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[SallyPickle]

Hello,

I hope I can get some much needed advice.

I’ve been increasing my oestradiol in the last 6 months to help get levels up due to osteoporosis diagnosis.  With Newson Health GPs agreement I have been on one Evorel Conti and one Evorel 50 changed twice weekly. 

I experienced bleeding a couple of years ago when just on one Evorel Conti and scan found lining to be very thin and atrophic.  Because of this we felt able to just add oestrogen to see how things went.  I did not have any bleeding. 

After a recent blood test my levels are now a little too high 601 pmol/l as we are aiming for about 400 and I didn’t want to risk lining getting too thick.  I have therefore reduced to one Evorel Conti and one Evorel 25 but have now started bleeding, feel anxious and have had my first migraine for a while.  Is this normal when you reduce rather than increase?  I can only find information about bleeding when doses are increased so not sure what’s happening.

It’s all very confusing and I feel really rotten.  I would really welcome any opinions and advice.

Thank you

Sally 

[CLKD]

I would think that it's normal, if the body hasn't as much hormone then reducing will bring the body into a bleed.  Maybe make an appt to have a scan in about 3-4 weeks to check the depth of the lining?  No progesterone in your regime? 

Have U looked at the Royal Osteoporosis Society web site? 

[SallyPickle]

Thanks CLKD, I appreciate you taking time to reply. 

I am on one conti patch which is 50 oestrogen and norethisterone progesterone and then in addition I have one evorel 25 which is oestrogen only. I was on the conti and evorel 50  before so am now getting 25 less oestrogen but the same amount of progesterone.

Maybe the progesterone in the conti is having more effect now with less oestrogen so lining is shedding.  Not sure that this makes sense but I did wonder if it might be the case?

I will ask for a scan if it doesn’t settle but I am hoping it will do as I readjust.

Thanks again 😊

[sheila99]

If it was me I would have a scan. It's a fair assumption they made about how much progestin you need but it might be that it wasn't enough and the lining has thickened. It wouldn't have been enough for most women. Anxiety can be a symptom or insufficient oestrogen so it may be that your body feels better at 600 than 400. It can also be a symptom of too much but unlikely to be this as you've reduced. Anxiety was one of my worst symptoms and every time I try to reduce I find it returns. Sorry I don't know about migraines. We're they a meno symptom for you? Would 2×evorel conti be an option? Though perhaps better after a scan to see what the lining's doing. Assuming you're post meno the advice is for all unexplained bleeding to be investigated. It probably won't be anything sinister but perhaps best to get checked out just in case. Reducing oestrogen shouldn't cause a bleed.

[CLKD]

   sheila99

[SallyPickle]

Thanks for your reply Sheila.  I will get in touch with the GP if the bleeding doesn’t settle but I had bleeding much heavier than this before on just the one evorel conti in 2021 and 2022 and both times at scan the lining was very thin with no sign of any other issues. 

I have read that any change to hrt can cause bleeding in the first 3-6 months so I’m not sure I could be referred for one at this stage but will call my GP in a couple of weeks if I’m still bleeding and ask the question. 

I am 60 and very much post-menopausal.  With Newson Health GP’s consultation I tried evorel with utrogestan but couldnt take the utrogestan either vaginally or orally, I don’t tolerate progesterone well at all.  We then tried increasing Oestrogen by using evorel patches on top of conti gradually and then going to two evorel conti together.  Once I swapped to them the extra progesterone made me really ill so we went back to the conti + evorel 50 and now I’m on conti + evorel 25.  I’ve pretty much tried everything so getting a bit fed up with it all now!  I’ve had occasional migraines since my teens but not had one for quite a while so think it may be hormone related but could just be anxiety and stress. 

Thanks again for your reply 😊

[Hollyboll]

Hi sorry you're feeling rotten and also worried. 
I can't get my head round / don't know enough about the combo you're currently on, and it may be you need specialist advice on some of the symptoms
but just to say reducing oestr definitely can cause bleeding.  As has been said - any change to dose can do that.  I was put previously put on a very high dose and lucky to end up with a leading meno specialist.  When he first started reducing it he suggested what I honestly thought was a ridiculously small decrease - about 5%.  Lo and behold I bled within 36 hours for first time in many months.  Since then I've had several decreases, of different sizes, and bled immediately after some, a bit longer after others, and not after a couple.  I think he said it's the decrease in hormones in natural cycle to which body responds by bleeding ... he definitely said bleeding was "normal" after a reduction. 

So I hope that puts your mind at rest a bit at least on that bit ... sorry I can't help with the rest

If you have heavy bleeding or persistent including after a dose change that doesn't settle within a few months of change, it obviously needs investigating and maybe worth asking to be referred now for a scan because the wait can be long - and any GP should refer you if you tell them you have post menopausal bleeding - there's no downside to having one?

[SallyPickle]

Oh thank you so much for your response Hollybol.  That’s really reassuring and has definitely put my mind at rest.

I’ve worked out that I’ve decreased by around 33% in total in about a month so no wonder there’s a problem 😳.  At one point I was on 112.5 mcg of oestradiol but that was definitely too much as I felt really wired so I explained that to the GP at Newson Health and we reduced it to 100 and then down to 87.5 and now to 75.  I will see how it goes and if the bleeding gets worse or hasn’t stopped in a week or so I will ask GP for a scan.  As you say, there’s no downside to having one. 

Thank you again, I really appreciate you taking the time to reply and for the reassurance.  😊

[Hollyboll]

Glad you feel better for it  
I don't think it's directly related to the % reduction every time - like most things in mno it's a bit too random for that ... I was just saying my 5% because I remember clearly thinking it was a cautious reduction - Newson had me up around 300 and that first reduction was 12.5 ...  I've since had bigger decreases in both absolute and percentage terms that haven't led to a bleed - but of course when one does more than one reduction or indeed increase (I had terrible bleeding when Newson increased my dose, and they kept on increasing it just saying bleeding 'normal' within a few months of an increase) you never know exactly which 'tips' it - and I've had to do some of the reductions in quicker succession too, for various reasons.  If only this was all an exact science

I've learned the hard way that the changes/fluctuations in hormone levels are at least as problematic / cause symptoms as the levels themselves, and any reduction like any increase is another change. 

Good luck xx

PS if you want a scan, just tell your GP the bleeding is heavy and you're concerned.  They should refer you, if only because they want cover down the line if you did end up having a problem and they'd made you wait and/or because it's quicker and easier for them to refer you if you tell them to - often they won't if you don't - than to deal with further appointments where you are worried about it.  Unfortunately I've also had to learn the hard way about unhelpful GPs!

[SallyPickle]

Thanks Hollyboll for all your help and advice.  Sounds like you have had to manage a lot of challenges, it must have been tough 😬.  Great you have a brilliant specialist though which must help a lot.  Are you happy to share the name of your specialist?  If you are I would love to know but totally understand if you prefer not to say. It’s a very confusing process all of this so I guess we just have to get things as good as possible and then manage the rest as best we can. xx 😊

[lilbebel]

Hello. I’m sorry you’re dealing with this nonsense. I am in the same situation. Bleeding that started with an increase in oestrogen. Cut the patch to make it 62 mg instead of 75. Stopped bleeding for a week and I have bleeding again. May I ask you what method your doctor is recommending that you use to lower the oestrogen? Are you cutting patches?

[SallyPickle]

Hello. I’m sorry you’re dealing with this nonsense. I am in the same situation. Bleeding that started with an increase in oestrogen. Cut the patch to make it 62 mg instead of 75. Stopped bleeding for a week and I have bleeding again. May I ask you what method your doctor is recommending that you use to lower the oestrogen? Are you cutting patches?

I know, it’s a real challenge, sorry you are having similar problems!  The GP said to just up 25 mcg in one go when I was increasing but I felt terrible and never got beyond half a patch increase (12.5).   With reducing I went from 112.5 to 100 then to 87.5 then to 75.  I did one reduction per over a month but I think I tapered off a bit too quickly (especially in view of hollyboll’s helpful advice) as I’m feeling really rubbish now.  I did just cut the patches to do this.  I hope you get on ok with the reduction and that your bleeding resolves.  Are you feeling ok in yourself with the reduction?

[lilbebel]

Hello and thank you for your reply. So, yesterday I resumed the full dose of 75 mg. I had cut my patches to give myself a dose of 62.5 mg and I tried that for two weeks. All hell ensued. I started bleeding heavily, rather than just spotting. My mood tanked. I developed severe  depression. I couldn’t stop sobbing, nor could I get out of bed. My face broke in acne. It was completely hormonal. God, it’s mind-boggling to see the impact such a small amount of hormone has on our whole mind body system.  Also, I’ve upped my progesterone to see if I can stop the bleeding and then go back to the normal amount. I’m so sorry you’re feeling rubbish. This is awful isn’t it. Sending you courage my friend. We will get through this. We must believe in ourselves and each other. ❤️

[SallyPickle]

Thank you so much for your lovely reply lilbebel.  What a horrible time you’ve been having.  It’s frightening when our mood is affected so badly.  You’re so right, these are very powerful hormones and I think trying to find the right level that suits us can be difficult and can involve a lot of upset along the way.  I really hope the bleeding settles and that you feel much better soon.  Thank you for your lovely message, it mean’t a great deal.  It is awful and we do need to have courage and belief that we can get through this.  Take care 💕