Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: florriepeck on April 21, 2021, 03:26:44 PM
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I'm currently on Evorel 75 patches and utrogestan 2 capsules every day: my menopause specialist GP changed me to this 6 weeks ago from Evorel 100 patch and utrogestan i capsule daily, due to recurrent bleeding.
Bloods showed oestradiol levels to be lower than GP would like ( this was after 4 weeks of 75 patch).
I'm waiting for a pelvic ultrasound.
Still bleeding intermittently: not heavily, more of a brown discharge, but so inconvenient, and with the aching legs/ joints of a proper period.
I have to contact my GP in another month to let her know how I'm getting on.
Anyone else had this unpredictable bleeding?
I only have a week or so bleed-free, then it starts up again.
I'm 57. I started originally on 50 strength patches, and wasn't bleeding on them, but vasomotor symptoms were not controlled.
Would appreciate any advice.
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Bleeding is not considered abnormal for the first six months of a continuous HRT regime. How lon in total have you been on a conti HRT?
Taz x
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First started 11 months ago
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It sounds like a classic case of the progesterone dose ( especially if only 100 mg taken orally) being insufficient to protect the uterus from a higher dose of oestrogen - in your case 100 mcg patch. Docs don't normally test oestrogen levels and should go by symptoms although private menopause docs always seem to ( and charge for them!).Interesting that it was your GP who talked about your oestrogen levels.
At your age unless they are very low and you are taking HRT for oesteoporosis then actual oestrogen levels are irrelevant as long as the dose is controlling your symptoms. In your case it wasn't hence the incrrease - but 100 mcg is a big jump from 50 mcg!
Good that you are having a scan to check the thickness of your womb lining and then you will be able to take it from there depending on the outcome eg you could maybe have fibroids or something else causing the bleeding maybe?
There is a possibility that the bleeding is from a natural ovulation but less likely at your age and also depends on what your (natural) periods were doing before you started HRT?
Let us know how you get on!
Hurdity x
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If you had bleeds before hrt and it feels like a period I think it's likely it is. Some women are in their early 60s before the reach meno and a late meno seems to be more common that doctors think. Despite being told by a meno specialist everyone was meno at 54 I still had pretty regular periods before going on hrt at 57. If you weren't meno before you went on hrt you might be better with a sequi regime.
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So, my NHS letter appointment came through quickly, and I'm going for a pelvic ultrasound scan this week ( and it says in the letter probably a transvaginal scan, too?).
I'm still bleeding on more days than not, still continuing on Evorel 75 patch and 200mg utrogestan.
I'm going to e mail my menopause dr ( Newson) after my scan and let her know how I'm getting on.
I don't know if I'll be given any information at the scan appointment re endometrial thickness, so that I'll be able to tell menopause dr in my e mail.
Hopefully, womb lining will be okay, but then I don't know what the next HRT step could be.
I didn't have much bleeding when I first started on Evorel 50 patches, but symptoms weren't quite controlled.
I know that people have worse problems to deal with, but the persistent bleeding is really getting me down.
Anyone know what could be considered as more suitable HRT?
I'd like to be thinking ahead of what Newson dr might suggest, so that I can read up on it.
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The scan may give you the answer to the bleeding. Do ask any questions when you're there, they told me how thick my lining was but only when I asked. If they don't find anything to explain the bleeding you might consider a mirena which will usually stop it.
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So I’ve been for the scans and my womb lining is 5.3mm.
Newson dr has said that it being over 5mm means that I may need a hysteroscopy.
I’m speaking to her tomorrow about her suggestion of changing my utrogestan to provera 5mg daily short term to control this bleeding.
Does anyone have experience of a situation like this?
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At your age unless they are very low and you are taking HRT for oesteoporosis then actual oestrogen levels are irrelevant as long as the dose is controlling your symptoms.
Hurdity x
I use mine for Osteoporosis, do you know what strength I should be on or where I can find the info. Thanks
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I had continuous bleeding for over 12 months and had the pelvic ultrasound and hysteroscopy which showed everything was normal. I was advised to have a mirena coil when I had the hysteroscopy and it was the best thing I ever did. The heavy bleeding stopped within a few days and I just had an Evorel 50 patch for the oestrogen. I hope you get sorted soon x
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At your age unless they are very low and you are taking HRT for oesteoporosis then actual oestrogen levels are irrelevant as long as the dose is controlling your symptoms.
Hurdity x
I use mine for Osteoporosis, do you know what strength I should be on or where I can find the info. Thanks
Your serum estradiol level needs to be at least 350pmol/l for bone protection. The strength of the product is irrelevant as women absorb oestrogen differently from different products, so you need a blood test to find out if you are achieving the right level.
JP x
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GP won't do this test
At your age unless they are very low and you are taking HRT for oesteoporosis then actual oestrogen levels are irrelevant as long as the dose is controlling your symptoms.
Hurdity x
I use mine for Osteoporosis, do you know what strength I should be on or where I can find the info. Thanks
Your serum estradiol level needs to be at least 350pmol/l for bone protection. The strength of the product is irrelevant as women absorb oestrogen differently from different products, so you need a blood test to find out if you are achieving the right level.
JP x
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Update, I'm to continue on Evorel 75 patches and utrogestan 200mg daily for now, and GP has referred me for a hysteroscopy, and said that I should hear from local hospital within a week.
She advised me to request sedation for the procedure.
I've been reading on NHS website that it can be done under a GA if you prefer: which I think I would!
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I had my hysteroscopy done under GA and had no problems at all. Good luck!
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That’s reassuring: did you have to ask for the GA?
I’ve been reading some horrendous accounts of women having the procedure without, and I think I’d be tempted to not have it done if that was the case.
Maybe it depends on area or dr: I’ll wait for my letter I suppose.
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That’s reassuring: did you have to ask for the GA?
I’ve been reading some horrendous accounts of women having the procedure without, and I think I’d be tempted to not have it done if that was the case.
Maybe it depends on area or dr: I’ll wait for my letter I suppose.
I mentioned to the consultant who did the ultrasound, she was more than happy to note it on my file. A lot of women ask for a GA.
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They should offer a GA as an option when you go for your pre-op. They also discussed having the mirena fitted during my appointment. There is no way I would have done it without. It’s all done very quickly and you don’t know anything about it 👍
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Thank you, I'll be sure to ask for the GA.
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So I’ve been for the scans and my womb lining is 5.3mm.
Newson dr has said that it being over 5mm means that I may need a hysteroscopy.
I’m speaking to her tomorrow about her suggestion of changing my utrogestan to provera 5mg daily short term to control this bleeding.
Does anyone have experience of a situation like this?
Mine was 5.5 mm and I had to have a hysteroscopy 1 year ago. However when it was actually done, the lining found was do scanty (doctor's choice of word) that they couldn't take a sample for a biopsy. I am not convinced that it was ever necessary. I was sure that the bleeding was caused by the Evorel conti.
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So I’ve been for the scans and my womb lining is 5.3mm.
Newson dr has said that it being over 5mm means that I may need a hysteroscopy.
I’m speaking to her tomorrow about her suggestion of changing my utrogestan to provera 5mg daily short term to control this bleeding.
Does anyone have experience of a situation like this?
Mine was 5.5 mm and I had to have a hysteroscopy 1 year ago. However when it was actually done, the lining found was do scanty (doctor's choice of word) that they couldn't take a sample for a biopsy. I am not convinced that it was ever necessary. I was sure that the bleeding was caused by the Evorel conti.
How long did your bleeding continue?
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Katejo, I really think that my bleeding is caused by the Evorel too and that it would settle down in time. I’m thinking that if no GA is available I don’t want that ordeal and might just decide to refuse the procedure and wait and see
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Katejo, I really think that my bleeding is caused by the Evorel too and that it would settle down in time. I’m thinking that if no GA is available I don’t want that ordeal and might just decide to refuse the procedure and wait and see
Hi Florrie,
I’m in the same boat. Was on evorel 100, but persistent bleeding. I did have a hysteroscopy without GA and it was absolutely fine. Slight cramping during one part, but no where near as horrific as some experiences. I would thoroughly recommend the procedure for peace of mind as they can literally see EVERYTHING on the screen and it can rule out so many things too. Mine was clear to the eye but still waiting for biopsy results ( no news is good news and all that!)
I am currently waiting for an appointment with a menopause specialist on the NHS, but in the meantime am seeing a private specialist in a couple of weeks as I just need sorting out.
A change of progesterone might just sort things out for you?
Ablation procedure maybe?
Best of luck, I know how awful the bleeds can be.
Xxx
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Katejo, I really think that my bleeding is caused by the Evorel too and that it would settle down in time. I’m thinking that if no GA is available I don’t want that ordeal and might just decide to refuse the procedure and wait and see
I changed to evorel conti Feb 2020 and have on and off bleeding thoroughout. I had an episode of extreme bleeding last summer and was referred on the 14 day pathway. The scan showed a fibroid (which they weren't concerned with) and a lining of 5mm. I was told I needed a hysteroscopy because the lining was above the cut off and I asked for sedation as I get very anxious during gynae proceedure. I was told they didn't do this and was sent home with what felt like a telling off for not having it done. It was a horrible experience and I felt a failure. Anyway my daughter got in touch with a patients liason person who spoke to the consultant on my behalf, who subsequently offered me a general anaesthetic and an appointment with a very down to earth doctor who outlined the risks of the 5mm lining (being low) and the risks of the proceedure (also very low). I was not keen to have it done as I didn't think it was necessary and negotiated a scan for 6 months later to check. At this follow up the scan the lining was within normal limits but because of ongoing bleeding they still suggested a hysteroscopy. As numbers of covid were so high I wasn't keen, so again put it back and scan was arranged for early May which I have just had and am waiting to hear. Two weeks before the scan I again had days of flooding episodes. I am now contemplating having the hysteroscopy under general anaesthetic and possibily having a mirena at the same time as I can't cope with the continued bleeding. Its a shame as I get on well otherwise with evorel.
So I would say sometimes you have to be really clear about what you want. It is really intimidating when doctors are forceful and appear aggressive, but you do have choices and can walk away and negotite something later. Good luck.
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Florriepeck - am I misreading it that you are taking 200 mcg every day? I guess you are under specialist care, but generally that's the dose for sequential, not for conti....see https://www.menopausematters.co.uk/to_progestogens.php. It might be that you are not suited to conti yet, or that you could drop the dose to 100mcg if taking it daily. As I say, might not be relevant to your current issues but thought I'd question it at least....
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Yes, I'm taking utrogestan 200mg every day, and have been doing so for nearly three months now ; I'm under care of Newson Clinic.
Their dr has advised me to continue on this increased dose for now, as she said it can take a few months for it to bring the bleeding under control.
I've had my hysteroscopy, and everything was normal.
Was nervous about having it done, as I'd read some horror stories about it being a painful and distressing procedure, but it was fine, and only slightly uncomfortable; just took paracetamol and ibuprofen an hour before procedure.