Menopause Matters Forum
Menopause Discussion => Personal Experiences => Topic started by: Diamonds and pearls 53 on December 31, 2013, 06:06:54 PM
-
Hi Ladies, I am back for a bit of advice please..I saw my G.P today after finally receiving the follow up letter from the NHS Gynae consultant I saw 6 weeks ago re some light bleeding on conti hrt which had ceased when I stopped the hrt. ( all scans,examinations etc were normal) Having been off hrt now for about 10 weeks and been suffering all the usual miserable symptoms of withdrawl I was very keen to resume,hoping to perhaps try a kinder hrt-patches or gel plus Utrogestan.
I was worried my G.P would not want to prescribe this as we had already spoken about the Guidelines for over 60's and I knew she wasn't keen. The consultant had referred me back to her care so now it was down to her! Well, armed with the info from this website and the advice I have gleaned from the very wise Hurdity et al I managed to persuade her to let me try Estradot patches 25 mcg and Ultrageston capsules 100 mg.. I was so relieved!
But..this is the lowest dose,which she insisted on,and I am worried it wont be enough..also on the pack it says I have to take the ultrogestan every day for 25 days of my cycle..but as i do not have a cycle does that mean continuously? - and should I expect some sort of bleed?...I am confused! I also mentioned to her that I thought you could administer the Ultrogestan as a pessary ( which i preferred the idea of) but she said that is only in the 200mg..is this correct?
I have only been given a months supply of medication and have to go back and see her again to monitor things but I feel it was a bit like the blind leading the blind..any advice gratefully received!
Diamond and pearls x
-
Hi Diamonds and Pearls
Great that your doc has prescribed this for you!
The standard advice is to re-start on the lowest dose to see if you are symptom free on that. This happened to me. I came off HRT when my doc changed me to Evorel conti 2-3 years ago, because the Cyclogest I had been using was giving me migraines. It didn't agree with me (the Evorel) so I stopped HRT completely. When my symptoms came back after 3 months she suggested 25 mcg which worked for a while but then not completely so I went back to 50 mcg. (I recently reduced to 37.5 mcg in the summer because of the bleeding but again have gone back to 50 mcg which works like magic for me!).
The standard dose for continuous Utrogestan - ie those who are post-meno - is to take it for 25 days out of 28. I'm not sure of the reasoning here but it could be just to ensure there is no lining build-up. If there was then reduction in progesterone (on the three days) would cause a small bleed. In practice many women are prescribed and use Utrogestan continuously. You are very unlikely to get any thickening on that dose of estrogen and Utrogestan.
Re the vaginal use. In the UK it is not licensed for vaginal use as part of HRT, but the 200 mg is used vaginally for fertility treatments. The company leaflet (translated from the French) though, states that vaginal use is an alternative to oral use for those who suffer side effects. However I can't imagine one would want to use it all the time like this if in a sexually active relationship! I have never taken it orally but it does seem to affect my bladder when I use it (11 days in 6 weeks now) so this would be annoying all the time - but we are all different of course. Many gynaes prescribe it vaginally in UK for women who suffer side effects from oral progesterone.
Also it is generally accepted by many gynaes ( due to some studies) that less is needed when used vaginally because it is absorbed straight to the uterus where it is needed, so for example it may well be that 100 mg used vaginally for 11-12 days per month would be sufficient to keep the lining thin - but you may well get a small bleed in this case.
I hope this explains and is helpful - and good luck and hope you feel better very soon!
Hurdity x
-
Hi Hurdity,
Thanks so much for your prompt reply and your invaluable information-I now feel reassured that I am on the right track! I just hope it works for me as I have been feeling so miserable. Just one more thing though..I also mentioned Oestrogel to my G.P as a possibility instead of patches and she said she did not think she could prescribe it but gave me the name of a specialist consultant at our local NHS trust so that I could enquire whether it was in fact available. I was quite surprised when she said this as i know lots of ladies on here use it-do you think it's down to cost in my particular area?
Diamonds and pearls x
-
Diamonds and Pearls I have worked in the NHS and General Practice for years yes Oestrogel is availble my Pharmacist always has it in stock. Its the Utogestan that is prescribed less.
I would persue the Oestrogel I can't see why it would an issue. I did speak to my Pharmacist today and ask him to get some Utogestan in as my GP has put a script in the post as its not something the Pharmacist ever has scripts for but he always has loads of Oestrogel in stock. Its a village Pharmacy and only one village Surgery my GP is a colleague elsewhere near my partner.
-
Just wanted to let you know that Oestrogel should definitely be available through your GP - I used it for many years. It's great because you can adjust the dosage to your requirements very easily. Oestrogel is on the list under HRT preparations so, if you want to try it, print off the info on this site and take it to your GP.
Good luck DG x
-
Hi Ellie and Dancing Girl. thank you so much for your replies-I did think it was strange that she 'wasn't able' to prescribe Oestrogel-I can't help thinking it may be down to cost.
Ellie, I shall have a word with my pharmacist and see if they stock it-they had to order in the Utrogestan but it came the same day so no problem.
Dancing Girl,you were one of the ladies I was thinking of when I asked about it as I remembered you saying how great it had been for you. I have to go back to my G.P. for a progress report so will take the printed info with me and show it to her..honestly why does it all have to be such a battle?!
Happy New Year to you both ..I am certainly hoping for a happier one!
Diamond and pearls x
-
Hurdity, another question..sorry..re the Utrogestan, although the prescription dose is for 25 out of 28 day, the advice on the patient information leaflet is to take it from day 15-26 and I see a lot of other ladies on this site seem to do this. Is this because I am post meno and the shorter time period is if you still have a cycle? I am a bit worried too because I took my first tablet last night and then was wide awake and buzzing for the next 2 hours or more..this is most unlike me and I never experienced it on the combi hrt tablets.. very disturbed sleep too.. any ideas?
Diamonds and Pearls x
-
Diamonds I am Perimenopausal so yes that is why I am on 15-26 day regime. I prefer a cycle anyway to know where I am at. So even if I was postmenopausal I would continue as I am. Your choice really Hurdity correct me if I am wrong? :)
-
Thanks Ellie, my G.P didn't explain dosage to me at all..and I was so glad to get the prescription that once I had it in my hand I shot out of the surgery as fast as possible! Tbh I am not sure she knew anyway as she had to keep referring to her medical book. .but she is very young..sigh!
Diamonds and Pearls x
-
Diamonds I agree so good you got the prescription we are knowledgeable here. If you are concerned emailed Dr Curry for £15 to check dosage. I agree re your GP run out of the door and keep a low profile ;D
-
I may do that Ellie..will just see what Hurdity says first, she usually knows, thank goodness! Yes, I felt it was touch and go re the prescription-the G.P actually suggested anti depressants instead as they were'less dangerous' ( due to my age ) but I was determined and she reluctantly agreed..but have only got a months supply so am praying I do not have any bleeding or she will probably insist I come off again.
Diamonds and pearls x
-
Hi Diamonds and Pearls
Here is the information from the SPC (summary of product characteristics) for utrogestan 200 mg and 100 mg:
http://www.medicines.org.uk/emc/medicine/19896/spc
The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on day 15 of the cycle and ending on day 26). Withdrawal bleeding may occur in the following week. Alternatively 100 mg can be given at bedtime from day 1 to day 25 of each therapeutic cycle, withdrawal bleeding being less with this treatment schedule.
If you look at the information on this site (ie MM) you will see the same information - with the 200 mg given days 15-26 ( or 12 days per month ) if you are peri-meno, and 100 mg for 25 days out of 28 if you are post-meno (ie half the dose for a longer time period)
http://www.menopausematters.co.uk/to_progestogens.php
In practice as I think I've said elsewhere, many women are prescribed it daily when post-meno without the 3 days break. It would probably be best to take as prescribed, and if it suits you after a few months to check whether you have any bleeding on this regime, you could try taking it continuously - but perhaps mention to you doc if you do.
RE ellie's point - I am the same, as are others on here. Post-menopausal but choose to continue with a cycle even though I am 60. In fact as I went onto HRT before I was post-meno but was almost 54 the doc never changed my prescription and I didn't know (by age 57) that I didn't need to have a cycle, as I hadn't bothered to read up on it until the regime I was on caused me problems!
Hopefully you won't get any bleeding but sometimes this does happen initially on conti HRT and especially changing to a new type!
Hurdity x
-
Hi Hurdity,
Thank you so much for your reply,that makes things much clearer..I shall follow the regime as prescribed and adjust accordingly if I have any bleeding. Out of interest,do you know why it is suggested you take the Utrogestan at night, if taken orally (can see why if taken vaginally) as I felt wide awake when I first took it -unless that was my imagination!..but it took me ages to get to sleep!
Diamonds and pearls x
-
Diamonds I am wide awake when I take it too :) If I use it vaginally it gives me a sore fanny so this would not be any use :safe: hehehehe ;D
-
Ellie !!!...Lol :)
-
I think most women find Utrogeston makes them drowsy and dizzy so it's best to take at night - however there are some exceptions - everyone is different! DG x
-
So ladies, especially Hurdity if you are around.. apart from the wakeful bedtimes,how long before I should feel a positive difference re my hot flushes and low mood? I have been on and off the low dose tablet hrt in the past and used to feel a difference within a few days whenever I restarted. This time, so far, nothing..in fact hot flushes especially as bad as ever. As I haven't used this combination before I wasn't sure what to expect.. I know it's only been a few days but just longing to feel better..
Diamonds and pearls x
-
I'm sure Hurdity will be along soon to advice but you have been given a very low dose of oestrogen and I think this will take a little longer to build up in your system to relieve symptoms. DG x
-
Thank you Dancinggirl, That is what I am hoping :)
Diamonds and pearls x
-
Dancing Girl I would say if you are still having hot flushes you are not having enough oestrogen. You may need to up the oestrogen. I found my hot flushes creeping back on 2/10 Femston but gone with 3 or 4 pumps of Oestrogel.
-
Hi there diamonds and pearls - there are lots of other women on here who know about this too! Dancing girl has answered your question - it's the side effect of drowsiness which means Utrogestan is recommended to be taken at night. So if it wakes you up and that's the only symptom then maybe take it in the morning! Bizarre effect though - since it has a sedative effect - but maybe 200 mg is a bit too high for your metabolism or something ( really have no idea here...). Perhaps the metabolic byproducts (after going through the liver) are keeping you awake? I know it wakes me more in the night but that's because it affects my bladder, - I still wake feeling more tired than otherwise when I have the utrogestan, and that's even when taking it vaginally.
I think you only started on 31st which is Tues - it is a low dose of oestrogen but it is early days to notice a difference. You can't say the dose is too low yet I would have thought. After stopping HRT for 3 months I went back onto 25 mcg patch which did eventually stop flushes - I began to notice after a few days), but then they started to return ( over a longer time - several months) so went back to 50 mcg.
As you are the same age as me and well post-meno, you have almost no oestrogen of your own so as Dancinggirl says it may well take longer, so personally I would stay on the 25 mcg patch for a while longer and see how you feel - I really would expect you to notice some difference soon - but we are all different!
Hurdity x
-
Thank you Hurdity for your advice..and Dancinggirl and Ellie too. :) Hurdity, it is just that as you are on the same regime you were the first person I thought of to turn to for help!
In the pack instructions it says to change the patch at night time and to take the Utrogestan at the same time but perhaps I will swap to mornings If I continue to feel so wide awake..I am only on 100 mg of Utrogestan at the moment so goodness knows how awake I will feel if the amount is increased! ( as I imagine would be the case if I were to be given the next strength patch?)
Hopefully the flushes will begin to abate once I have a bit more oestrogen in my system,as has been suggested. I guess things calmed down more quickly with the pill hrt as the dose was higher ( even though it was classed as low dose) Fingers crossed!
Diamonds and pearls x
-
Hi Diamonds and Pearls
Here is the information from the SPC (summary of product characteristics) for utrogestan 200 mg and 100 mg:
http://www.medicines.org.uk/emc/medicine/19896/spc
The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on day 15 of the cycle and ending on day 26). Withdrawal bleeding may occur in the following week. Alternatively 100 mg can be given at bedtime from day 1 to day 25 of each therapeutic cycle, withdrawal bleeding being less with this treatment schedule.
If you look at the information on this site (ie MM) you will see the same information - with the 200 mg given days 15-26 ( or 12 days per month ) if you are peri-meno, and 100 mg for 25 days out of 28 if you are post-meno (ie half the dose for a longer time period)
http://www.menopausematters.co.uk/to_progestogens.php
In practice as I think I've said elsewhere, many women are prescribed it daily when post-meno without the 3 days break. It would probably be best to take as prescribed, and if it suits you after a few months to check whether you have any bleeding on this regime, you could try taking it continuously - but perhaps mention to you doc if you do.
RE ellie's point - I am the same, as are others on here. Post-menopausal but choose to continue with a cycle even though I am 60. In fact as I went onto HRT before I was post-meno but was almost 54 the doc never changed my prescription and I didn't know (by age 57) that I didn't need to have a cycle, as I hadn't bothered to read up on it until the regime I was on caused me problems!
Hopefully you won't get any bleeding but sometimes this does happen initially on conti HRT and especially changing to a new type!
Hurdity x
Hi Hurdity
You actually covered some questions I was about to ask.... you must have been reading my mind...lol...
I'm currently following the same routine that (I think) you are still following which is 200mg x 12 days x vaginally every 2 months, but frankly I'm getting tired of having a period even if it's only every 2 months. My period isn't that dramatic. It's heavy-ish maybe on day 2, but it's then pretty light for maybe a total of about 4-5 days.
As you may remember, I am also tapering my diazepam dose (now down to about 0.6mg, but still got a few months to go. It's a slow process....), and I now find that I'm less frightened of taking the Utrogestan because it doesn't seem to be giving me any problems, even taking the 200mg. Prog can be a benzo agonist (or vice versa), so I think that is why I had trouble with it when my diazepam dose was higher.
My problem is that Utrogestan STILL isn't available on prescription in Australia, so I have to obtain my supplies by other means (shhhhh). So, even though my doctor knows I'm using it, I can't ask her any questions because she's not experienced with it at all. So I need to rely on you (and the other ladies here) to give me the latest thinking on Utro dosing.
I have been toying with the idea of taking Utro continuously (to avoid a period), but I wasn't really certain what would happen during those 3 days when you stop taking the 100mg. So two questions..
1. Would it be acceptable, do you think, to just keep taking 100mg everyday without taking a break at all? (You did mention that above, but I just wanted your expert opinion).
2. Doing the vaginal thing isn't too much of a drama, but when it's everyday I'm wondering if I would get pretty fed up with that too. I've never taken Utrogestan orally, but I'm wondering how successful others have been taking it this way.
-
Hi Dana
Sorry I missed your post - when I am not on the forum for a couple of days sometimes I don't catch up as it's always the most recent ones that come up! When you've done a few more posts you'll be able to send me a pm if you want to get in touch!!
I used to be on a 2 monthly cycle but when I had the bleeding (actually found to be due to an ectropion) and they found a thickened lining after a scan I reduced to a 6 weeks cycle. Now that really is a pain, taking Utrogestan that often and then the bleed week. I didn't mind the 2 months, so tentatively thinking of going back to that - maybe a week at a time and see how the bleeding goes.
Glad to hear Utrogestan seems to be suiting you though - many women are finding this even after problems with other synthetic progestogens. How frustrating that this product nor anything similar is not available in Aus - is there no-one putting pressure on the authorities (whoiever decides this is Aus?) to introduce it? I am sure buying it is cheaper than paying to go to a private practitioner and being prescribed compounded progesterone which I presume is what many have to do in your position?
Re taking Utrogestan continuously without the 3 day break, I don't think my opinion is especially expert and I haven't taken it like that. However there are definitely some members on here that do - hopefully they will come forward, and are prescribed it like this by their GP - or perhaps it is just the specialist gynaes, private or otherwise.
However there is a paper about a small study in 2005 of a group of 30 women using gel (1.5 mg Sandrena) and vaginal progesterone 100 mg alternate days which showed this was effective in preventing endometrial thickening. Although it was a very small study and can't say how you would react, it is a promising result.(unfortunately can't attach it)
I would suggest you try the 100 mg daily vaginally and see how you go when you stop for the three days maybe? Personally given the above I would imagine in most post-menopausal women without other problems ( eg fiibroids) and especially if not very overweight, there is more than enough progesterone when used vaginally. If oral use requires 100 mg daily then I can see that alternate days for vaginal use could give the same dose to the uterus if not more.
Re daily vaginally use - I wouldn't do this - it's certainly no good for sexually active relationships anyway! Also it does affect my bladder so have to get up a couple of times in the night.
Re oral use - I think that question got lost at the bottom of your post as it was probably directed to others - but if you do a search there will be lots of threads about utrogestan. If you want some thoughts from current members why not start a new thread on this specifically?
There is also another recent thread I think with utrogestan in it - something like Estrogel and Utrogestan support group so do have a look at that one too.
Hope this helps and good to have you on board with the utrogestan/bio-identical HRT crew - there are more and more of us I'm glad to say!
Hurdity x
-
Thanks for the reply.
The latest I've heard about Utro's availability in Australia is from the Aust Meno Society, but they said "There are sometimes mixed messages so we have not heard yet if there are any developments on this issue". I have no idea what that means, but they have given me a contact for a pharma company that has a particular interest in hormones, so I'm going to contact them to see what they have to say. I think it all just becomes a bit political TBH. I don't mind getting it from my sources, but I just feel sorry for other Aust women who don't even know that a non-synthetic, non-compounded prog is even available.
I did try the alternate day routine quite a while ago, but never had much luck with it because I was still getting some break through bleeding even after a few months. Maybe I needed to give it more time though, but patience is not my best virtue..lol....
With my current cycle of Utro, I've now done 7 days x 200mg with no ill effects, so I may just stick with this routine for the foreseeable future. If I was to go to the continuous routine I don't think I would like to use it vaginally because it can get a bit messy after a while.
OTH, I'm not sure how I feel about taking it orally either. An American friend of mine is taking 100mg Prometrium orally every day and seems to be doing okay. I guess I'll just have to try it to see how it works. Once this cycle is finished, it might be a good time to try some experiments.
-
Am feeling anxious..have been doing well on 25 mcg Estrodot patches with 100mg Utrogeston and my symptoms have been much reduced (I started this on Jan 1st after an enforced break from my tablet hrt whilst bleeding issues were investigated)As scans etc proved clear my GP reluctantly allowed me to resume hrt and I chose to follow the patches plus Utrogeston regime, largely on the advice from ladies on here.
So far so good, until tonight when I noticed a slight pinky discharge...just like before...and my heart sank.
I take the Utrogestan for 25 out of 28 days but am only on day 20 so don't understand why this might have occurred,especially as the oestrogen dose is so low.. any thoughts anyone? Am feeling so down- I really don't want to have to come off hrt and I am scared my G.P will insist I do ,especially in view of my age.(60)
Diamonds and pearls x
-
I think you have mild breakthrough bleeding caused by the Utrogestan.I wouldn't worry because all your scans etc have been fine and since then you have only been on a very low dose of HRT.
My experience of Utrogestan is that I start bleeding before I've finished the 10 days per long cycle ( usually on day 9) This is I think due to the poor absorption- it's not well absorbed orally so you can get some dips in the levels in the blood stream which could initiate a bleed.
When I took Norethisterone ( for 5 years) I didn't bleed until 3 days after the last tablet, each cycle.
I am now trying another regime with Utrogestan because I had severe period pain with the last couple of long cycles. My gynae has suggested taking 100mgs 21 days per month, or 15 days if I have side effects. He did suggest I could take it every day to prevent any bleeding but I prefer to have some sort of period - as long as it's predictable and this is yet an unknown for me with the new regime!
I hope that I may be able to tinker with this a bit and maybe go back to 5 or 6 week cycles rather than monthly. Like you I am wondering if this will bring on any breakthrough bleeding.
What you have is, I'm sure, just some breakthrough bleeding due to the absorption .
Re. your previous query over the prescribing of Oestrogel- if you ever wanted this and your dr refuses, you could try asking them for a private prescription. (NHS drs can give these.) You could then buy the Oestrogel and the cost may not be much more than the prescription fee. I pay for all my own HRT as it's a private prescription and the gel is about £9. This includes the pharmacist mark-up and dispensing charge.
-
Hi D&P53 -when on continuous HRT, as you are, it is very common to get some spotting of even a bit of breakthrough bleeding, so I really wouldn't worry. If you get prolonged bleeding then this needs to be investigated. As your GP is so against HRT in the first place I wouldn't rock the boat by rushing in with the slightest worry - just adds fuel to their opinions.
I had a Mirena and Oestrogel for over 4 years - I had tried various other conti HRTs. All the conti HRTs I tried gave some break through bleeding for the first few weeks or months and with the Mirena I had breakthrough bleeding and then spotting for about 5 months before it settled down. I always got the occasional spotting, as you are describing, at various times.
If you taking the 25 of 28 day regime of Utrogestan I believe it is not unusual to get a bit of a bleed after the break of Utrogestan - but as suggested by other, the absorption of the Utrogestan can sometimes vary so could cause some spotting.
Don't worry. DG x
-
Hi Sarah,thank you for your reply, I sincerely hope that it is just breakthrough bleeding-it is just the teeniest bit of pink,not even enough to stain a pad but it is there when I wipe. I will see how I go after the 3 day break from Utrogestan which is in 4 days time. I am not going to rush back to the GP as I feel sure she will insist I stop hrt (due to the dreaded age 60 cut off) and I have only just started to feel relatively normal again...
Interesting to hear about your experience-I had thought about long cycle but when I mentioned this to the GP I was met with a blank look..sigh..I do hope your new regime works well for you,I would like to take less Utrogestan but it does not look likely now if I am having signs of a bleed on such a low dose of oestrogen.To be honest I shall be grateful to be able to continue in any form as i was an emotional wreck without it!
Thanks for your advice re Oestrogel-I did enquire further and my GP sought advice and confirmed I would be able to have it prescribed if I wished.I hadn't pursued it as I'd been doing well on the patches-until now! It may be another avenue to consider though.
Diamonds and pearls x
-
Hi Dancinggirl, Thanks so much for reassuring your advice-I am just paranoid about being told to come off hrt and as you say, any excuse where most GP's are concerned, especially for the over 60's!
I shall wait it out a bit and hope it settles down. I have only been on this regime for 10 weeks so I guess it is early days.It just seemed odd that it happened 4 days before the 3 day break instead of during or after.Oh well,I shall try to stop worrying and hopefully things will settle down.
Thank you again for your reassurance.
Diamonds and pearlsx
-
Hi Diamonds and pearls
How long were you off HRT before starting this regime and sorry I can't remember what you were on before?
As others have said you can get spotting initially with conti HRT although your oestrogen dose is very low so there is much less likelihood of any build-up. Personally also I would have thought a drop in progesterone levels should not cause bleeding on a conti HRT, unless the lining is building up, in which case more progesterone is needed. (Bleeding on a conti implies that the there is lining to shed and therefore the progesterone is not doing its job!). However I don't know the reason for the initial bleeding commonly encountered when starting conti HRT as this does seem to settle eventually if you are post-menopausal.
I hope you don't mind my asking if it happened after sex or just out of the blue? I also can't remember what they looked for when doing the investigation? In my case last year I had all these investigations which were also clear and gynae decided it was due to the cervical ectropion and wonder whether your cervix was looked at too?
I am sure it's nothing to worry about but I would monitor it and go back to the doc if it happens again. There is no reason to stop HRT if there is actually nothing at all wrong!
Hurdity x
-
Hi Hurdity, I was off hrt for 10 weeks and this was my 3rd experience of bleeding-very minor every time, and all checks-smears,swabs,transvaginal scans plus a good look at the cervix by a consultant proved normal. Gp had thought she could see an erosion on the cervix but the Gynae consultant said not so no need for a Colposcopy.No explanation could be found except that it was the hrt. I was on Indivina conti tablet hrt (low dose) and had been for the past 4 years.The first time it happened, about 14 months ago, it was after intercourse (had to stop hrt and it stopped quickly) but the following 2 occasions it just appeared.The second time I didnt stop taking hrt and it stopped after 2 weeks but the 3rd time the Gp said I must stop and again bleeding stopped after 2/3 weeks.
Every time my lining was very thin,last time ,less than 1 mm so I can't believe I have any significant build up..must confess this time-and last-have felt quite' hormonal' too when the bleeding started -tender breasts and my bra feels tight.
I battled to stay on hrt and feel so anxious that if this continues I will have to come off it. And I can't go any lower re the dose I am on either.I just really hope it is a settling in period as life without it was miserable.
Diamonds and pearls x
-
Strange isn't it?
It doesn't seem like oestrogen breakthrough bleeding if the lining was thin, but equally I would be surprised if you bled due to temporary fluctuation in progresterone levels if the lining hadn't built up. It's certainly beyond my understanding - but the most important thing is that you have been checked out and all is OK.
I think I mentioned elsewhere that my doc at the surgery gave me some norethisterone to take once a year to "strip" the lining in case it built up on the Utrogestan - but so far I haven't taken it.
It seems we all react differently....
Try not to be anxious and make the most of how much better you feel if you can, and hope it settles soon!
Hurdity x
-
Hurdity, neither the G.P nor the consultant could give me an answer as to where it was coming from.. just said it was the hrt!I just looked back at my diary and last time it took just under 4 weeks for it to stop, and 3 of those weeks I had been off the hrt on GP's orders. It was never anything more than a faint pink stain and never increased in quantity..very strange.Don't know how long to leave it before seeing the doctor if it doesn't stop..I know what she will say and I'm all too aware that this will be the end of my chance to take hrt... I know this sounds ignorant but what actually causes a bleed? ..is it the oestrogen or the progesterone..if its the prog could 100mg over 25 days be a bit too much when paired with only 25 mcg Oestrogen? or am I grasping at straws?
Diamonds and pearls x
-
One small thought- could it be vaginal atrophy?
Are you sore?
Reason I ask is that it is possible for the vaginal walls to bleed very slightly through small tears, or just chaffing of the thin tissues. This can show itself as a stained discharge.
The amount of oestrogen you are using now may well be too low to restore vaginal health to pre-meno levels unless you use topical HRT too.
I think your dr is being unhelpful if she wanted to take you off HRT because of this spotting. The cause needs to be found and it may be nothing to do with HRT.
It's the reduction /withdrawal of progestins that cause a bleed. Too much however can I think also make the uterine lining too thin and fragile and it can bleed that way .
You could as an experiment reduce the progesterone next month to 12 x 100mgs days in a cycle and see how that goes but you would have a bleed perhaps.
-
Thank you Sarah..actually this time I do feel a little sore and today have felt my bladder is a bit irritable..lots of visits to the loo.When I saw the consultant (the first time) he did say there was a very slight indication of VA but no more than he would expect for someone my age. Have never had any problems before though.
I don't use topical oestrogen but was thinking of asking for it as a precaution..will definitely do so now.
As I mentioned, I did wonder if the 100 mg Utrogestan was too much to balance out the oestrogen and as my lining is so thin (less than 1 mm when a had my last transvaginal scan in Nov) perhaps your suggestion of bleeding coming from fragile uterine walls could be the answer? I also feel a bit like I used to when I was premenstrual-headachey,sore boobs etc...I imagine that's the prog too?
I would like to try your suggestion of reducing the prog but don't know if I should do this without seeing my GP- and I am scared to see her in case she says that's the end of hrt without yet more investigations.I'm afraid the Consultant I saw had no answers either and just wanted me off it as I was 60... It's a dilemma!
Diamonds and pearls x
-
Hi again
Just to clarify re your question about what causes the bleed and Sarah's reply - it's not just a question of "the bleed" - I think I posted elsewhere that there are lots of reasons for abnormal bleeding - including those mentioned by Sarah2, vaginal atrophy, ulceration of the enodmetrium caused by too much progesterone, and progesterone withdrawal bleeding. There is also oestrogen breakthrough bleeding (too much oestrogen caused by over thickening of the uterus lining), and oestrogen withdrawal bleeding (caused by sudden reduction in oestrogen levels) - where the lining is sufficiently thickened to have something to shed. There are other causes of course, like certain abnormalities so there is no way of knowing which except by testing/investigation.
When you had the scan which showed the lining to be 1 mm, did the consultant look at the surface - ulceration causes by too much progesterone would be visible? Here is some information I found about progesterone breakthrough bleeding:
Progesterone breakthrough bleeding occurs when the progesterone-to-estrogen ratio is high, such as occurs with progesterone-only contraceptive methods. The endometrium becomes atrophic and ulcerated because of a lack of estrogen and is prone to frequent, irregular bleeding.
You did say yours is just a streak/spotting - whch was all mine was really (spotting).
I agree with Sarah2 that many of us need topical oestrogen as well as full HRT - I do, and I am on a higher oestrogen dose than you - I have never experienced true VA in that sense though. I would have thought though, that you would be aware of soreness, irritation etc if your VA was so bad to cause bleeding - but I have no experience of this! Certainly worth asking for topical oestrogen as this can only do you good!
So frustrating not to have consensus amongst consultants, because mine ( who investigated my bleeding with hyesteroscopy) said he was quite happy for me to continue, which has really made me feel positive about it all, especially as I'm 61 in May eek! If only women did not have to spend our time worrying so much about this crucial part of our lives.
You really need a proper consultation with a specialist to advise on whether to reduce the progesterone, or conversely increase the oestrogen - which is the other option - especially if you are still experiencing symptoms).
You could always have an e-mail consultation with Dr Currie - giving her a brief run down of your history and what the investigations showed and mentioning your worry re the GP/consultant, as you have done on here, and then ask the question as to what she would advise - eg re some of the suggestions given here. It costs £25.
Hope this helps!
Hurdity x
-
Thank you Hurdity for your very detailed answer-now this is the kind of in depth response I would have liked to have received from the last Consultant I saw..but no,he just glanced at the transvaginal scan ( done by a radiographer ) and said it was obviously a fibroid -which I had been previously informed by a different Consultant (and a Radiographer) was small,calcified and redundant!When I mentioned this he changed tack and just said it was the hrt and I must come off due to age.He did not comment on the surface but of course I was about 6 weeks off hrt by then so presumably the surface would have recovered from too much progesterone anyway?
You are lucky to have found a supportive Consultant Hurdity,I have felt like I am banging my head against a brick wall on several occasions. I may well email De Currie and see what she advises.. hopefully my GP would pay attention to her recommendations.
As always your input has been informative,thanks so much for your support.I will keep you posted..
Diamonds and pearls x
-
Hmm more of a bleed today..this time more bloody but still only appearing when I wee /wipe.Wonder if I should stop the Utrogestan early? (Due to stop for 3 days on Sat) and see if that makes a difference..or should I just carry on and see what happens? Feel so conflicted!
Diamonds and pearls x
-
Sorry to hear this Diamnonds and Pearls.
I would continue to take the Utrogestan as directed.
Interesting that you do have a fibroid but I wonder if they suddenly become "alive" again with stimulation from oestrogen?
Hope it doesn't develop into a proper bleed! How frustrating and disconcerting for you.
Hurdity x
-
Thanks Hurdity, I think you are right-better not start 'tinkering' with the dose at this stage..no further developments so far but am anxious every time I visit the loo! Just hope everything settles down..out of interest, on your long cycle regime how long does your bleed usually last and is it fairly predictable?
Diamonds and pearls
-
Hi Diamonds and pearls.
My withdrawal bleeds on HRT have always been completely predictable - always 1-3 days after stopping the progesterone, usually 2 days. They are usually about 5 days long and not very heavy. So far (last 7 years) I know exactly what's going to happen and when - I'm lucky, I do realise. I just hope the small fibroid they found last year ( they weren;t worried) doesn't grow but consultant didn't seem bothered about and I am sure I would soon notice! I have never tried longer than 2 months though, but I never head any breakthrough bleeding on this regime - just the post-coital spotting due to ectropion.
Hopefully yours will clear up soon!
Hurdity x
-
Hi Hurdity,
The long cycle regime sounds tempting, especially as you only have to take the prog every couple of months..how many days do you actually take if for? I wouldn't think you need to worry about the fibroid,and yes I am sure you'd notice if there was any activity.
The good news is my bleeding has stopped!-I won't celebrate just yet but perhaps it was just to do with absorption or the balance of the two hormones.Funnily enough it stopped after I had applied my new patch and the PMT type symptoms have subsided too..I will see what happens and sincerely hope that things will settle now but I can't help wondering if the dose needs tweaking..
Diamonds and pearls x
-
Spotting is normal in the first few weeks or even months of HRT and hopefully in your case it will settle.
I take 200 mg vaginally for 12 days per 7 weeks (ie the 12 days is within the 7 weeks). This is based on the fact that you probably need less than half the dose vaginally that you do orally because so much is lost to digestion when taken orally.
On the oral dose you take 12 days of Utro after 16 days of oestrogen only (50 mcg patch). If using vag then double the oestrogen only days (because as above you probably need no more than half the dose - then this gives 12 days Utro after 32 days oestrogen = 44 days which is just over 6 weeks. I've rounded up to 7 and I'm sure this is ample for me. I would be getting breakthrough bleeds and a thickened lining if not and if this happens I might reduce to 6 again.
We are all individual and I don't have any major abnormalities in my uterus (well I didn't last year) so I am hoping for the best! There is no knowing whether this will work for you but you are on a low dose of oestrogen so you need even less progesterone to oppose it.
Hurdity x
-
Thanks for that info Hurdity, so if I understand you correctly you can only do the long cycle if you take the Utrogestan vaginally? Otherwise, if you take it orally, it is a monthly cycle with the prog being taken for 12 days each month? And on 25 mcg would I still be on 100 mg Utrogestan? Sorry to ask so many questions but I need to be clear if I speak to my GP as she didn't know much at all and had never heard of it being used vaginally when I mentioned it.
I really hope things will settle down for me as I was quite happy with the way things were, but it's good to have all the options available in case I have to go back to my GP.
Thanks again for all your advice,
Diamonds and pearls x
-
D&P
Sorry to butt in, but no that is not the case with vaginal use=long cycles only.
In the UK it isn't licensed for vaginal use except as part of fertility treatment I think ( though in France it can be used for HRT vaginally) but some women use it this way with the agreement of, or on the recommendation of their specialists.
I have been using Utrogestan for around 9 months as long-cycle progesterone, taking 200mgs x 10 days every 8 weeks- orally. My specialist was happy for me to use either route ( he is very familiar with the drug) but as I already have bladder sensitivity I prefer the oral route.
The reason some women prefer to use it vaginally is that the absorption is better sometimes.
I think I mentioned on this thread or another one that I started bleeding on day 10 rather than 2-3 days after stopping it ( each long cycle) which made me think the absorption was erratic. My dr did tell me that Utrogestan can give erratic bleeding- I was warned in advance!
I am now trying a different type of cycle due to bad period pains- won't bore you with the details- but a shorter cycle and 100mgs Utrogestan over more days.
-
Thanks Sarah, I am learning all the time! I guess a shorter cycle with Utrogestan being used vaginally (plus a bleed) might not be to everyone's taste each month..whereas 10 days every 2 months plus a bleed isn't so bad..I am not sure what to do- I have still got a bit of pinky discharge on and off,just like the beginning of a period,and I feel pre menstrual too.Will hang on and see if things settle down,if the absorption is poor maybe that's the problem. On the website it says this type of regime can take up to 6 months to settle ..I really hope it hurries up!
Diamonds and pearls x
-
Hi Diamonds and pearls
That's exactly it - most would not want to use vaginally that often - for me 12 days in 7 weeks is more than enough!
Re the dosage - the licensed dose is 200 mg x 12 days per 4 weeks orally. As I've said already, if not on this thread, then on another, any major deviation from the licensed dose needs to be done carefully and under medical supervision. I doubt whether any NHS doctor would agree to 200 mg x 10 days orally every two months, because this is more than 3 times the length of time on unopposed oestrogen than the licensed dose. Personally I wouldn't want to be on this dose - well I would, but wouldn't countenance it!
If you are under a private gynae then as I've said before you can have access to regular scans to check for endometrial hyperplasia - but of course once you've been prescribed the hormone you can do as you like - but with caution and vigilance if you are on NHS as many of us are on here.
Hopefully it will settle soon!
Hurdity x
-
Hurdity and D&P- just to clarify- the dose was 200 x 10 days on an 8-week cycle- so the bleed was after 8 weeks, not after 10 weeks. I suppose the correct way to describe this is a 6-week cycle. However, I am 'allowed' to take that amount every 6-8 weeks and I trust my gynae to know what he is doing - he's aware of the hyperplasia risks.
I think this is the same or similar to several women on the forum who are deviating from the licensed 12 days from days 15-26 as a monthly regime?
John Studd recommends 100mgs x 7 days (700mgs in 4 weeks) over a 4 week cycle. 200mgs x 10-12 days ( 2000mgs) over 8 weeks ( bleed week 8 ) is more than double that amount.
I don't know how other people access repeat prescriptions because I have to contact my gynae for a prescription each time I need more. He will check my notes of what I had when. He prescribes 2 months at a time and does a review every 6 months, in person. The Utrogestan are dispensed in a way that I am given pretty much the amount needed ( adding in a few extra sometimes depending on how they are packaged) because I have to pay for each tablet, rather than a pack, though sometimes a pack is needed.
-
Thanks Hurdity and Sarah..I really appreciate your patience in trying to help me..I do find it all rather daunting and confusing-it was so much easier to just pop a pill with my old regime but of course that's not an option now! just one more thing..as my dose of 25 mcg estradot is so low do you think 200mg prog taken orally over 10 days would be too much? Would love to try the 7 day 100 mg dose that John Studd recommends, and that Sarah mentions..but don't think my GP would agree somehow!
Ladies, thank goodness you are there to advise me,it makes me feel less alone in all this,thank you!-will doubtless be back with more questions!
Diamonds and pearls x
-
My honest answer is- I don't know! It does sound a lot but then I am using around 1mg or less of Oestrogel daily which is a low dose too- equivalent to a 37mg ( mcg?) patch.
How are you planning to do this- are you going to go to your dr and ask or are you going to adjust the dose yourself?
-
Sarah, I don't think I had better self medicate-I shall persevere for a bit with the conti regime and hope things settle. If not,and the bleeding /discharge continues I shall have to go back to my G.P and ask her about adjusting the dose. I may also consult Dr Currie ( as Hurdity suggested in an earlier post) and see what she recommends. I just want to find a way of staying on hrt, if I possibly can!
Diamonds and pearls x
-
Sarah - if you are taking 200 mg progestogen for 10 days in 8 weeks then it is an 8 week cycle. Regarding how much you are prescribed, as you are under a private gynae so yes you can be closely monitored. It is still less in 8 weeks (2000 mg) than the licensed amount for 4 weeks (2400mg), I agree this might be excessive for some doses but it needs to be done under medical supervision as you do.
Also I have to re-iterate that John Studd recommends 7 days of 100 mg progestogen (Utrogestan) in his discussion about progesterone intolerance. I repeat that anyone who is seeing him will have the benefit of regular private scans for which they will pay, to check the womb lining. I would not suggest any woman just decides to do this without medical supervision and if she cannot afford regular (annual) scans. Also since the amount of progesterone to oppose the oestrogen building up the womb lining, is dose dependent - this 7 day x 100 mg dose can't possibly apply to all doses of oestrogen! Nor does he distinguish (well on the section of his website I was looking at!) between oral and vaginal use which will make a considerable difference to absorption and action on the womb lining.
Having said all of this Diamonds and pearls, you are on a low dose of oestrogen compared to most women on HRT, and therefore will need less progesterone - other things being equal, so it may be sufficient.
I think you will find Dr Currie will recommend continuous combined HRT, but perhaps if you consult her, give her your reasons for wanting to be on a cycle and see what she says. Hope it is all successful!
Hurdity x
-
Thanks again Hurdity, I am more than happy to stay on the continuous combined hrt but just want to eliminate the bleeding..if Dr Currie were to advocate that I continue with this do you think she would advise an increase in the oestrogen or slightly less progesterone?
Diamonds and pearls x
-
Hurdity- I'm confused! if you yourself take 2400mgs for a 6-7 week cycle then is that not less than the licensed amount because you are not having a 4-week cycle where it's taken from day 15-26 every 4 weeks? Apologies if I've misunderstood what you have said.
If I take 200mgs x 10 days after 6 weeks ( bleed follows roughly 12 days later) than that surely is a 6-week cycle the same as you are doing?
I don't think my dr prescribes on the basis of always having scans. obviously they are available as required, but not as routine if there is no need, he's very aware of the risks of hyperplasia and we discuss the best balance to try to achieve. Would you be unhappy on the dose that I am on?
-
Aaaaagh!
The cycle is the total number of days of oestrogen added to the total number of days of progesterone! If you take 6 weeks of oestrogen + 10 days progesterone = cycle of 52 days which is about 7 1/2 weeks. In the menstrual cycle Day 1 is the start of bleeding, Day 29 the start of the next bleed and within that 4 weeks you have had the oestrogen and then the O and P....
If you look down at my post to Diamonds and Pearls about 12 below this one I explain the difference between the vaginal dose vs oral. There is no licensed vag dose in UK for HRT as you yourself pointed out. I explained how I arrived at what I take and is based on research I've read re absorption. I don't have the refs to hand. I've read about this over the last 3 years.
During the discussions with Diamonds and pearls we have been very careful to distinguish between oral and vaginal doses, and I have explained my dosage and the reasoning carefully. Please don't confuse the issue Sarah!
Re the 7 days - this is what the British Menopause Society and Women's Health Concern Paper says and it relates to progesterone intolerance:
One of the main factors for reduced compliance with HRT is that of progestogen intolerance........
The dose can be halved and duration of progestogen can be reduced to seven to 10 days to minimise progestogenic side effects.
This may result in bleeding problems and hyperplasia, so there should be a low threshold for ultrasound scanning and endometrial sampling if clinically indicated.
Re your Q Diamonds and pearls - I appreciate your asking me and I try to help based on my limited knowledge, reading and experience, but Dr Currie is a top gynaecologist and I would not remotely begin to presume what she would advise! I said what I did because I had a consultation with her last year and this is what she advised me - based on my circumstances. Let's just hope for your sake that the bleeding stops !
Hurdity x
-
Hurdity, I really do appreciate all of the help and advice that you have given me.I should have realised that my question was an impossible one for you to answer-sorry! I will wait a little longer and as I said earlier, I won't adjust the dose without medical advice but will probably have to go back to my G.P if things don't settle down soon.I have my 3 day break from prog starting tomorrow so it will be interesting to observe whether anything changes...we will see!
-
Am feeling really despondent today, still got bleeding on and off and its now a week since this started..not sure how long I should leave it before going back to my GP. I feel sure she will just follow the guidelines of sending me for tests again, and will not be open to adjusting the hrt. Don't know what to do for the best.
Diamonds and pearls x
-
Hi D&Ps 53 - Not sure if this will be of any interest/relevance but thought I'd let you know anyway, if anything by way of comparison of another type of long cycle regime.
I'm highly progesterone intolerant and have attended a London hospital meno clinic since 2009 trying different types of HRT - and have been searching for a bearable long cycle regime.
As we know, we're all different (I'm 51, 7 years post meno, suffer with migraine too since meno which complicates things further) and have been on this regime for a while now:
* HALF Estraderm patch 25 x twice weekly.
* Vagifem 10 x twice weekly.
* Utrogestan 100 x 12 every six weeks, vag route.
(I also take a range of supplements including fish oil and magnesium.)
I usually have no withdrawal bleed or just something slight. I can't bear to have bleeds and did when I was on higher estrogen and didn't feel any better with the increased dose.
My symptoms are not too bad on this low dose trickle of estrogen however I do suffer when on the dreaded Utrogestan. For me it's the Least Bad Option (often discussed on here for those of us who are prog intolerant).
On this very low dose of estrogen, the clinic still insist on TWICE yearly scans.
I hope you manage to find a suitable regime.
Night_Owl
x
-
Hi Night Owl, thank you for your message, and for details of your regime.I am actually on a conti regime at the moment of 25 mcg estradot patch 2x weekly and 100 mg Utrogestan daily for 25 out of 28 days. This is a new regime for me after having to stop my tablet hrt due to investigations for bleeding issues (3 times in the last year and which stopped each time I came off hrt) All proved normal but the consultant wanted me to stop hrt due to my age (60) However he agreed to refer me back to my GP'S care and I persuaded her to let me try the separate oestrogen and prog hrt as this was recommended on here.However 10 weeks on and the bleeding has started again.
I am not sure whether a long cycle regime would be better..I was just looking at options.To be honest I suspect my GP will strongly suggest that I come off hrt altogether this time.
Your dose of oestrogen is very low,do you find that is enough to control meno symptoms-hot flushes etc, also how does the Utrogestan affect you in the prog phase-does it make you feel very premenstrual?
Do you mind saying which London meno clinic you attend and do you find them sympathetic? They are obviously very thorough if they insist on twice yearly scans on such a low dose of estrogen! I was wondering about asking my Gp for a referral and am in SE London myself so your clinic might be one i could consider.
Many thanks for the information,it is interesting to see how different everyone is!
Diamonds and pearls x
-
Diamonds if you are in London could you afford a private menopause appointment? Or even hop on a train out of Paddington to see Dr Annie Evans http://www.drannieevans.com/ You can also Skype, email or call her.
It may be worth paying for one or two appointments privately to get this sorted out. Dr Currie is obviously too far but Dr Annie Evans seems very like minded and progressive with regards HRT.
-
Diamonds there is also Marie Stopes in London http://www.mariestopes.org.uk/Womens_services/Menopause_check.aspx
-
Thanks Ellie,yes I am considering a private consultation if things don't settle down. I may send Dr Currie an email to get some advice from her as a first port of call though. I hadn't thought of Marie Stopes..will have a look there too, thanks for the links.
Diamonds and pearls x
-
Dr Currie is great for email but if you need a prescription perhaps Marie Stopes or Dr Annie. I live commuter area to London my male GP is lovely he is a colleague but if I need more expert "girlie/female discussion" advice I think I will hop on a train to Dr Annie :)
-
Ladies,you have been great with your advice thus far,but just one more question before I think I shall have to go back to my GP. I am still bleeding on my 25 mcg estradot patch and 100mg Utrogestan pill.It ebbs and flows but after an almost clear day yesterday it has returned today and is more bloody with come little 'stringy' clots as well..I felt ok yesterday, until I applied a new patch, and after that started to feel very anxious, emotional, PMT-ish and generally unwell.This has continued today, plus hot flushes and the extra bleeding which was very depressing to see.
So..has anyone else experienced this on such a low dose hrt? I was on low dose tablet hrt for 5 years previously but it never made me feel like this..quite the opposite in fact! I don't understand, I'd have thought the oestrogen would make me feel better,not worse.. is it possible that this combination just does not suit me? I am wondering whether to ask my GP for the very lowest dose tablet hrt as I just feel I am getting no benefit from this regime.of course,in the light of the bleeding,whether she will agree or not is another matter!
-
Not on a patch but yes on Femston 1/10MG until it was increased to Femston 2/10mg. I think the dose could be too low.
-
Ellie, I would need a conti hrt though as I am 4 years post meno..I feel so confused I don't understand why I should carry on bleeding with such a low dose of oestrogen and why it should have stepped up after a changed the patch..unless that's coincidence. All I know is that the combination is making me feel quite unwell now,The first 2 months were ok and most of my flushes were relieved.but now I am starting to feel almost as bad as when I was off the hrt altogether.
Diamonds and pearls x
-
Exactly how I was and my Femston was upped to 2/10MG.
-
Ellie that's interesting..but I doubt my GP would increase my dose in view of my age..she was pretty reluctant to prescribe the low dose due to my previous bleeding issues.I will see what she says though.
Diamonds and pearls x
-
It may be worth a second opinion from Marie Stopes as your GP does not seem supportive. They can prescribe too. The fees should be reasonable as they are a charity. HRT on a private script does not cost a lot.
Also Margaret Pyke the NHS Contraceptive clinic offers HRT too. They would be free.
I think you could be on the wrong dose as it works at first they stops working. You could try sequential I believe Hurdity says there is no reason not too. I shall stick to sequential like Hurdity so I know where I am :)
-
Thank you Ellie, all useful info.I am not sure what to think but at least I have some options. I will discuss sequential hrt with my GP too and see what she says... I just want to feel better!
Diamonds and pearls x
-
It can take 6 months for a conti regime to settle down, especially with Utrogestan. But your oestrogen levels may to be too low as well which is why the bleeding is coming - or, you are not absorbing the utro very well and that is why you are bleeding.
You don't have to have conti HRT post meno- some women choose to have a sequi regime. Many GPs though are a bit reluctant to deviate from the 'rules' though.
-
Just a quick update, I have seen my GP and as I had anticipated she has asked me to come off hrt as I am still bleeding on this regime. I was also feeling progressively unwell and It seems likely that this was caused by the conti Utrogeston. She has, however, agreed to refer me to a Menopause clinic to see if there is a solution to my bleeding problems so I have not quite given up on trying to find a way to stay on hrt post 60..
Diamonds and pearls x
-
Hi Diamonds and pearls
Thanks for the update and sorry to hear you have been asked to come off HRT, and that you have been feeling unwell on the continuous progesterone (sadly you may well be one who is intolerant) but great news that your GP is referring you to a menopause clinic!
I hope you manage to find a solution and the clinic is able to find out the cause of your bleeding problems. Do keep us posted and hope you are feeling better.
Hurdity x :)