Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Autumn27 on January 04, 2019, 04:41:09 PM
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Hi Everyone,
This is my first post, and unfortunately am feeling a bit desperate.
I have been on bioidentical HRT, for 7 years, under the supervision of an NHS Menopause Clinic due to liver issues and Bone density issues.
For the first time in August I had a bit of light bleeding. The clinic gave me an ultrasound, my womb was OK so they upped my Estrodot patches from 75 to 100. All seemed good, but then after a few weeks, bleeding started again.
A doctor I spoke to over the phone upped my micronised progesterone, from 100 to 200. I had a phone call appointment in a month's time.
In that entire month I bled more than before. I also didn't feel too good on the new regimen of continual high dose Progesterone and increased Estrogen. I was worn out by the bleeding.
That next month the clinic doctor told me to stop progesterone for 5 days to 'bleed out'. I then had 3 choices: change to synthetic progestin because it was stronger, have a Mirena Coil inserted, and if I didn't wnat that, then stop taking hormones.
Tbh none of these options appealed. She said I should now go to my GP to sort things out. As it fell over Xmas, I had to wait for an appointment for a whole month to this week before I could see a GP. The GP was anti HRT anyway and quite unsympathetic, hadn't read my notes, told me to stop taking hormones permanently and to try diet and exercise for the Osteopaenia. The GP said she couldn't prescribe progestin without knowing which type, that I had to go and ask the Menopause Clinic.
So I have to wait another whole week for access to Menopause Clinic docs. In the meantime
I have been bleeding on and off for almost 35 days in the past 2 months. I feel terrible, depressed and alone. I don't know what to do to stop the bleeding. It's now a full on, heavy period, raging away, my ovaries ache.
Any suggestions on any other way to stop this bleeding from anyone who has been in the same situation?
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Hi, I am so sorry you bare going through this. I completely sympathise. Having just stopped taking my HRT today because I am sick and tired of bleeding every few weeks, I decided I would stop and see where my body is at now.I'm 68 and have been taking HRT since I was 53. The last few years have been the worst with spotting/period pains/bloating/mood swings etc., ... I am praying my hot flushes don't make a reappearance and have bought some Red Clover because a lot of women say this alleviates the hot flushes. Also I'm looking into DHEA (google it). I do hope you come through this, someone once said 'mess with hormones at your own peril' sadly we are given this dose and that and some GP's are so unsympathetic .. please keep us posted on your journey. Sending you love and all the very best. x
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Hi Pat,
Thank you for your kind reply. I wish you all the best with your journey after stopping HRT. I am 55, and am worried I may have to do the same.
I've been trying to work out if it's the increased Progesterone that has made things worse, or the increased Estradiol. I'm tempted to stop the Progesterone for a few days again, but worried about the womb lining thickening. I just don't know what to do, and am in limbo. I was quite happy before on my long term dose of 75 Estradot and 100 progesterone, but a blood test in Oct revealed I had very low estrogen, hence breakthrough bleeding and the new prescription.
All this detective work is so tricky with no medical training, and the Menopause Clinic is oversubscribed, and it's a 4 month wait for a phone call appointment, never mind an actual appointment. GP's aren't up to date in HRT issues either, so aren't much help.
Best of luck Pat and thanks again. x
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You are welcome!! I'm going to try some natural routes and I willlet you know if they work! Fingers crossed for us!! xx
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Hello Autumn27,
Welcome to the forum and the menopause malarkey :welcomemm:
What are the liver issues, if you don't mind me asking? What happened to the osteopenia in these 7 years on HRT?
It's certainly frustrating but at least your womb scan was OK.
Conolly X
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Hi Autumn27
:welcomemm:
Firstly - have you been taking continuous combined HRT for these last 7 years ie Estradot 75 mcg + daily 100 mg utrogestan (taken orally?).
If you have been taking it continuously then whether you need extra oestrogen or progesterone will depend on the outcome of your investigations. If the bleeding was caused by overthickening then extra progesterone is needed, but if your womb lining was very thin then endometrial atrophy could have occurred - although this is less likely on 75 mcg Estradot if you were absorbing it, as well as taking the utrogestan orally.
If you're not absorbing the progesterone very well leading to a thickened lining then taking it vaginally is more effective - although this is not usually welcomed when on continous progesterone if you are in a relationship for obvious reasons and can also cause bladder irritation sometimes.
Also did the clinic say after the ultrasound - did you get a report fo the thickness - I am presuming it was overthing hence their increasing the oestrogen to 100 mcg?
I must say I'm a bit confused by your treatment! Increasing oestrogen would increase the likelihood of bleeding and spotting due to overthickening of the womb lining with insufficient progesterone - but I'm not clear why the oestrogen was increased in the first place :-\
Maybe you can clarify and then we can help further?!
Hurdity x
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Hi Hurdity,
Thanks so much for your message.
Yes, I have taken continuous HRT at 75 Estradot and 100 progesterone orally for the whole 7 years, after a few trial and errors at the very beginning.
The increase in Eostrogen was because I reported some minor bleeding a couple of months before, as well as sleep disturbance, foggy brain etc, and a blood test showed very low estrogen levels. The clinic thought I was not absorbing the estrogen properly, so they increased it to 100, and told me to move the patch to my behind, rather than the front of my lower abdomen.
4 weeks later I was given the Ultrasound, and a womb thickness of 4mm was recorded (that did not affect the already prescribed increased Estrodot). A regular DEXA scan also showed a decrease in bone density, having already been told I had osteopenia.
Bleeding started again, so a different doctor at the clinic, over the phone, increased progesterone to 200, to counteract the oestrogen she said. After a month of further heavier bleeding followed, and after another call, the doctor said the Utrogestan progesterone was not strong enough, and I should try Progestin or Coil. I felt terrible with the additional Utrogestan.
I decided to try taking the same 200mg micronised Progesterone vaginally to see if that was better, but 2 weeks later, no improvement at all.
If a higher dose eostrogen patch would increase bleeding, then maybe I should try going back to what I was on, 75 Estradot and 100 progesterone?
Thank you so much for any thoughts on this.
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Hi Connolly,
Thank you. In aswer to your question, the bone density has not improved significantly over the years with the Estrodot. It stayed virtually the same and there was a slight improvement, but in the past 2 years it decreased.
Re the liver, nothing serious, just some Hemangioma (benign cysts).
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If you have osteopenia and this is due to your not absorbing the oestrogen then you have no choice but to increase your oestrogen dose as recommended, rather than revert to 75 mcg, and to stop the bleeding you do need increased progesterone as advised. I can quite understand your not wanting to take such a high dose of utrogestan continuously due to the ongoing side effects from large doses.
One alternative is to take it cyclically eg 200 mg vaginally for 12 days per cycle - when you would get a predictable monthly bleed rather than random bleeding, otherwise as your clinic has suggested a stronger progestogen or the Mirnea coil. The latter would mean you could take whatever oestrogen dose you needed without the problem of bleeding although there can be some spotting for the first 6 months.
Hurdity x
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Hi Hurdity,
Thanks so much for taking the time to offer your opinion. If I did switch to cyclical Progesterone, could I stop the Progesterone now, to try and stem the bleeding? I have been on it now continually for 21 days. The last time I stopped 26 days ago, was after one of the doctors at the clinic told me to stop for a few days to 'bleed out'. The bleeding is heavy in it's 9th day, toilet bowl bright red kind of bleeding. Am exhausted and would do anything to make it stop.
I appreciate your help, as I have no access to a medical opinion for another 4 days, and just feel I can't go to work on Monday in this state.
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Hello Autumn27,
According to this review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941181/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941181/) it's a tricky situation, but increasing progesterone and/or oestrogen don't seem to work for unscheduled bleeding on continuous HRT, decreasing them would be wiser.
Maybe after 7 years on Estradot 75 and Utrogestan 100 daily, your postmenopausal body don't need that much anymore.
When you started HRT were you postmenopausal (12 months without bleeding)?
Conolly X
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Hi Autumn - it is not obvious what you should do - since the more usual reasons for bleeding do not seem to apply - ie womb lining settling down to continuous combined HRT, or excess of oestrogen to progesterone causing over-thickening, or the reverse leading to endometrial atrophy.
In your position I would go back to your specialist and push for a hysteroscopy so that they can take a closer look at your womb lining - just to really check all is OK (eg re abnormalities such as fiborids, polyps or other things) - unless you;ve had one already.
Once you have been given the OK then I presume you would choose one of their suggestions.
I'm not sure whether a cyclical regime would work in your case if your bleeding is not caused by over-thickened womb lining. As for stopping the prog now - the most likely outcome would be an increased bleed - but this is usually only the case with the addition ( and then withdrawal) of progesterone to what is known as an "oestrogen primed endometrium" - which would show as being thickened as in the normal menstrual cycle or on cyclical HRT.
In the very short term you could both decrease the oestrogen and then stop the progesterone for a week but as I said you may get an increased bleed.
I would get to the doc asap just so that you can agree a way forward that is best for you - to limit the bleeding whilst giving your bones the protection they need.
Sorry I can't help further!
Maybe after 7 years on Estradot 75 and Utrogestan 100 daily, your postmenopausal body don't need that much anymore.
Conolly - Autumn has said she is taking a higher dose of oestrogen due to osteopenia and has not been absorbing the oestrogen well.
Hurdity x
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Hi Hurdity,
Thank you for your reply, I really appreciate your generosity in giving your time and thoughts. I have been reading as much as possible in these past few days, trying to understand my situation and tere is no clear answer, as you say.
I think that one of your earlier comments, about vaginal atrophy leading to bleeding could be the original cause of the light bleeding, before my doseages were increased. I had never used the Vagifem that was precribed, seeing at is one more bothersome thing.
I decided to go back to my original 75 patch and 100 micronised P, 2 days ago. The heavy bleeding has suddenly stopped this morning. So huge relief. At least I can feel normal again while I wait for my appointment.
I agree that maybe some further investigation is warranted.
While reading info online, I cam across this very useful information from NHS menopause clinic in Oxford- if anyone is interested. It's very clearly laid out, and also touches on issues with prescriptions.
https://www.oxfordshireccg.nhs.uk/professional-resources/documents/clinical-guidelines/gynaecology/HRT-formulary-and-treatment-guidance.pdf?UNLID=3972751042017616429
Thanks again, and I'll post what happens next at the appointment, as it might be useful to someone else.
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Hello Autumn27,
According to this review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941181/ (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941181/) it's a tricky situation, but increasing progesterone and/or oestrogen don't seem to work for unscheduled bleeding on continuous HRT, decreasing them would be wiser.
Maybe after 7 years on Estradot 75 and Utrogestan 100 daily, your postmenopausal body don't need that much anymore.
When you started HRT were you postmenopausal (12 months without bleeding)?
Conolly X
Hi Connolly thanks for your message. I was post menopausal, when I started HRT.
I would like to continue with HRT for many years if I can, I truly believe in the wonders of it- when the doseage is right.
All the best x
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Hi Hurdity,
Thank you for your reply, I really appreciate your generosity in giving your time and thoughts. I have been reading as much as possible in these past few days, trying to understand my situation and tere is no clear answer, as you say.
I think that one of your earlier comments, about vaginal atrophy leading to bleeding could be the original cause of the light bleeding, before my doseages were increased. I had never used the Vagifem that was precribed, seeing at is one more bothersome thing.
I decided to go back to my original 75 patch and 100 micronised P, 2 days ago. The heavy bleeding has suddenly stopped this morning. So huge relief. At least I can feel normal again while I wait for my appointment.
I agree that maybe some further investigation is warranted.
While reading info online, I cam across this very useful information from NHS menopause clinic in Oxford- if anyone is interested. It's very clearly laid out, and also touches on issues with prescriptions.
https://www.oxfordshireccg.nhs.uk/professional-resources/documents/clinical-guidelines/gynaecology/HRT-formulary-and-treatment-guidance.pdf?UNLID=3972751042017616429
Thanks again, and I'll post what happens next at the appointment, as it might be useful to someone else.
What an excellent link which summarises all the treatment options and risks taking into account the NICE Guidelines! I've bookmarked it!
Hurdity x
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I thought I'd post an update:
Unfortunately at my Meno Clinic I only got to see a research fellow, not one of the main consultants who are more experienced. She is the one who has been talking to me on the phone.
She wanted me to up my continual Utrogestan to 300! I can barely cope with 200. It's that or the Mirena Coil. Which I really don't want.
No further investigations have been arranged.
I had recently decreased my patch to the original 75 and Utrogestan to 100, in an attempt to stop the bleeding, and it worked for a week. But now the bleeding is back.
I have no future Meno Clinic appointments until April, the GP doesn't know what to do, and I have to decide for myself.
Meanwhile I have a busy, full time stressful job to contend with.
I have no answers, no one does!
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Hello Autumn27,
So sorry your appointment wasn't helpful. Did she tell you why she want to up Utrogestan to 300 mg? What about oestrogen?
Thank you for the link above, very helpful.
I have already told you my opinion based on that article, ie decrease both oestrogen and progesterone until the bleeding stops and after that increase them gradually if symptoms are not controlled or to help with osteopenia. It's clear that your body is not coping with this regimen.
Conolly X
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Hi Connelly,
I did decrease both Estrogen and Progesterone, and the bleeding stopped for one week, then started again.
The woman I saw suggested 300 of the Progesterone to counter the Estrogen.
Thanks.
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Hello Autumn27,
I don't get it. If you have to increase progesterone to counteract oestrogen, wouldn't it be wiser to decrease oestrogen instead? You have gone back to your previous regimen, 75 patch and 100 mg Utrogestan, right? After so many years on this regimen I would decrease to 50 patch and 100 mg Utro.
Also, increasing prog to counteract oestrogen would be useless regarding the osteopenia. Are you on other medication or exercises for that?
Conolly X
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Hi Autumn27
Thanks for the update
Sorry to hear that you have not had satisfactory treatment from the menopause clinic and you had to see someone less experienced.
I quite understand your not wanting to increase the progesterone further. Most women do not want to take this high a dose - with the exception of women undergoing fertility treatment who take high doses vaginally - but this is for an entirely different purpose so a clear greater willingess to put up with side effects if a baby could be the outcome!
Are you using 200 mg vaginally?
Normally when using continuous combined HRT, as you know eventually bleeding stops for the majority of women and especially if post-menopausal and should be invesitgated if not. There is cearly something amiss with the way the uterus lining is dealing with the effect of progesterone. From what I've read, under the influence of oestrogen and progesterone, different parts of the endometrium can be proliferative ( the effect of oestrogen alone) as well as secretory (the action of progesterone on the stimulated endometrium) and when this all works properly - there is no bleeding.
Often when it's not working and the balance of oestrogen and progesterone is out of whack - the lining can thicken and can cause spontaneous bleeding as these thickened parts of the endometrium break away. Abnormalities such as fibroids and polyps and as I understand (I think) - adenomyosis - can also cause bleeding.
As your lining was not thickened then this can't be the case - however as I suggested in my previous post I would still ask the GP to refer you for a hysteroscopy - not involving the menopause clinic - especially if you are not able to tolerate such a high dose of continuous progesterone.
Once this has been done then take it from there.
My suggestions thereafter and provided all is OK, are firstly as the menopause clinic - a Mirena coil, or as I suggested earlier - going for a cyclical regime when your bleeding will be most likely predictable. To start with you would take 200 mg utrogestan 12 days per cycle and see how you got on - and would be good to have your doc's approval of this - at least if s/he doesn't seem to have much of an idea you can propose what you would like to try!
Hello Autumn27,
I don't get it. If you have to increase progesterone to counteract oestrogen, wouldn't it be wiser to decrease oestrogen instead? You have gone back to your previous regimen, 75 patch and 100 mg Utrogestan, right? After so many years on this regimen I would decrease to 50 patch and 100 mg Utro.
Also, increasing prog to counteract oestrogen would be useless regarding the osteopenia. Are you on other medication or exercises for that?
Conolly X
Conolly - just to explain - the progesterone does not counteract the oestrogen in the way you are thinking. The systemic levels of oestrogen and its effect on target tussues - such as its effect on bone resorption - is entirely dose dependent, and independent of the progestogen which does not diminish it (and from what I dimly recall some prog preparations may even enhance it ie oestrogen + prog combo had even greater positivie effect on bone density in one study - but I might be remembering that wrongly!). Progestogens are only used to "counteract" oestrogen with respect to endometrial protection and as such, in a dose dependent manner.
Autumn27 has been told she is osteopenic despite 75 mcg patch and testing of oestrogen levels confirm lack of absorption. Therefore her bone health will only be improved by an increase not a decrease in oestrogen ( systemic levels) and it is stemming the bleeding to enable higher oestrogen levels to be achieved which is the main focus of any future treatment.
Hurdity x
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Hello Hurdity,
Thank you for the explanation, but that wasn't my point (maybe I have expressed myself poorly). I was thinking about what Autumn27 had already stated in her first post:
"For the first time in August I had a bit of light bleeding. The clinic gave me an ultrasound, my womb was OK so they upped my Estrodot patches from 75 to 100. All seemed good, but then after a few weeks, bleeding started again.
A doctor I spoke to over the phone upped my micronised progesterone, from 100 to 200. I had a phone call appointment in a month's time.
In that entire month I bled more than before. I also didn't feel too good on the new regimen of continual high dose Progesterone and increased Estrogen. I was worn out by the bleeding.,"
Increasing progesterone and oestrogen has already been tried and it didn't work. Increasing progesterone further won't be a good idea, first because it won't address the osteopenia that clearly hasn't changed on the 75 patch and second because it has many adverse side effects.
Not all osteopenia is caused by low oestrogen levels. If Autumn27 has an oestrogen absorption issue, increasing to 100 patches would not make a big difference and it would need extra progesterone.
That's why I said that decreasing oestrogen to address the bleeding, which is Autumn27 main complaint, would be wiser, and just after her endometrium had achieved a proper balance, ie no bleeding, further action could be taken regarding osteoporosis, even a change of HRT.
There is this almost unanimity regarding oestrogen, that the more the better. I find it disconcerting because my worst days pre-menopause were when I had extremely high oestrogen levels which triggered migraines (much worse than hot flushes) and they certainly have increased my breast cancer risk, so maybe it is time to forget the hype and think wisely because you don't want to get rid of hot flushes and osteoporosis (again, not primarily caused by oestrogen deficiency) at the expense of other future problems (including hemangioma). That's why professional guidelines are reticent when it comes to long term use of high doses of oestrogen after years of menopause, there aren't sufficient long-term studies to sustain such claims. Of course, in the end it's a personal decision.
Conolly X
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Hi Both Hurdity and Connolly,
Thanks so much for your thoughts on this.
Conneolly, I take your point, but as I am not absorbing the oestrogen on the 75, in my opinion decreasing any further would make no difference to the bleeding. My blood levels showed barely a trace of Estrogen. On the 100 Estradot and 100 Pr I felt a noticeable improvement in wellbeing- until bleeding started in earnest 3 weeks later.
In answer to your suggestion Hurdity, at the clinic I asked about switching to cyclical treatment, but the research fellow woman said no, they didn't do that with women who were post menopausal by x years. She wouldn't discuss it further.
I am taking 200 Progesterone vaginally, because I tried orally and felt bad on it. At the same time vaginally not great either. I don't know which method absorbs more? Apparently orally you absorb just 10% of micronised progesterone(I read somewhere)
I don't know which is the higher risk thing for me-mirena coil or synthetic progestin. Neither are things I want. Yet I can't sustain this bleeding.
I have a GP appointment on the 25th but am wondering if I can get an emergency appointment before then. I will ask about a hysteroscopy, maybe I can get a referrel to a gynea clinic.
If I tried a synthetic progestin, are there any recommended ones? At least that could work in the short term I suppose.
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Hello Autumn27,
I understand that having a Mirena coil or switching to Evorel conti patches (the progestin is norethisterone) is not going to make any difference regarding risks. I would prefer Evorel conti patches, because I can't even think of the coil, but that's me. You can also try Estradot patches and Utrogestan but then you would have to put up with a bleed (sequential Utro) or take it continuously (I couldn't stand it, had suicidal thoughts).
Do you have any idea if you have polyps or fibroids? I guess you will find out anyway after hysteroscopy. If polyps are the source of your erratic bleeding you could have them taken out during hysteroscopy (make sure to tick that option beforehand), if you have fibroids, then Mirena coil is the best option because it helps to shrink them.
I really hope you can find a definite solution for the erratic bleeding. Hugs.
Conolly X
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Hello Autumn27
I think your body has had enough of the Utrogestan.
I switched to Oestrogel and Utrogestan 100, initially ever other night vaginally, 6 months ago. I felt great for about 3 weeks. So much better than previously on compounded bioidentical hormones. Then the bleeding started. And wouldn't stop. I'd stand up and feel it running out of me. I had PMT symptoms aplenty. Bloated, water retention, exhausted, emotional. I spoke to my private specialist and she said to increase the Utrogestan to every night. I did. The bleeding stopped for a week, perhaps 10 days and then restarted. And with the exception of a few days here and there I've been bleeding ever since. It has a pattern, I bleed heavier during the day, less in the evening and hardly at all at night. I know what you mean about exhausted, I've basically been having a pretty heavy period for 6 months!
My doctor says Utrogestan doesn't suit me, that it suits many women, but not all by any means. And therefore I must change. There is another progesterone they would recommend, it begins with P, but I don't remember the name right now. But I'm having a Mirena coil fitted in a months time. It can't come soon enough. I've had one in the past for BC. It took about 4 months to settle, then it was fine. No bleeding at all for me. I'm hoping history repeats itself.
I have family history for thinning bones so I want as much oestrogen as necessary to keep my bones strong. I too haven't been absorbing the gel very well, so I either need more of it or a combo of a patch and gel. But it's impossible when loosing this much blood and having almost continuous PMS, to try that.
Why are you against a coil?
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Hi Sue,
Thank you so much for sharing your experience. 6 months of bleeding must have been awful. I a heading in that direction, and I have arrived at a similar conclusion about Utrogestan and my body's reaction to it after 7 years of continual use.
Re the coil, it's the real fear of all the things that can go wrong, sepsis, coil getting lost in body, the pain of insertion, that it may not stop the bleeding anyway. I have a slightly inverted (backward facing) cervix, and have never had children, so it wont be a straightforward insertion. A colcoscopy in the past was incredibly painful and took 3 different nurses to do it.
On top of that I am keen on the idea of only using bioidentical hormones, and not synthetic progesterone as in the coil.
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Hello Autumn27,
I understand that having a Mirena coil or switching to Evorel conti patches (the progestin is norethisterone) is not going to make any difference regarding risks. I would prefer Evorel conti patches, because I can't even think of the coil, but that's me. You can also try Estradot patches and Utrogestan but then you would have to put up with a bleed (sequential Utro) or take it continuously (I couldn't stand it, had suicidal thoughts).
Do you have any idea if you have polyps or fibroids? I guess you will find out anyway after hysteroscopy. If polyps are the source of your erratic bleeding you could have them taken out during hysteroscopy (make sure to tick that option beforehand), if you have fibroids, then Mirena coil is the best option because it helps to shrink them.
I really hope you can find a definite solution for the erratic bleeding. Hugs.
Conolly X
I do have a small fibroid, have had it for years, the clinic fellowship woman said it wasn't the cause of the bleeding.
I could try evorel conti I suppose, it's worth a try, before going for my least favourite option of the coil.
Thanks for your suggestions x
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Hi Both Hurdity and Connolly,
Thanks so much for your thoughts on this.
Conneolly, I take your point, but as I am not absorbing the oestrogen on the 75, in my opinion decreasing any further would make no difference to the bleeding. My blood levels showed barely a trace of Estrogen. On the 100 Estradot and 100 Pr I felt a noticeable improvement in wellbeing- until bleeding started in earnest 3 weeks later.
In answer to your suggestion Hurdity, at the clinic I asked about switching to cyclical treatment, but the research fellow woman said no, they didn't do that with women who were post menopausal by x years. She wouldn't discuss it further.
I am taking 200 Progesterone vaginally, because I tried orally and felt bad on it. At the same time vaginally not great either. I don't know which method absorbs more? Apparently orally you absorb just 10% of micronised progesterone(I read somewhere)
I don't know which is the higher risk thing for me-mirena coil or synthetic progestin. Neither are things I want. Yet I can't sustain this bleeding.
I have a GP appointment on the 25th but am wondering if I can get an emergency appointment before then. I will ask about a hysteroscopy, maybe I can get a referrel to a gynea clinic.
If I tried a synthetic progestin, are there any recommended ones? At least that could work in the short term I suppose.
Hi again Autumn - your research fellow woman is wrong - you can continue with cyclical HRT for as long as you want provided your system ( and you!) can cope with it. Many post-menopausal women opt to continue with a cycle due to progesterone intolerance - even low grade side effects, like foggy head and lethargy - can be wearing after a while. Also whereas there can be an increased risk of endometrial cancer with long term cyclical HRT, some gynaes still prefer this option (cyclical HRT) over continuous combined HRT due to the latter involving continuous progestogen and the lpossible link to increased risk of breast cancer. It's swings and roundabouts really - but as I said in my previous post - as you are not absorbing the oestrogenfinding a way to maintain an increase to help with your osteopenia and reduce bleeding is the best way forward. (As an aside Conolly - not sure why that comment about the hype when Autumn isn't absorbing oestrogen? Anyway I haven't seen any hype... some women are suffering and have been advised to try to achieve high oestrogen levels by their gynaes especially those suffering from reproductive depression) .
Yes vaginal use of progesterone - much more is absorbed. In fact some research shows that you can use approx half the dose of prog when used vaginally than when used orally, and it also is thought to be held in the uterus making it even more effective. For higher doses of oestrogen I would always use it vaginally because high oral doses are not well tolerated as I previously said.
Hi Autumn - it is not obvious what you should do - since the more usual reasons for bleeding do not seem to apply - ie womb lining settling down to continuous combined HRT, or excess of oestrogen to progesterone causing over-thickening, or the reverse leading to endometrial atrophy.
In your position I would go back to your specialist and push for a hysteroscopy so that they can take a closer look at your womb lining - just to really check all is OK (eg re abnormalities such as fiborids, polyps or other things) - unless you;ve had one already.
Hurdity x
OK I mentioned fibroids and polyps in my earlier post (see above) as a reason for further investigation - and you now say you do have one. Does this mean you have had a recent hysteroscopy? Far be it from me to correct your research fellow but without a recent hysteroscopy you can't say whether it is the cause or not of the bleeding. If it has grown (although maybe unlikely if your oestrogen levels are low) then these can cause more bleeding than from a uniform endometrium without fibroids - that's my understanding anyway.
Re synthetic progestins - the Mirena coil does contain a synthetic progestin - levonorgestrel, and in fact all the HRT progestogens are synthetic except for progesterone itself (Utrogestan). The other one which could be taken with a patch which you could try is Provera - this one can be well tolerated by women and taken orally. You could still also try this on a cycle if you prefer.
Have you thought of writing to Dr Currie for advice? It is only about £30 I think. Although she does not generally favour bleed regimes, she might do given your situation, but may probably recommend a Mirena?
I think my suggestions to you remain the same as before:
Ask for referral for hysterosocopy - and treat anything if found
Maintain the higher dose oestrogen patch
Monitor your oestrogen levels through the doc (ref osteopenia)
Increase patch dose if still not absorbing or change to gel ( or tablet if well under 60)
Have a Mirena coil fitted (I know you might not like the idea...and as you say it may be more difficult especially if you haven't had children) or go for cyclical regime - either 200 mg utro vaginally or Provera at recommended dose.
Sorry I keep repeating myself but nothing you have said has changed my view on the way forward to try! Just my suggestions though ::)
Hurdity x
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in of insertion, that it may not stop the bleeding anyway. I have a slightly inverted (backward facing) cervix, and have never had children, so it wont be a straightforward insertion. A colcoscopy in the past was incredibly painful and took 3 different nurses to do it.
On top of that I am keen on the idea of only using bioidentical hormones, and not synthetic progesterone as in the coil.
I'm still bleeding. It will be 7 months by the time I get the coil inserted!
I think you are worrying way too much and unnecessarily about the coil. I've had one before. I've never had children either. My cervix is also tilted. An experienced practitioner will pop it in easily enough. You are advised to take pain killers 1 hour before the appointment for the cramping.
The horror stories on the web about the coil are sensational. But there aren't that many of them and there are millions of coils in use. Yes it would be great to only use body identical progesterone, but there is only the one of those and it's not working for either of us. I've tried it at 1 capsule every other night vaginally, and 1 capsule every night vaginally. I tried 2 capsules once but felt drugged the following day. I tried it orally for 3 days a few years ago. Day 1 OK. Day 2 sluggish, sad and itching from head to foot that drove me mad. Day 3 suicidal. I will never swallow one again. I have given it a good long try and I'm working with a leading menopause expert and feel I'm getting great advice. So coil it is.
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Hi Hurdity,
Thank you so much again for your long and detailed response. I'm sorry if you keep repeating yourself (!) but I'm not sure I completely understood previous information you were giving me. I really appreciate your time and effort. You are amazing!
I am quite keen on the cyclical regime, and asked years ago to be put on it. At that time another (new) doctor at the clinic told me to go ahead and try it, but left me on the low dose of 100 progesterone, so of course it didn't work. I didn't understand that at the time, Mr Panay explained it at my next annual appointment but didn't then prescibe the treatment to try it again.
So I agree with the summary of all your suggestions, and yesterday I was thinking about trying to get a single private consultation with a specialist just to get a considered medical opinion. I am with Nick Panay's NHS menopause clinic in London, and usually see him or Dr Horner, but the last 3/4 times have not beeen seen by them. The last 4 contacts in the past 6 months have been with a pharmacist, and then the research fellow woman who's manner I find cold and she is unwilling to discuss anything in detail. Everything she has done has made things far worse. Which is probably why I feel untrusting of her suggestions for the Mirena. I don't understand why a hysteroscopy was not suggested, or cyclical treatment for a while, for example.
So I think writing to Dr Currie is a very good idea. I'm not sure that if I paid to see Mr Panay, or the Mr Horner, privately for a one off consultation, he would have access to my medical records to be able to help.
"Yes vaginal use of progesterone - much more is absorbed. In fact some research shows that you can use approx half the dose of prog when used vaginally than when used orally, and it also is thought to be held in the uterus making it even more effective. For higher doses of oestrogen I would always use it vaginally because high oral doses are not well tolerated as I previously said."
I presume, for clarity, you meant higher dose of Progesterone, not estrogen?
My preffered solutions in this order
1. Cyclical regimen with 200 Utrogestan
2. Trying a synthetic progestin hormone patch
3. Coming off all HRT and finding another way to solve all my issues but when I think how good I felt on 100 Estradots...hard to quit.
4. Mirena Coil. Still my grimmest and least favorite option- 1/10
Thanks again, x
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I think you are worrying way too much and unnecessarily about the coil. I've had one before. I've never had children either. My cervix is also tilted. An experienced practitioner will pop it in easily enough. You are advised to take pain killers 1 hour before the appointment for the cramping.
The horror stories on the web about the coil are sensational. But there aren't that many of them and there are millions of coils in use. Yes it would be great to only use body identical progesterone, but there is only the one of those and it's not working for either of us. I've tried it at 1 capsule every other night vaginally, and 1 capsule every night vaginally. I tried 2 capsules once but felt drugged the following day. I tried it orally for 3 days a few years ago. Day 1 OK. Day 2 sluggish, sad and itching from head to foot that drove me mad. Day 3 suicidal. I will never swallow one again. I have given it a good long try and I'm working with a leading menopause expert and feel I'm getting great advice. So coil it is.
I think we all have individual preferences. Maybe if I could have a general anasthetic I could go through with it. I hate the thought of it, it makes me feel sick.
One of the horror stories was on this site, someone got sepsis. Of course, I'm sure it's a small percentage. Re the Utrogestan, I've had 7 trouble free years of it on 100 dose, I was lucky I suppose. But the 200 doesn't suit me continually, that's for sure.
Who is your leading menopause expert?
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Hi there - you quoted me: "Yes vaginal use of progesterone - much more is absorbed. In fact some research shows that you can use approx half the dose of prog when used vaginally than when used orally, and it also is thought to be held in the uterus making it even more effective. For higher doses of oestrogen I would always use it vaginally because high oral doses are not well tolerated as I previously said."
Your response "I presume, for clarity, you meant higher dose of Progesterone, not estrogen?"
I did mean oestrogen - and sorry my words were ambiguous. Sometimes it's difficult to see how it reads when i know what I mean ;D !
What I meant was - if you are using higher dose of oestrogen, then you needs higher doses of progesterone to protect the endometrium (but there are only two doses of progesterone listed - 100 mg for continuous and 200 mg for cyclical), and that being the case, because women do not tolerate high doses orally I would always use the increased progesterone dose vaginally.
Sorry - about that - does that explain better?
Good luck with it all and please keep is updated!
Hurdity x
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Hi All,
For anyone interested in prolonged bleeding problems, here's my update. Following an email correspondence with Dr Currie (highly recommended and worth £30!) I went to my female GP armed with info.
Dr Currie recommended further investigation to rule out a polyp or other issues. Unfortunately my GP said no. My GP incorrectly said that a polyp would have should up on the Ultrasound and that I didn't need further investigation. Despite 9 weeks of unexplained heavy bleeding.
Dr Currie also said I could try cyclical Progesterone vaginally to see if that worked. My GP said no, that it was pointless to try and that Progesterone wasn't as effective taken vaginally. That opinion differs to medical information online. However, I am now trying it anyway, as I have enough supplies to give it a go for a month or 2.
Ultimately Dr Currie recommended the Mirena, and so did the GP, so I am going to try that next, in the meantime will continue with the cyclical regime, 100 Etsradots, with 200 Utrogestan vaginally, to see if it improves my situation and regulates the bleeding.
Thanks to all for the advice so far, you've been very helpful and supportive!
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Hi Autumn27
Thanks for the update - glad you have had advice from Heather Currie but what a terrible GP - contradicting one of the country's leading menopause experts (apart from the Mirena advice).
You should go to another GP and demand referral if this has been recommended by Dr Currie, and if your GP is incorrrect and s/he is being negligent in not referring you due to ignorance if this is the case? The whole point eg of hysteroscopies is to identify potential polyps or fibroids or other pathologies which do not show up on U/S scans. If you haven't been given a reason for the bleeding then this needs resolving before a Mirena is inserted and I believe that may be stated in the prescribing instructions for Mirena ( ie exclude possible abnormal reasons for bleeding first)?
I hope your bleeding eases soon.
Hurdity x
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Hi Hurdity,
Thank you for your response. I was quite disappointed that my GP was so adamant that I didn't need further investigations. Also the Research Fellow at the Menopause clinic had also said I didn't need them either. It is my life on the line, so I would like to know the cause of my bleeding.
I do have the option of other GP's at the same surgery. I suppose I could try one of them, it takes 3 weeks to get an appointment. I have been considering changing doctors surgery for a while now, just afraid to risk a new surgery to find that it might be anti HRT altogether. Some visiting doctors at my current surgery have refused prescriptions for HRT and I've had to get the practice manager involved. It's a minefield out there!
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It's just appalling that some doctors continue to refuse to prescribe HRT if there is no medical contra-indication! Good luck with your investigations (if you manage to get a referral and an explanation) and future treatment.
Hurdity x
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Hi All,
I'm back to report on an update on my experience with 3 months of uncontrolled bleeding on HRT.
I seem to have finally found a solution that works for me. Following Hurdity's earlier advice, and consulting by email with Dr. Currie, I decided to attempt cyclical HRT instead of continual.
I stopped all progesterone and remained for 2 weeks estrogen patch only (100 mcg Estrodots).
I then did 14 days of 200mg Utrogestan Progesterone, obtaining the vaginal ones that come with an applicator (much easier to insert properly and insure correct dosing)
Much to my relief everything is now working as it should be, with a 4 day bleed after the progesterone ceasing.
So as I was not keen on having a Mirena and potentially creating more issues for myself, (under GA) this is a huge relief for me, and am posting this info incase anyone finds themself in a similar situation!
It's now been 7 whole weeks of being back to normal, and I feel so much better. Thanks so much to everyone who offered thoughts and for your help solving this problem! ;D
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So pleased to hear that things have improved for you Autumn27 and your bleeding has stopped! Long may it last - fingers crossed eh? It's success stories like yours (hopefully long term!) that makes it all worthwhile! :)
Hear hear Stellajane (does anyone say that any more or is that too old-fashioned?!)!
Hurdity x
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Thank you Stellajane and Hurdity!
I am so grateful for this website and for all the lovely people sharing their knowledge.
I hope anyone else going through this will give this solution a try!
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Hi, I'm not sure if it's ok to post on an oldish thread but here goes...
I would love to know how Autumn27 is getting on with the new sequential routine? I find myself in a similar situation. I have been on 100 Estradot patch and 100mg Utrogestan vaginally for a few months now and I have been feeling really good. Unfortunately, bleeding (proper full on period) started about 14 days ago and has been continuous. I had a scan in May and was told the lining was ok. I am seeing my consultant in a couple of weeks and will see what she advises but I am considering reducing the patch to 75 (though I don't absorb all that well), or asking about a sequential route. I would like to distrurb things as little as possible now that I am feeling good in myself. Thank you for any advice and updates. x
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Hi CherryC. Autumn27 has not been on the forum since her last post but you could send her a personal message via her profile which she might pick up.
Taz x
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Ah thank you for the advice Taz, I will do that x
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Hi Cherry,
Just picked up a couple of PMS, from you and another lady asking where I'm at with my bleeding. I have had no bleeding since January- so thankfully 7 months of everything being OK. I did 4 months of the sequential regime, which stopped the continual bleeding, and helped me regulate my body, and then I decided to see if I could go back to my old regime, which I preferred.
So now I am back on my 100 daily Utrogestan progesterone and 100 Estrodot patches, and have been taking these for 3 months, with no bleeding or issues.
I hope that helps anyone who may be considering trying sequential as an option to stop bleeding.
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Thanks for your positive post Autumn. I too went back onto sequi after bleeding problems with conti but this was actually suggested by my lovely GP so I was lucky. I'm so glad you are feeling so much better.
Taz x :)
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I’m in a similar position. Getting desperate now- due to go on family holiday tomorrow and seriously considering cancelling due to never ending heavy period on 1 daily dose oestrogel and 14 days UStrogen/ progesterone (2 tablets). Should I increase tablets to try to alleviate bleeding? GP says to monitor over time- but no use this week! 😞