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[Dawn W]

Hi all,
I really hope someone can give me some advice. This menopause & hrt malarkey is really confusing isn't it?
I have been period free for over 12 months, & was suffering really badly with hot flushes, foggy brain, anxiety & was at the end of my tether.
My gp prescribed Femoston conti 0.5/2.5. The first 2 weeks were like a miracle & I was almost euphoric. Then I started to bleed, which I know is common in the first few months. I stuck with it & stopped bleeding. After 5 months, the hot flushes & anxiety returned. I was also suffering with continuous thrush. My gp then prescribed Elleste duet conti 2/1mg. After 2 weeks, I started bleeding again, which I sort of expected with the increased dose. But it's now been going on for 4 weeks, with no sign of stopping. It's also been really heavy at times, with awful stomach cramps.
My question is, how long do I give things to see if they settle? I was also wondering if the aestrogen level is maybe too high, or can I increase the progesterone to counteract the bleeding. Am very worried & confused.
My gp has suggested another alternative, if this one doesn't suit, of Indivina 1/2mg?
All help greatly received.
Thanks in advance.

[Dancinggirl]

Hi and welcome to MM Dawn

I suspect you were not deep enough into post meno to use a continuous HRT and your womb lining is thickening too much - your GP should probably send you for a scan to be on the safe side.   

I'm afraid some women do find that hey get ongoing problematic bleeding any any continuous HRT - this is why many choose to stick with a sequential HRT and put up with monthly bleeds. You may do better with a Mirena as this will control bleeding much better, usually gives fewer side effects as well (less chance of cramps) and you can then use as little or as much oestrogen as gel or patch alongside.

Here are the links on this site to the options you could consider:
https://www.menopausematters.co.uk/postmeno.php
https://www.menopausematters.co.uk/to_progestogens.php

Dg x

[Dawn W]

Thankyou so much for your reply Dancinggirl,
There seem to be so many options & variations of hrt, that it seems to me that it could take forever to get the right balance. Not sure if I have the energy or patience tbh.
I'm sure that if the bleeding doesn't settle, my gp will definitely refer me for a scan.
My theory is that the oestrogen level is too high for me & the progesterone level, too low to counteract it. Was thinking of testing my theory by giving it until the end of the 2 months, then if the bleeding hasn't stopped, adding a norethisterone tablet (5mg) for the last month to see if it makes a difference.
I have to see the gp after 3 months anyway, so hopefully will have some kind of result.
I don't fancy using the Mirena coil. I hate anything intrusive.
Fortunately my gp is very good & will take the time to check things out for me.
Here's hoping things settle soon. I'm thinking of taking out shares in sanitary products.
Do you have any advice on the constant thrush? The gp has prescribed a weekly fluconazole tablet for 3 months to try to zap it!
Dawn x

[Dancinggirl]

Hi Dawn - I really wouldn't add too much progesterone as this could result in other unwanted side effects - too much progesterone can counter the benefits the oestrogen gives!

You switched from the ultra low dose of HRT to a much higher dose of HRT, so it will take longer for any bleeding and spotting to settle - your uterus needs time to adjust. I'm surprised your GP didn't simply put you up to Femoston 1/5 to see if that worked well for you!!!  Maybe ask to try this version as this is still a higher dose than your first HRT but not as high as the Elleste 2/1.  Though you clearly need a higher dose of oestrogen, you didn't need such a big dose?
It is normal to get bleeding in the first 6 months of any conti HRT so it may be a matter of patience. Chopping and changing HRTs is probably not the answer - the important thing is the HRT keeps flushes etc under control then it is doing it's job.  Unfortunately erratic bleeding is one of the main reason why women struggle with conti HRT so you could consider switching to the sequential version of Femoston as this would give you a predictable bleed each month which could be less hassle. 

Please don't rule out the Mirena - I felt the same way about it as you - however when I got so many problems with conti HRTs, I felt I had to try it and frankly it was the best non bleed HRT regime I ever had.  There are many reasons why the Mirena is preferred by so many gynaes - it solves many problems generally and over 90% of women who try the Mirena are happy with it. 

OK - THRUSH - this is likely to be urogenital atrophy which is common when meno hits and if you are constantly bleeding this won't help either. You need some local oestrogen e.g. Vagifem ( on prescription ) and use vaginal moisturiser daily - SYLK or the YES products are the best and you can get these online. To restore the vaginal flora balance you could also use Multi Gyn Actigel ( again buy online) as this is great for treating and preventing thrush, bacterial vaginitis , itching etc.  Basically, the oestrogen deficiency results in the vaginal flora drying out and therefore the whole area becomes more prone to infections.  Maintaining the flora balance will help prevent these problems but it has to be maintained for the rest of our lives to prevent ongoing problems. We get so many women coming to this forum in distress because they are sore, itchy, burning and have UTI symptoms and don't understand why - GPs are not good at diagnosing this but local oestrogen and moisturisers can make a big difference.  It takes time for all this treatment to work and one has to persevere and maintain everything but it is worth it.

My suggestions for you would be:
Perhaps keep on the Elleste for a month or two to see if things settle. OR Ask to try the Femoston 1/5 conti, as this dose may be enough to control MOST of your symptoms and maybe reduce bleeding problems - if this doesn't control your symptoms and bleeding continues for more than 6 months then I would consider trying Elleste again ( as it has the most powerful progesterone) or Oestrogel with Provera or Utrogestan but use the sequential versions and put up with monthly bleeds OR seriously consider a Mirena. 
Ask your GP for Vagifem - below I will give you the section from the NICE guideline about treatment for urogenital atrophy which you could print off to show the GP.   
Buy some Multi Gyn Actigel  to treat the soreness and itching.  Perhaps take some probiotics and cut out as much sugar as you can to help reduce the chance of thrush (diet can help with all this). Also buy some SYLK or the YES moisturiser and use this after every shower (don't have baths or use anything scented on you ‘lady bits'). Don't use moisturiser at the same time as the Vagifem as it can effect absorption, so use the Vagifem at night and mosturiser in the morning.  Vagifem is used every day for 2 weeks and then twice weekly after that - for ever as this will help prevent further problems.

Urogenital atrophy
1.4.9
Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.
1.4.10
Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.
1.4.11
If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.
1.4.12
Explain to women with urogenital atrophy that:
symptoms often come back when treatment is stopped
adverse effects from vaginal oestrogen are very rare
they should report unscheduled vaginal bleeding to their GP.
1.4.13
Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.
1.4.14
Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.
     

I had a premature meno in my mid 30s, so used HRT for 25 years and tried just about every HRT there is.   I'm now 62 and I stopped systemic HRT 2 years ago but still use Vagifem - so my advice is based on my experiences.  I hope this is all helpful.  DG x

[Dawn W]

Dancinggirl,
You are a lifesaver!
It's so lovely to get some positive advice. I've been really worried & been panicking like mad.
I will print off your advice & discuss it with my gp when I go back.
I will try to persevere with the Elleste 2/1 for another month, then, if there's no improvement, will ask to change to Femoston 1/5.
Thank you so much for the advice on thrush. I will definitely ask for Vagifem & look into purchasing the other products you mentioned.
I have found this forum so useful already. I refer to it constantly at the moment.
I no longer have a mum to ask for advice, so feel pretty lost to be honest.
I really don't know what to expect, or what is 'normal'.
Will keep you posted as to my progress.
Thanks for being there.
Dawn x

[Dancinggirl]

Dawn - no women is educated about this time in our lives and what happens can be scary and frustrating. GPs and often gynaecologists are not good at treating menopause yet we are expected to work through all this.

The site has really helped me and I feel I've made some good friends, so I try to pass on what I have learned and help others.  Hopefully the next generation of girls will get better treatment but the message does need to get out there - menopause is still very taboo!! - I feel that we are still the trail blazers when it comes to getting the help we need at this time in our lives.  Hope you feel better soon.  DG x

[Dawn W]

Ok, update.
The bleeding seems to have stopped over the last three days. (Fingers crossed).
I am still getting the most horrendous yellowish, clear discharge & awful stomach cramps. Also have felt quite nauseous the last two days. Reading the side effects list of the Elleste Duet, they would appear to be quite common? Is there anything I can do to alleviate any of these?
Am still thinking the oestrogen level in the Elleste may be too high for me.
Have bought some multi gyn  actigel as you suggested & have used one dose so far. Also got some yes vaginal moisturiser.
If I do change to the Femoston conti 1/5, will I have to go through the possible bleeding during the first few months again?
Am really feeling quite disillusioned over this hrt at the moment, but I really don't want to go back to how I was feeling before either!
Sorry to be a pain.
X

[Dancinggirl]

Dawn - the erratic bleeding that is so common with any continuous hrt is a difficult one to solve in my experience - my THEORY is that, for some of us, the uterus simply doesn't want to ‘play ball'!!!!

The Mirena was my only successful non bleed option and I used Oestrogel alongside.
On all patch and pill Conti HRTs I got a variety of side effects and erratic bleeding with awful cramps that outweighed any benefits. I doubt it's the amount of oestrogen causing your problems as I tried using very low doses of oestrogen and just got more progesterone side effects.
If you really can't tolerate a sequential HRT regime, then the Mirena would be your best option.
Many women stick with a sequential hrt regime and put up with monthly bleeds because Conti regimes give too many problems.
DG x

[Dawn W]

Thanks Dg
Hm, I'm thinking, if things don't settle, maybe going to the sequential hrt, may be a better bet. The side effects are worse than the original symptoms.
What sort of side effects do you get with the sequential hrt?
Also, quick question, with the multi gyn actigel, how often should I use it? It says on the box to use every 3 days?
Thanks again
X

[Dancinggirl]

I use Multi Gyn as and when I need but using it once or twice a week will help to maintain the flora balance.
There are generally fewer progesterone side effects with sequential but one does have to put up with the bleed and possibly some pmt a couple of days before the bleed arrives.
Sequential is preferred by many women. DGx

[Dawn W]

Thanks Dg
So it would be ok to use it more than than every 3 days?
I think, if things don't settle on the Elleste, I may, firstly try the Femoston conti 1/5. Then, if no joy on that one, switch to the sequential instead.
Is there a preferred sequential hrt?
D x

[Dancinggirl]

Femoston is a good HRT as the progesterone is one of the gentlest in terms of side effects - so I would try the Femoston 1/10 sequential first. 
Many women do like the Oestrogel or oestrogen patches with either Utrogestan or Provera but this regime can seem a bit complicated at first and many don't get on with Utrogestan as it can give problematic bleeding.

The MultiGyn can be used for a few days in a row if you feel you need it - I sometimes use it 2-3 times a day for 2-3 days if I feel itchy or sore but I find the SYLK everyday with Vagifem used at night twice a week, tends to keep things ticking over very well. DG x

[Dawn W]

Dg, you're a star!
You've been so helpful. Just feels like I have someone to turn to.
Thankyou.
Will keep you posted.
D x

[Dawn W]

I'm back again!
Have been doing not too bad on the Elleste duet conti after a very shaky start.
The bleeding stopped after a very nasty 5 weeks.
I've still been getting bloating, cramps but have been coping with those. Have been managing the va with multigyn actigel & yes moisturiser. That works really well.
But have just started bleeding again after nearly 5 months on Elleste.
Help!
Am feeling very anxious.

[Dotty]

Hi bleeding can happen in the first 6 months of taking any hrt. Bleeding after 6 mo this should be investigated x