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[Fionalowri]

Hi there,
I'm 54 and started on Evorel Conti at the end of May.  My last period had been in August 2016, though I still recognized elements of my monthly cycle occurring after that, just no more bleeds, or just slight spotting from time to time.  My moods got very low and I felt emotionally fragile a lot of the time.  I would wake at around 4 in the morning and find it hard to get back to sleep.  Hot flushes and palpitations were also common occurrences, along with slight nausea and dizziness.  My doctor was happy to put me onto HRT and I felt a lot better within a few weeks.  A couple of weeks ago I started to bleed and it was much like a normal period, it began to tail off after 5 days and had stopped after 7.  I felt a bit down during and after the bleed, and had some nausea and felt a little lightheaded from time to time. I had sore breasts in the 2 weeks leading up to the bleed, but had put that down to having just had a mammogram a few days before. I was on the evorel conti patches for 4 months before the bleed started.

I went to see my Doctor on Friday and she was very concerned about the bleeding and I have been told to stop taking the hrt and she is referring me for some sort of scan and a blood test which picks up a marker for cancer.  I hadn't been too concerned about the bleed before that as it did say it was quite common in the first 4 - 6 months of starting on the patch.  I wouldn't have gone to the doctor normally, but I wanted to talk about changing the progesterone element of my hrt to a micronised progesterone  and having the estrogen as a separate patch, so mentioned the bleeding as well.  She said as I hadn't had a period for over a year I shouldn't be having a bleed and that it shouldn't suddenly happen after 4 months.  She had been very happy for me to start the hrt and had said she was happy for me to stay on it for as long as I liked.  But now she is saying that perhaps my menopausal symptoms will have naturally finished, as it has been 5 months since I started on the patches.  I am not convinced. It has been two days since I removed the patch, and so far nothing untoward has happened, but I am worried what might be in store for me in the coming weeks.  Any advice, or similar experiences out there please?

[Taz2]

Hi Fionalowri - just wanted to welcome you. Try not to worry as you are right in that bleeding on a conti HRT is very common.

I see that you had your last period in August last year and started conti HRT in May. It is usual to have to wait a year without periods before beginning a conti HRT so it could well be that you would have had more natural periods in this time. It sounds like a natural bleed to me as you had sore breasts etc. before the bleeding which is much more "period" like.  You may find that you have more bleeding due to the stopping of the progesterone which can induce a bleed. Scans can be done while you are bleeding by the way.

You have been referred as the doctor is following guidelines which state that any bleeding after a year without has to be investigated. This doesn't really seem to apply in your case as you hadn't been a year without a natural period before you began a continuous HRT but it is good that you are being given a thorough check up.

The scan will be an ultrasound of the womb and probably an internal one too which is just a probe which is inserted into the vagina. I have had both of these and the only uncomfortable part is having to have a full bladder for the ultrasound. Don't sneeze! 

There is someone else on here going through similar but I can't remember who it is for the moment. Let us know how you get on and don't worry if the appointment comes through quickly - again guidelines are that you should get a date within two weeks.

Taz x 

[Fionalowri]

Hi Taz,
Many thanks for your reply and welcome and for letting me know what the likely procedures might be.  I realised after I had left the doctor that I had no idea what tests she was sending me for; it seemed quite a dramatic response at the time and it would have been nice to have had more (any) information about what was happening and why.

Do you know what they are looking for when they do a scan?  I read somewhere that they check to see if the lining of the womb has thickened, do they check the ovaries as well to see if they are still functioning? If they can even tell such a thing.  It would be nice if they could explain a little bit about the procedure, but perhaps that information will arrive with any letter they send out.

I did wonder why I had been put on the continuous form of HRT as it had been under a year since my last period, but assumed it was because of my age. I find it difficult to always ask questions of my doctor, partly because I assume that she has good reasons for what she is doing and saying, but I'm not too sure how knowledgeable she is about HRT and I kept having to correct her about things, for example she didn't know there was a patch that contained both hormones!  I was thinking about asking to change to a sequential type if all the tests turn out ok, as if I had another bleed while on the conti I'm sure she wouldn't let me continue. Hopefully the tests will be fine and something can be worked out.

[Taz2]

Yes the scan is to check the thickness of your womb lining. The NHS details are here https://www.nhs.uk/conditions/postmenopausal-bleeding-or-spotting/Pages/Introduction.aspx  I think the scan can take in the ovaries as well but not absolutely certain on this.

Some women are put onto conti HRT if they are around the age of 53/54 even if they've not gone quite a year since their last period I believe. As you hadn't gone a full year then the diagnosis of post-meno bleeding is a bit tenuous as there are ladies on here who are older than that and still having normal periods and you have no way of knowing whether you would have gone on to have more periods. I was still having fairly regular ones at 53 although I did have nine months without before starting up again. It is good that you are being checked in this way although I appreciate it can be worrying.

Taz x

[Fionalowri]

Hi Taz,

Thanks for the excellent link, that explains the procedure very clearly as well as the risks of PMB. 

I was looking back in my diary for last year and though I didn't have any more proper bleeds there were still a number of months after that where I continued to have spotting about the time I would have expected to have a period, so i am very much hoping that this is nothing more than my hormones on their last gasp.  Will post outcome of procedure when I know.

Thanks for support and information, it really does help to be able to discuss these things, makes then seem much less daunting.

Fiona x

[Hurdity]

Hi Fionalowri

  from me too.

You have already been given great advice from Taz and I just wanted to say I agree completely with her. Your doc knows very little about menopause it seems. I mean it really is not indicated to check for cancer at this point - firstly as Taz says - because you may still be peri-menopausal  and also because bleeding for the first 6 months on a conti HRT even if post-menopausal - is normal. You also don't need to stop the HRT either - not sure if you have done or not?

I would always take up the offer of any investigations - but in your case - there is very unlikely to be  anything to worry about. I know Taz has already said this but just wanted to add my support and hopefully reassurance! When I've had scans they can never find my ovaries - they are so atrophied they seem to have disappeared - however I presume still producing a minute amount of hormones 

Do let us know how you get on

Hurdity x

[Fionalowri]

Hi Hurdity,

Many thanks for your reassuring response.

I still remain surprised at my doctor's sudden change in attitude to the HRT.  She did tell me to stop using it, though I was reluctant to do so as it had made a big difference to how I was feeling, and though I was starting to get a few side effects from the HRT, they were still preferable to what I experienced without it.  So reluctantly I did remove my patch.  At first it seemed fine, but now after a week without it my sleep is starting to suffer (waking at around 4 and not being able to get back to sleep again) and while the hot flushes have yet to resume, I'm getting very hot just before I go to sleep, followed by quickly feeling cold when I kick off the duvet, and my mood is starting to drop again. I am very tempted to put a new patch back on tonight (I still have a good supply), when I would usually have changed patches anyway, but am concerned about how that would affect my relationship with my doctor, as I would be going directly against her advice.

I didn't understand why she had got so concerned over some bleeding during the first 4 months, but the reason she gave was that it had been over a year since I had had a natural period and the advice on the medication was that any bleeding after 6 months, or if it started after a long break had to be investigated. So it all surrounds this ambiguous phrase after a 'long break'.  Yet the advice on the Evorel Conti leaflet also states it is only suitable for women whose last period was more than 18 months previously and mine had only been 9 months. Surely there must be written into the instructions the realization that most women won't have had a period for 18 months before they start using it and any bleeding in the first few months of using the patch is going to mean that it has happened well after 18 months since their last bleed, so I'm not sure how my 12 month break can constitute a 'long break'. (Hope that all makes sense.)

I think the doctor had little knowledge of Evorel Conti, as she didn't prescribe straight away as she wanted to confer with a pharmacist to find out which patch I could use that combined both hormones.  So I doubt she knew of the advice to only start using after 18months period free.  I think I may have been better on a sequential HRT for the first year or so and if the scan turns out fine then I may ask her to put me onto this.  My worry is that because she now seems  convinced that something untoward has happened she may refuse or think me unsuitable for further treatment.  If this were to happen I think I would look for another doctor.

Still debating with myself about if I should reapply the patch tonight or not.

No word about any scans yet either.  Not sure an extra week or two of HRT would make much difference to any results. I'm not sure if that might be the reason she asked me to stop.

Will let you all know any outcomes.

Fiona x

[Hurdity]

Your doctor seems to misunderstand the menopause, bleeding and what is required for a referral. If you are on HRT then the time since then doesn't count re time since natural period! None of that is relevant any more as you are no longer in a natural state! How irritating to have to be in the hands of someone like this. In the absence of any particular medical reason for you to stop HRT there is no reason to do so and I can understand your wanting to resume. If you want to be absolutely sure you could contact Dr Currie for an e-mail consultation ( £25 - website home page - scroll down). Also Women's Health Concern ( e-mail or telephone consultation - various costs from £10 for e-mail, to £20 for 10 mins - £45 for 45 min telephone consultation).
https://www.womens-health-concern.org/help-and-advice/telephone-advisory-service/
https://www.womens-health-concern.org/help-and-advice/email-advice/

Hope this helps

Hurdity x

[Fionalowri]

Here is the update on scans and other things.

Firstly, thank you Hurdity for the links you gave in your reply, very useful to know, though haven't made use of them yet.

I finally went for a ultrasound vaginal scan some five weeks after seeing my doctor, not sure why it took so long, but when I googled the waiting time for getting a scan the NHS site did say it was two weeks for women over 55 or somewhat longer if under that age.  So it looks like I was in the 'somewhat longer category.'  Also I got a phone call direct from the hospital to arrange the scan and they sent the letter of confirmation after that, so I could have missed an earlier phone call as I wasn't expecting one.

After stopping the HRT I did go on to have another bleed some two weeks after, and four weeks after the bleed I had had before, again very much a typical (for me) period rather than just spotting, which was preceded by very obvious PMT.

I had the scan 16 days after the first day of the bleed, so possibly mid cycle, and all was fine. The procedure, for anyone who hasn't had one, wasn't at all uncomfortable for me and much less so than having a smear test done. The lady who did it said immediately that there was no thickening of the lining of the uterus, though she did say I had a small fibroid, but that it shouldn't cause any problems now I was going through menopause, and that she didn't see any reason why the HRT would cause a problem because the dose is relatively low. My ovaries were also still there and looked fine. So all good news on the scan front, other than having a fibroid that I never knew about. She didn't give me an exact measurement for either the lining or the fibroid, and I forgot to ask.

I was feeling fine for first two and half weeks post bleed, but then followed a crash in mood with feelings of anxiety, dark thoughts, low self-esteem and emotional fragility, and I'm waiting to see if I have another monthly bleed.  Have an appointment booked with my doctor on the 8th of December and hoping, in light of the scan results, that she will agree to me continuing on HRT, possibly on a sequential one rather than the continuous. If she still is unhappy about it I thought I would ask to be referred to a menopause clinic, does anyone know how that works?

Hopefully I will find an HRT that works for me as I would rather avoid the worst of these symptoms as I know how quickly they can wear you down.

[Sazzer]

Can I ask how you are doing now - I have had the exact issues and since starting conti have bled continuously since week 2 and feel drained and with obvious constant pmt symptoms. Did you find something that worked ?

[Taz2]

Hi sazzer. Welcome.

It is common to have breakthrough or even continuous bleeding for the first six months of a conti HRT so don't despair. I had the same problem but when things were no better at the end of the six month time span I changed to a sequi HRT which gave me a light, predictable bleed each month. Other members on here have done the same.

I'm sure you will get lots of help and advice on here.

Tax x 

[cazzie29]

Hi Fionalowri

Just thought I'd let you know of my experiences regarding Evorel Conti. My doc put me on this patch in September of last year after having tried tablet forms of HRT which either didn't control my symptoms or just made me bleed continuously. All was well with the Evorel Conti for the first 3 months, then I had breakthrough bleeding which led to almost continuous bleeding, although never too heavy, just annoying.

Went back to the doc 2 weeks ago and she is arranging for me to go to the menopause clinic (although this could take a while) and she has made me an appointment for a biopsy. The biopsy, she said, was just to put my mind at rest, as last year, I had an ultrasound scan which showed everything was fine.

I asked the doc if I should continue with the Evorel Conti whilst waiting for the meno clinic appointment and she felt it was fine to do so if it was helping me with all my other meno symptoms.

It seems to take some women a few attempts at finding the right HRT, me being one of them, but I will persevere for a little while longer in the hope that I can get it right, as I am generally feeling so much better but do worry in case I am damaging my health. This is definitely not an easy stage of life 😩.

I hope my post is of some help to you x