Menopause Matters Forum
Menopause Discussion => Personal Experiences => Topic started by: Kittyjay on November 07, 2015, 09:01:20 PM
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Hello helpful ladies. I'm a bit concerned so I hope for some good advice as usual. I've been using estradot 75 and 12 days of utrogestan vaginally for 12 days a month. As I've suffered with horrendous bleeds, (debilitating pain and sooo much blood), I asked the gp for a longer cycle to suffer less with the bleed time. He's put me on a 3 month cycle of 10 weeks estradot then 2 weeks of 200 utro. This is my last month of monthly bleeds before moving to 3 monthly.
For the first time ever I've had a really light bleed with hardly any pain so I'm now panicking that the lining hasn't shed properly and I'm about to start the new regime, and not have another bleed for 12 weeks.....do u think my concern is justified or should I think 'lucky me' for this month and look forward to a nice long stretch of estradot only? Any ideas/advice greatly appreciated. Many thanks, Kitty X
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Just a bit more info in case it helps.... I'm 44 diagnosed early meno at 41, on hrt since to protect heart/bones due to my ageX
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I can only give you my experience, but in all honesty this was why I gave up using Utro. Even though I was using the correct amount vaginally, and monthly, it never gave me more than a very light bleed (more like spotting sometimes). I have now settled on using Provera which works a lot better for me. For the first couple of months it gave me very heavy bleeds and cramping which would seem to have been it removing the built up lining, but now I have no problems with it at all. This is something that a lot of people don't acknowledge with Utro, but it is reported here...... http://www.menopause.org.au/for-women/information-sheets/34-bioidentical-hormones-for-menopausal-symptoms.
Progesterone is very rapidly degraded in the human gut, liver and circulation so it has been difficult using oral therapy to maintain a level of progesterone sufficient to inhibit hyperplasia or prevent cancer in the endometrium. Progesterone can be absorbed through the skin but the amount circulating after a measured amount of progesterone cream has been applied to the skin, is insufficient to have any effect on the endometrial cells. There is some evidence that progesterone can be absorbed through the vaginal epithelium and through the buccal mucous membrane, but at present there are no reliable studies available to confirm that the amount absorbed from this source has a protective effect on the endometrium.
With Utro it is very important you keep an eye on how well the lining is being shed. Like I said, this is just my experience and many people will probably disregard what I've posted because Utro appears to be the preferred choice on MM, but you have to make your own decision through consultation with your doctor.
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Hi Kittyjay
Had you actually reached menopause at 41 ie last period 12 months previously, or were you peri-menopausal? This makes a difference in relation to the variation in bleeds. HRT does not control your cycle which still carries on in the background to some extent and ovulation can takes place. If you are still peri-menopausal then some of the bleeding will be due to your own hormones/oestrogen as well - and you will have been producing your own progesterone if you ovulated. If you have been having regular good bleeds on the 75 mcg patch with 12 days 200 mg utrogestan per month vaginally - then this shows it works well for you. If you are peri then your own cycle may have weakened.
If you are well post-menopausal then I can't explain it!
That amount of utrog used vaginally is quite high ( although there isn't a defined oestrogen dose to correspond with vag utro dose) - so maybe this month you didn't have much of your own oestrogen and the utro dealt with the HRT oestrogen very effectively. As a different example to Dana, I use the same amount of vag utro on a 2 monthly cycle ( ie 12 days of utro on the first of every alternate month) and I use a 50 mcg Estradot patch. This gives me a good bleed and I am early 60's
Re the long cycle - personally I wouldn't go straight to a 3 month cycle on that level of oestrogen - because you could end up with breakthrough bleeding in between. Some gynaes are not that keen on 3 month cycles for this reason and increased risk of hyperplasia too. Is it just the GP suggesting this or have you been to a specialist gynae/meno clinic? If it were me I would gradually increase - first to 6 weeks for a couple of cycles or so, and then to 8 etc and see what happens to your bleeds.
Dana's quote rightly points out the dangers of using progesterone cream for endometrial protection - in Australia they don't have micronised progesterone as we do herein UK, and in Oz women are forced to use creams or buy from the internet if they want to use progesterone. However this does not apply to the UK, Europe or US where micronised progesterone is licensed for use. In UK it is licensed for HRT orally only, but for fertility it is licensed for vaginal use - since it goes directly to the uterus. In France it is licensed for vaginal use for HRT and there is scientific literature bearing out its effectiveness. Many gynaes in UK prescribe it this way because it is actually a more effective way of getting progesterone to the uterus, since orally much is lost to digestion.
I agree with Dana though, that once you increase your cycle length - especially if you went straight to 3 months - I would have regular scans (whatever progestogen you are using) and your doc should only be prescribing a long cycle if s/he is prepared to monitor your uterus lining for you. Since you are having an early menopause they should permit this - since you have to take oestrogen for much longer than the rest of us!
Hope this helps :)
Hurdity x
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Thanks to you both for your great replies. I feel I need to read through in more detail again but wanted to say thanks in case I don't get back on here tonight! I do feel unsure about the 3 month regime- seems a long time so I think I'll try 6/8 weeks firstly. It was purely my gps idea and after the awful bleeds etc I bit has hand off for a longer absence of a bleed! But on reading more I'm not so sure ....
Hurdity at 41 I hadn't had a period for 6 months and doc did blood tests - fsh was late 70s so he said I was post meno! (Previous fertility treatments had shown prem ovarian failure too...)
xx
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The quote I posted wasn't only talking about progesterone cream.
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I do feel unsure about the 3 month regime- seems a long time so I think I'll try 6/8 weeks firstly.
Sounds like a good plan - at your age you want to be able to have as high an oestrogen dose as you can that makes you feel good.
Good luck with it and keep us posted :)
Hurdity x
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Stellajane - I know! I've always had really painful heavy bleeds on utrogestan hence why I wanted them further apart as they are awful 😟 I too take it vaginally with the applicators given (when I took 100 on days 1-25 I didn't get applicators and much prefer to use them vaginally with the applicators that come with the 200 ones) - just my preference though!
Hurdity- thanks for your responses- I will try something midway between 1 and 3 months for now and see how it goes. I really like both parts of my hrt - just need to find the right space of time for the utro.
Thanks again ladies xx