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[CherryC]

Hi ladies, I apologise in advance for this very long post.  I have just compiled this as a question to put t Dr Currie, but now realise the service is unavailable until mid April.
I hope you don't mind me posting it here in case anyone can offer some advice and suggestions that I can be mulling over.

I have been on 100mg Estradot patch, 100mg Utrogestan daily vaginally, and a blob of Testogel for 8 months.
Having tried a few other regimes, this one has been suiting me very well in terms of how I feel in myself.
Taking Utrogestan orally made me feel sedated, but vaginally I am not really aware of any negative side effects.

However, since starting this regime (via consultant), I have had two period like bleeds, one in November and one just this past week.
I had an ultrasound scan a little while ago and the lining was 6mm. I was told this was fine as long as no bleeding, but of course I have now had a period like bleed, which I assume is shedding.

It was suggested by the consultant some time ago, that if I do get any bleeding, an alternative vaginal progesterone like Lutigest may be worth trying.
However, I am just wondering what all my options are to try and maintain feeling ok.
I previously suffered on and off from some migraine type headaches on other hrt regimes, but have had no headaches whatsoever on this one.

My question is whether I should:

Try something like Lutigest vaginaly and would this be any less likely to cause bleeding or side effects?
Stick with the Utrogestan but maybe on a long cycle with a controlled bleed to keep the lining thin.
Stick with the Utrogestan vaginally but reduce the amount of Oestrogen to 75 or 50. (My levels tested twice on the 100 Estradot was about 350 and more or less keeps symptoms under control, other than a bit of heat at night)
Any other suggestions?

I also worry sometimes if it is safe to take Utrogestan vaginally on a continuous basis.

I was due to visit the consultant later in April, but this will obviously not happen now due to the virus.

I would be very grateful for your advice so I can be weighing up the options. Thank you x

[Dandelion]

Hi ladies, I apologise in advance for this very long post.  I have just compiled this as a question to put t Dr Currie, but now realise the service is unavailable until mid April.
I hope you don't mind me posting it here in case anyone can offer some advice and suggestions that I can be mulling over.

I have been on 100mg Estradot patch, 100mg Utrogestan daily vaginally, and a blob of Testogel for 8 months.
Having tried a few other regimes, this one has been suiting me very well in terms of how I feel in myself.
Taking Utrogestan orally made me feel sedated, but vaginally I am not really aware of any negative side effects.

However, since starting this regime (via consultant), I have had two period like bleeds, one in November and one just this past week.
I had an ultrasound scan a little while ago and the lining was 6mm. I was told this was fine as long as no bleeding, but of course I have now had a period like bleed, which I assume is shedding.

It was suggested by the consultant some time ago, that if I do get any bleeding, an alternative vaginal progesterone like Lutigest may be worth trying.
However, I am just wondering what all my options are to try and maintain feeling ok.
I previously suffered on and off from some migraine type headaches on other hrt regimes, but have had no headaches whatsoever on this one.

My question is whether I should:

Try something like Lutigest vaginaly and would this be any less likely to cause bleeding or side effects?
Stick with the Utrogestan but maybe on a long cycle with a controlled bleed to keep the lining thin.
Stick with the Utrogestan vaginally but reduce the amount of Oestrogen to 75 or 50. (My levels tested twice on the 100 Estradot was about 350 and more or less keeps symptoms under control, other than a bit of heat at night)
Any other suggestions?

I also worry sometimes if it is safe to take Utrogestan vaginally on a continuous basis.

I was due to visit the consultant later in April, but this will obviously not happen now due to the virus.

I would be very grateful for your advice so I can be weighing up the options. Thank you x

Hi
I don't know lutigest at all and don't know if I can be of any help.
I bled on conti oral utro 100mg so vaginal utro was added, after hysteroscopy showed no cancer despite a slightly thickened lining.
This was in Jan 2019 after six  months bleeding, not heavy.
Then in June 2019 the bleeding started up again so my 100mcg patch was reduced to 75mcg and all went well until the end of last year when I started bleeding heavily, passed a huge clot once.
I have had two period like bleeds, the last one being really heavy with small clots and pelvic pain.
I'm fed up of going back and forth to the doctors.
I'm just coming to the end of my last heavy period like bleed which lasted longer than a period, but today, when I wiped after a visit to the loo, there was brown red mucous on the tissue.
Sorry for the amount of info.
I am running out of patches and have gel as a backup and considering reducing to 50mcg but I flush on 75mcg and get night sweats needing a fan, so it can only get worse if I reduce the oestrogen, as the old IBS I used to suffer, explosive diarrhoea 3 or 4 times on a morning may return. Dr offered me drugs and a colonoscopy for that which I refused as I knew it was hormone related.
We both need to see our doctors as abnormal bleeds should not be happening, but I cannot change my regime as I am addicted to valium which is cross tolerant with progesterone and I've heard enough catastrophic experiences of women on other non meno forum becoming incapacitated and extremely ill when they tinker with much lower doses of progesterone or stop it.

[Hurdity]

Hi Cherry C - firstly if you are not yet post-menopausal then this will lead to unpredictable bleeding ie proper periods, albeit somewhat muted by the daily progesterone.

Secondly if you have had any womb issues like fibroids or polyps this can cause abnormal bleeding - but if you had a scan and no abnormailites were detected this is presumably unlikely.

The fact that your lining was 6 mm - a bit higher than the maximum recommended suggests this could be the cause although it is still not very thick, but could have thickened since then?

Most other bleeding like this on continuous combined HRT (if not due to periods, fibroids etc) is most likely due to the imbalance between oestrogen and progesterone as the amount of progesterone needed to protect the womb from thickening is dose dependent yet the progesterone dose given or prescribed is just a single dose whatever the oestrogen.

If you are taking it vaginally then this is going to where it is needed so at least gives a more stable dose than taken orally.

Like you suggest - the options for continuous use are either to increase the progesterone dose (could you take 200 mg on alternate days with 100 mg vaginally?), or decrease the oestrogen dose and which one you choose depends on whether you are OK with lower oestrogen or whether you can tolerate increased progesterone.

Also as you suggest you could take the progesterone cyclically for a controlled bleed (200 mg x 12 days per 28 or monthly) but your doc would need to supervise a longer cycle in view of your bleeding, as you say not really possible at the moment.

Personally I would not want to take prog all the time vaginally as it irritates my bladder and wakes me in the night, and also causes itching.

Re Lutigest - this is not licensed for HRT so it would be difficult to get hold of this although the Chelsea and Westminster recommended it off label: https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/copy_of_GPPrescribingAlternativesDISCHARGEPLAN.pdf . The amount of Lutigest used for luteal support in pregnancy is half that for utrogestan so the same dose of Lutigest ( 100mg) for HRT used continuously may well have a"stronger" effect and protect the womb better than utrogestan. If you are able to get thus prescribed by phone and sent then why not try it if you prefer continuous progesterone?

Hope this helps and good luck.

Hurdity x

[CherryC]

Thank you both Dandelion and Hurdity for your really helpful replies.

Dandelion, it is really useful to hear of your experience - I hope you manage to get something sorted too and wish you luck.

Hurdity, your advice is extremely helpful too. At 58 I am post menopausal.  I do actually have some small fibroids, which are just kept an eye on during ultrasound scans, so I guess that could be a contributory factor.  Though I initially found using Utrogest vaginally irritated the bladder during the night, that soon stopped and is no longer a problem thankfully.

Thank you for your points on the various options, which is a great help. I am under the Chelsea & Westminster, so may be able to get a prescription for the Lutigest.  I will write to the consultant and see what she suggests at this moment in time and under the circumstances.

It's great to have experiences, help and advice on the Forum too, to help with decision making.

Many thanks. x