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[Autumn27]

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?

[Pat2121]

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

[Autumn27]

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

[Pat2121]

You are welcome!! I'm going to try some natural routes and I willlet you know if they work! Fingers crossed for us!! xx

[Conolly]

Hello Autumn27,

Welcome to the forum and the menopause malarkey 

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

[Hurdity]

Hi Autumn27

 

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

[Autumn27]

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.

[Autumn27]

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).

[Hurdity]

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

[Autumn27]

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.

[Conolly]

Hello Autumn27,

According to this review 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

[Hurdity]

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

[Autumn27]

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.

[Autumn27]

Hello Autumn27,

According to this review 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

[Hurdity]

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