Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: meno-mel on July 14, 2023, 01:44:41 PM
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Hi, I've just settled on a new HRT regimen of Estradot50 and Utrogestan (12 days a month), it's been about 4 months and seems to be ok and it's reduced my night sweats to maybe three a week, but the other night I was drenched three times in one night, it varies a lot.
On the utrogestan part I felt quite confident too which was nice, less anxiety. I still have periods and I'm booked to have a scan 28 days after my last period started to measure my uterine lining and only if it's not too thick, I'll be allowed more oestrogen.
I have really heavy periods every month, as they have scheduled it to be at it's maximum, I wondered what is the maximum that it's allowed to be?
I had it measured 20 years ago at 6mm mid cycle if that is relevant.
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Hello meno-mel
I have been post meno for a long time and a few years ago I was told that anything above 4mm needed to be investigated. At that time my lining was 4.9mm so I had a hysteroscopy and all was fine. About a year ago I had a scan that showed a lining of 2mm which the consultant said was just right for my age etc.
I am sure other ladies will be along to advise you but I think a lining above 4 mm prompts scans etc.
I hope this helps you and take care.
K.
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Are they trying to measure it at it's thickest or thinnest? It's normally the thinnest measurement that concerns them and should be 4mm (some say 5 if on hrt) after a bleed. Can be up to 16mm just before from your own hormones, not sure if there is an allowable max on hrt but surely this is also going to depend on how much oestrogen you produced yourself that month (and in peri huge spikes are possible).
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Are they trying to measure it at it's thickest or thinnest? It's normally the thinnest measurement that concerns them and should be 4mm (some say 5 if on hrt) after a bleed. Can be up to 16mm just before from your own hormones, not sure if there is an allowable max on hrt but surely this is also going to depend on how much oestrogen you produced yourself that month (and in peri huge spikes are possible).
It was confusing, she mentioned that they wouldn't be able to know what it was just after shedding if the scan was just as my period was due to start and I agreed with her.
But they control the entire timetable. It's taken me 3-4 months to nudge my periods to where the HRT clinic want them to be, so I can take my utrogestan on their appointed days without messing up my cycle. It's up to them when they scan me. It all seems very deliberately done to measure it at its maximum, so I'll not be impressed if they compare that to a chart of minimum measurements!
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As suggested, it really does depend on where you are in your cycle ........ this should be obvious but was explained to me as I hadn't given it a thought ::)
5-6mm if taking HRT B4 flags are raised. Fibroids may well cause problems with small blood loss when aggravated by hormones.
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I had a polyp for years which bled on contact, my Gynae wanted to remove it ...... ASAP even though it was non sinister. I declined. It shrunk away at peri ::)
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If there's any possibility they'll stop your hrt if it's too thick I'd be tempted to take utro early and hope you bleed before the appointment (appointment on day 5/6 for choice).
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If there's any possibility they'll stop your hrt if it's too thick I'd be tempted to take utro early and hope you bleed before the appointment (appointment on day 5/6 for choice).
This is what I'm afraid of. When they gave me the appointment I was having my period at the very start of the calendar month, they told me they wanted me to try to nudge it into the following week or 2, middle of the calendar month. It's easier for them if all their ladies are synchronised. So I did that using utrogestan and luck. Now my period is the middle of the month. It's annoying they told me to do that without considering whether it was a good idea or not for me!
I'm not sure I can bring it back in under a month because my body really doesn't care when I take utrogestan, I'll bleed before it, after it, during it, whenever my body wants but always with 24-34 days in between bleeds.
So if I take utrogestan early, say 24th July to 4th August, then I might have my period early too and pass their thickness test.
Or I could just go with a really thick lining and watch them panic as I say "I told you so". I'm sure they don't want to make unnecessary referrals either, maybe they'd do a repeat in a fortnight?
I'm only getting a scan because I bled regularly all last year on conti regimens, even though I thought I was post meno having completed the period free year plus some, without being on hormone treatments.
By October they decided to refer me for post meno bleeding, it's a long wait if I turn it down, so I won't do that.
I woke this morning in floods, emptied my 30ml menstrual cup three times so far this morning and still running to the loo urgently as well. I've period cramps, not too much nausea and feel wiped out. This is my third heavy period since the end of May, my first since switching to the much more effective for me, Estradot50 and it's the heaviest in a while.
I'm guessing it's heavier because I'm getting more oestrogen out of Estradot50 than Evorel50, that's how it feels.
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Hello meno-mel
I have been post meno for a long time and a few years ago I was told that anything above 4mm needed to be investigated. At that time my lining was 4.9mm so I had a hysteroscopy and all was fine. About a year ago I had a scan that showed a lining of 2mm which the consultant said was just right for my age etc.
I am sure other ladies will be along to advise you but I think a lining above 4 mm prompts scans etc.
I hope this helps you and take care.
K.
Hi Kathleen,
Do you still have bleeds with your HRT?
It's the part I find most confusing. I don't bleed any more naturally, but every time I go on HRT I have a monthly 5-day bleed exactly like a period and no breakthrough bleeding in between.
I know my mum gave up HRT around the age of 60 because she was fed up bleeding every month.
But it seems some people, in fact many people, can use HRT without bleeding, even with an intact uterus.
I don't know if there is an HRT that won't make me bleed.
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I had a scan 18 months ago and mine was 2mm and apparently that's normal for my age. I'm 65.
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Hello again ladies.
meno-mel. - I don't have periods or regular bleeding with my HRT and my last natural period was thirteen years ago.
Since starting HRT in 2013 I have had breakthrough bleeding when my oestrogen dose was too high or when beginning a new regime after a break.
I have had a few investigations and each time the bleeding was attributed to the HRT as no other causes could be found. As I say, I don't bleed usually and my current regime is one 1mg sachet of Sandrena gel daily ( this is the equivalent of a 50 mcg patch or two pumps of Oestrogel) and a 100mcg Cyclogest pessary for the progesterone part which I use on alternate nights.
I hope this is helpful and take care.
K.
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Maybe consider a mirena to control the bleeding?
Yes it’s comparable to marmite, but In the main, it does a grand job of maintaining the womb lining.
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Hi Meno-mel
I am a bit confused. Sorry I haven't followed your story as I'm a bit sporadic on the forum these days.
However - how old are you and are you definitely post-menopause?
If you are not post-menopause and your natural periods are breaking through the hRT cycle then scanning won't be able to tell you very much. If you are post-meno then as already said, the only time to have a scan is immediately post bleed so your lining is at its thinnest. This of course is tricky eg last scan I went to was something like 7 or 8 days after a bleed and it was 9 mm. Cue hysterosocopy and biopsy etc (no problems found).
How dare the clinic control how you take your progesterone - I mean artificially try to regulate your cycle if your body is saying not!! I mean surely there must be leeway on when you can have a scan? Is this NHS or private? If private then they have to c hange it. If NHS just say that date is not convenient and then reschedule for when you think you will eg be 7 days after day 1 of bleed.
There is also greater tolerance of lining thickness if on HRT, and especially if there is abnormal bleeding.
If you're having very heavy periods and are post-menopause then something else might be causing the bleed. If you are peri - and would like to increase the oestrogen then an increase in progesterone would also be needed, and in any case this may be beneficial to reduce the bleeding.
As Nas says, a Mirena should do the trick re bleeding ....
Hurdity x
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When scanned at a private hospital several years postmenopause, I was told (below) 4mm was the magic number & my lining was at that time 1-2mm on low dose cyclical HRT. The following year I had some mid-cycle spotting so was scanned at an NHS hospital post-withdrawal bleed on higher dose oestradiol & the lining was 6mm, which was way more than I expected. I was anticipating another hysteroscopy but to my surprise the sonographer said she thought that measurement would probably be deemed OK on HRT, especially as the lining was smooth & regular, with no evident abnormalities & sure enough, both GP & Gynae were happy with it & no hysteroscopy was required. That said, I was on the waiting list for hysterectomy, so perhaps they were more relaxed knowing the uterus was coming out at some point.
Wx
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When scanned at a private hospital several years postmenopause, I was told (below) 4mm was the magic number & my lining was at that time 1-2mm on low dose cyclical HRT. The following year I had some mid-cycle spotting so was scanned at an NHS hospital post-withdrawal bleed on higher dose oestradiol & the lining was 6mm, which was way more than I expected. I was anticipating another hysteroscopy but to my surprise the sonographer said she thought that measurement would probably be deemed OK on HRT, especially as the lining was smooth & regular, with no evident abnormalities & sure enough, both GP & Gynae were happy with it & no hysteroscopy was required. That said, I was on the waiting list for hysterectomy, so perhaps they were more relaxed knowing the uterus was coming out at some point.
Wx
Hi Wrensong, sorry to be nosey, but why were you having a hysterectomy if there was nothing abnormal?
Thanks for all the responses, it helps me think to get more viewpoints!
It's NHS and I went on the list in October for abnormal post meno bleeding, first appointment offered was in August and I thought it was deliberately on day 28, but the HRT nurse said no, they don't make their own appointments any more, it's apparantly more efficient to have scan dates booked by some guy miles away with no knowledge of when the scan needs to be :o
She said she didn't want to cancel the appointment I have, because after accepting it, I might not get another for months if I cancel.
I'm 53 and my GP told me I'm post meno because before HRT I had over a year period free. The HRT nurse says if I think my periods are periods and not breakthrough bleeding then I'm peri. This was sort of backed up by the fact for a year on conti regimens I bled five days a month and not inbetween times. I don't see how breakthrough bleeding could follow the cycle of periods unless it was my own body producing it.
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Hi meno-mel,
I had a scan with the NHS in June this year and was told that 4mm is normal and 5mm or above triggers investigation, although 5mm if you're on HRT is quite likely to be normal. They also look for how uniform the lining is.
Hope that helps,
Caroline
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I don't think there's any chance I'd be under 5 mm 28 days into my cycle, but at least they can check for other things like fibroids, polyps or whatever was causing me to bleed on conti all last year.
If they take Estradot off me, if my lining is too thick, maybe they'll give me tibolone instead? That'd be ok as well and I'm nearly 54 which makes a difference somehow to that decision.
I feel so bunged up, constipated since my period started, when usually it's the opposite happens.
I can't hold my wee, I was in the kitchen thinking I'll just fill the kettle, reached to turn on the tap and needed the loo urgently, it's twenty feet to the loo but I didn't make it and half an hour later I did the same thing, except I just made it.
It's too full down there, my tilted uterus is currently full but emptying, my bowel's full and the bladder is squeezed out of me.
I was ok on daily vagirux, but they aren't giving me enough now to make a difference, I'm stuck on two a week and doing lots of laundry.
Grumble, grumble, grumble, Sunday morning blues.
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Are you sure you haven’t got a fibroid pressing on your bowel/ bladder? This can cause constipation and an urgent need to wee.
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Meno-mel: various longstanding probs with progesterone, too involved to explain here.
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It isn't good enough that you are denied medication :bang: :bang: :bang: would they treat those with diabetes, heart conditions etc. the same?
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Are you sure you haven’t got a fibroid pressing on your bowel/ bladder? This can cause constipation and an urgent need to wee.
My constipation is definitely linked to my cycle. I've often thought it feels like my uterus has got so big that my bowel is blocked, that feeling is just before my period, then I sometimes get the runs for a day or two when my period starts.
Since my periods returned after the 14 month break we all thought was menopause, they have been fairly regular, but so very heavy.
I bleed loads and loads, 10ml an hour isn't unusual on the second day (I use a menstrual cup with measurements on it).
Maybe I do have a fibroid or something? Anyway, the bleeding was only "abnormal" after the first six months, so it's been happening the ten months I've been on the list for a scan, plus the six months before that when it was still "normal" because it's normal to bleed on conti during the first six months.
So this scan might be important I guess, as it's the first look at why I've had so much post meno bleeding for the last year and a half.
Now I'm just scaring myself!
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If using cyclical HRT it must be under 5mm immediately post bleed and with a continuous combined regime it must always be under 5mm.
Most private clinics will not tolerate anything over 4mm and often refuse to prescribe HRT if over that limit.
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I do felt constipated in the week prior to a bleed even if a period wasn't due.
Don't be too scared meno-mel. Nature can cause all kinds of female problems >:( ...... let us know how you get on.