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[Hannah50]

Hi, I've posted before about my concerns with endless spotting. On average spotting 50 out of every 70 days preceding a new coil in early Oct. After the coil change I had 3 weeks of nothing but then I'm back to spotting almost every day, sometimes heavy with mild cramps (some clots) - I've only had 10 days of not spotting since the beginning of November, and even those days are not all together. My other hormone symptoms come and go, palpitations, insomnia, anxiety. I had a vaginal scan around late Sept which was within normal limits. I am continuously bloated. This is really starting to bother me as I worry it's not normal. Previous coils have stopped all bleeding within weeks so is this all just menopausal hormone imbalance? I have been on Evorel patches for 5 years, increased to 100mcg since May. Has anyone else experienced this much spotting? Thanks

[bombsh3ll]

This is a nuisance but extremely unlikely to be anything sinister given you have had an IUS for several years and a normal pelvic scan, and provided cervical screening is up to date.

My first thought was either an unstable and atrophic uterine lining or vaginal atrophy however neither of these would be as likely on a reasonable dose of systemic estrogen.

There's the possibility of non-absorption, and a blood test would be reasonable to check this.

Additionally, even though it apparently pre- dates the IUS change, a course of antibiotics would also be reasonable to treat any endometritis.

If neither of these is the answer, particularly with the bloating as well, I would consider removing the IUS and changing progestogen.

If the bloating persists I would make sure your recent scan included a report on your ovaries (if not request another) and a ca125 blood test.

[Hannah50]

Hi, that's a super answer and much appreciated, thank you! I had a CA125 test (for bloating) which was normal, and I'm almost certain my ovaries were checked with the scan. My options for alternative progesterone are limited as a utrogestan trial (a year ago) left me feeling very flat/low and I suspect if I had mirena removed my bleeding would ramp up significantly. It's hard to remember exactly but I think the bloating may roughly tie in with increasing to 100mcg, if that sounds reasonable? The possibility of non-absorption or trying antibiotics is useful and I'll mention that if I end up back at the GP. I'm going to wait until mid Jan so fingers crossed. Another thought - is it possible to continue spotting etc even after my body reaches menopause, just because of the HRT? I'm 51 and a half and was really hoping this silliness might be the peak before the end? Many thanks

[bombsh3ll]

Yes some women do just have persistent or recurrent bleeding or spotting as a side effect of HRT. This is not pathological.

If you love your current regime in every other way and don't want to change then you might choose to simply accept this as a minor inconvenience.

However for most it can be eliminated by tweaking the treatment.

There are multiple other progestin options not just micronised progesterone or the IUS, most of them oral, there's the combined patch although you would have to wear two to achieve 100mcg estradiol - this is safe but more expensive if self funding and NHS access is variable, and there is also tibolone, a good option for progestogen intolerant women.

[Hannah50]

Thank you, I really appreciate your knowledge and advice.