & don't understand what to do, GP contacting Gynaecology again.  I just want to know what's wrong & what to do, hysterectomy is obviously not a light decision.  This year has been a hard 1, lost 3 family members, mental health naturally been all over the place & this is making it worse.  In contact with Mental Health services.

Thank you so much if anyone can help.

[bombsh3ll]

This is such a tragedy.

We have had the tools to eradicate both menstrual, dysfunctional and iatrogenic vaginal bleeding since before you were born.

If the combined pill worked well for you - and you didn't need to have dutifully spent every 4th week on it bleeding, the withdrawal bleeds were inbuilt for paternalistic reasons not medical necessity but you are where you are - then why not simply go on a suppressive progestin continuously, and add your preferred estrogen, essentially building a customised version of the COCP with transdermal estrogen?

Examples of suitable progestins would include Desogestrel 150mcg (2* cerazette 75mcg)
Drospirenone 4mg(slynd)
Provera 5-10mg
Norethisterone 1-5mg
Levonorgestrel 150mcg (note only available in 30mcg so would have to take 5 daily)

It has always been a particular crusade of mine but NOBODY has to put up with persistent or repeated vaginal bleeding of ANY etiology unless they want to, and I believe that this can be achieved non- invasively in over 90% and non-surgically in 95-99%.

[Bellacake]

Thank you for responding bombsh3ll 

I'm using Transdermal estrogen & using Utrogestan for the progestin, I presume by your reply that this isn't a suppressive progestin?  I can't believe that the gynaecologist has not looked into the medication side of things more, far better than advising or putting people through unnecessary surgery.

I'm not sure where I am at in my peri/menopause journey but know I'm constantly anaemic, on medication for this & I feel so frustrated at times, don't always feel listened to & often wonder when the remaining part of the medical world will take people's concerns regarding these matters on-board & treat people as individuals, people shouldn't have to Google looking for answers or be armed with knowledge before visiting, people go to them for direction and advise.

[bombsh3ll]

No, micronised progesterone will not shut down bleeding, at least not at the doses prescribed within HRT.

If someone is postmenopausal and not bleeding anyway, they can usually use micronised progesterone continuously and not bleed, however this is not your situation as it doesn't sound as if you have ever completely stopped bleeding.

The synthetic oral progestins listed above are much more effective at stopping bleeding, as is the mirena IUS but obviously not everyone wants this and I would always suggest the least invasive and easily reversible option first.

There are a couple of reasons your GP/gynae may not have suggested any of these - there has recently been a lot of social media evangelism about "body identical" hormones to the point that many women only now want micronised progesterone even though clinically it may not be the best option to meet their needs.

Therefore providers sometimes assume this is all you will accept, and/or have their own beliefs about synthetic hormones being inferior - there is a slight increase breast and metabolic risk with some progestins vs micronised progesterone, however this is frequently offset by better tolerability, bleed control and better protection from endometrial cancer.

Additionally because the older agents have become less fashionable, clinicians have become de-skilled in prescribing them, some may never have written a prescription for a progestin outwith a combination product such as a birth control pill.

Some of them are also unlicensed for endometrial protection (but supported by the BMS based on available evidence and frequently used by experienced clinicians in this field).

You could always take a progestin for now until there is a reasonable expectation that you are postmenopausal, and then revisit micronised progesterone after that.