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[Sarah708]

Hello - thanks for letting me join. I could seriously do with some suggestions please.

I’ve been on HRT for nearly two years. Last December I changed from Evorel Sequi to Evorel Conti continuous and bleeding started having not had a period for a year. Also on mini pill.

After 3 months I changed to Utrogestan continuously (1 tablet a night) and the bleeding stopped instantly. Felt better on gel x 2 pumps and  Utrogestan.

A month later the bleeding started again. Had scan and womb lining perfect. Subserous fibroids x 2.

Put back on cyclical regime of Utrogestan and gel (2 pumps). Bleeding just minor spotting once or twice a month, but this is improving, but when I’m not taking the Utrogestan I wake lots for a wee and generally feel like I’m seriously missing the  Utrogestan - bloating, terrible wind and more anxiety.

So my lovely supportive GP agreed with my BMS research to double  Utrogestan and try a continuous regime again. I told her I’d already started a trial run, so the next day I started spotting - it’s not come to much yet. This would be day 25, so I’m wondering if a three or even five day reset might help? So no Utrogestan for three to five days? I know the instructions call for a three day break, but this is not necessary- but could it help me?

I’m just desperate to make the Utrogestan work, so I’m keen to hear what others do, so I can approach my Gp with ideas - she’s really HRT friendly, but I’m thinking I’ll need to go privately if I can’t solve this.

Thanks for wading through all that! I’m 52 btw.

[SarahT]

Hello Sarah,

I am sorry I don't have the answers for you, my hrt regime is too different for me to advise. I just want to welcome you to the forum. I am sure someone with the right experience will be able to jump in. Good for you for doing your own research to find out how to advise your own gp. Seems a bit mad but a lot of drs do need extra training on menopause issues as we all know, and many of us do our own checks.

[Sarah708]

Thank you! Yes it’s all a bit crazy isn’t it. I’m building up to getting her to prescribe testosterone next….!!

I’d really like to understand what’s not working a why though - so complicated!

[sheila99]

I would be inclined to try the 3 day break. It can be useful in late peri as it allows a bleed if there's been a build up. I think you can't be certain you're meno as you were on the pill when you didn't bleed? The other possibility is that it's the fibroids causing it. When did you stop the pill? How old are you (though this may not help as some aren't meno til their early 60s)?
Double dose utro is a known strategy for problem bleeding too but if you're not meno the 3 day break might be better.

[Sarah708]

Thank you for your reply
- I’m 52 and still on the mini pill too, although I wonder why with so much progesterone, so it’s absolutely possible I’m still peri.

So that’s good to know about the three day break - really hope it’s not my fibroids. I guess it’s just a process of trying different strategies. I do wonder if a five day break would help but I’ll stick with the three.  Thanks again

[sheila99]

If you want to use 5 days instead I don't think it matters. I think they say 3 because it's the withdrawal of progesterone that triggers the bleed and 3 days is enough time for this to happen. I'm not sure how much the mini pill is complicating things though, as you say it's a lot of progesterone. It's also possible to use 2 Pop as the prog part of hrt. At 52 there's a good chance you're still peri in which case being bleed free is difficult without a mirena (though possibly 2XPOP might work?).

[Sarah708]

Thanks Sheila99 - I guess I’m going off license here, so I’d need to go private probably. But I’m up for experimenting but I do wonder if I actually need the mini pill on top of two tablets of progesterone.
It would be interesting to read up on that more. But I absolutely don’t want another child!!!

I’m loathed to have the coil as I think the synthetic progesterone would be a problem - it felt horrible on the patches. Plus I’m terrified of the idea too. Is there much written about contraception and HRT - I’ll try a three day break this time, then if needed five days.

The bleed happens if it’s continuous but stopping has virtually stopped the spotting.

[sheila99]

HRT doesn't provide contraception unless you're using a mirena or (presumably) 2xPOP. Although it's still synthetic the prog in a mirena is a different type to norethisterone used in evorel conti so you may find it's OK for you. I share your concern about having something you can't easily remove yourself though.