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[Nickyp]

Hello, I am new to the forum and would love some advise. I am 52, haven't had a period for 4 years. I have been taking a continuous hrt for a year and therefore no monthly bleeds. Over the last week or so I have had some spotting. Was really worried....I tend to be a worrier, so made an appointment to see the doctor. He advised me to stop taking the hrt, if it still continues then to go back. Well......after 2 days of stopping the hrt I am proper bleeding, scary when it hast happened for so long. My question is am I bleeding like this as a result of stopping hrt, I think I read somewhere the drop in progesterone can cause this. Has anyone else had experience of this?

[Hurdity]

Hi NickyP

  from me too.

The usual reason for bleeding on continuous combined HRT is when the progestogen dose is insufficient for the added oestrogen and therefore the womb lining builds up and is shed sporadically - first as spotting and then bleeding.

As you suggest - the most likely cause of this proper bleeding after stopping the patches is firstly your womb lining has built up on the patches ( hence the spotting) and secondly now you have stopped the progestogen - this signals the body to trigger the bleed and the excess lining has come away.

This is the most likely explanation, but your doc may want to exclude a pathological explanation - hence the advice to stop HRT. Not all docs say you have to stop HRT after experiencing bleeding on it - and it is possible to investigate the womb lining while on HRT. Your GP may well not be an expert on this and therefore if you report the bleeding - then may refer you for further investigation under the 2 week rule. Therefore if you are concerned and would like investigation for reassurance - report the bleeding ( say next week if it continues) and see what the doc says.

Above all do not worry - at this point!

As Hasty says - what patch are you on, and did you get any bleeding/spotting when you first started the HRT?

Hurdity x

[Nickyp]

Thanks for your comments, it's so nice to have someone to talk rather than rattling things round in my head. I was on tablets, elleste duet conti, seemed fine up until the spotting which was almost a year to the day of starting it. The shedding theory makes sense as it seems to start after I had done some strenuous exercise. I saw a male doctor and he didnt seem that keen on investigating further, just suggested I make another appointment to see a female doctor if things didn't stop after stopping the hrt.Keep reading all things it could be...doctor google and all that, it's so hard not to worry. I did have a scan a year ago as had a dull ache in my ovary area, that all turned out to be nothing. Just hoping nothing can have changed that much in a year... think maybe I'll give it a week and go back and see the doc. If there is nothing wrong then i think I'd like to go back on the hrt as it seemed to sort me out Ok.

[Dancinggirl]

Nickyyp - you might do well with a Mirena as part of the HRT regime - you simply add in oestrogen as either pills, patch or gel alongside.  This can be a really good 'on hassle' HRT regime, as problems with bleeding are far less likely and the Mirena protects your womb lining better. If you were doing generally well on the Elleste then it's shame at such a young age to be without HRT.  DG x

[sap22]

Hello, I am new to the forum and would love some advise. I am 52, haven't had a period for 4 years. I have been taking a continuous hrt for a year and therefore no monthly bleeds. Over the last week or so I have had some spotting. Was really worried....I tend to be a worrier, so made an appointment to see the doctor. He advised me to stop taking the hrt, if it still continues then to go back. Well......after 2 days of stopping the hrt I am proper bleeding, scary when it hast happened for so long. My question is am I bleeding like this as a result of stopping hrt, I think I read somewhere the drop in progesterone can cause this. Has anyone else had experience of this?

Hi Nicky, I stopped the systemic HRT as I was having spotting for six weeks, plus had a scan and one of my fibroids is very close to the womb lining.  So I wanted to stop and see if I could manage with just local.  Bleeding stopped, but yesterday and today again a watery brown discharge... feel quite emotional also.  Instinct is it may be my system is up the creek as I was on it for six months, and latterly high doses of oestrogen 100mcg twice weekly.  The scan had a lining of only 4mm, so will see whether it goes.... I wonder if yours has stopped and how you feel without the systemic.. xxx

[Nickyp]

Hi sap22. Thanks for your reply. It's all a minefield isn't it, but nice to know there are others out there experiencing all sorts of symptoms. I am quite new to hrt so not sure what systemic is? . I was put straight in the continuous one as hadn't had a period for 3 years. I was doing ok on it until the last few weeks. I didn't know there were lots of other options. The good news is my bleeding seems to have stopped, although I do keep checking which is getting a bit obsessive. I don't know now if I need further investigations or it was the hrt causing it? I guess I need to go to the doc and have this discussion. I am scared about the investigations, not so much the procedures but what might be found. But I guess that is normal.  I feel quite emotional and the hot sweats are beginning to return...

It sounds to me like your right and your system is just playing up. At least you've had the scans and know what's going on is nothing that can't be sorted. Fingers crossed it will settle down over the next few days.

[Dancinggirl]

Nickyp - I have had bleeding after stopping HRT - I think this can be quite usual.  As the bleeding has stopped, I wouldn't worry - maybe check with GP if uncertain. 
Its worth taking this break from HRT to see how you feel - re-assess whether you want or need to go back on HRT.

BTW ‘systemic' means using the full HRT that is absorbed throughout the body (which you have been using), as apposed to the local oestrogen treatment (which is very low dose) for urogenital atrophy that many women need either on it's own or alongside systemic HRT.

As you did OK on a continuous HRt then the Mirena with separate oestrogen could be a good, longer term, option for you.
Here is the info from this site about the Mirena:
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00


Hope this helps  DG x

[Nickyp]

Thanks dancinggirl. Can I just ask how long did you bleed for after stopping hrt? I just think mines stopped and then get spotting again, so just wondered if this might be the tail end of the bleeding or still got the spotting problem I had in the first place before I was advised to stop hrt.

[Dancinggirl]

After stopping the HRT I bled quite a bit for about 4-5 days and then it tailed off and was a bit of spotting - in all about 7-8 days.  If you have ongoing heavy bleeding with cramps etc. then this would need to be checked. 
Do get things checked out with the GP if you are worried - they could send you for a scan to make sure the lining is OK - however I suspect they might not bother unless you had ongoing bleeding. 
I am certainly not an expert but your issues sound very like what I experienced.  I was getting erratic spotting on a particular HRT regime and when I stopped I got this bleeding for about a week. My understanding is - my womb lining was building up and the progesterone in the HRT regime I was using hadn't stopped this build up - the spotting was the lining spontaneously breaking away at various times.  When I stopped this HRT regime the womb lining obviously completely shed of it's own accord. I'm not a doctor or even a scientist so I won't pretend to fully understand what's going on but I do know that it is important not to have a thickened lining for any length of time.
I think this thickening and therefore erratic spotting or bleeding can often happen with continuous HRt (so taking progesterone all the time) and this is why many women stick with a sequential HRT and put up with a monthly bleed and they then know that the lining is shedding properly.
The Mirena is still the best way to protect the lining from building up because it delivers progesterone more directly to the womb. I'd give things a few more days and if the spotting doesn't stop then pop back to the GP to get checked out.
DG x