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[Flissfloss]

Hi. I’ve been on HRT for 4 years very successfully. Having missed a few periods I was advised to go to continuous utrogestan last March. This was working well. I had a couple of periods but nothing major. I introduced vagifem in November and started bleeding again. Very normally but by the start of this year every two weeks GP panicked and went on pathway and after an exceptionally difficult hysteroscopy (tiny tiny cervix) under GA we established nothing wrong.
I’ve now been on utrogestan continuously 200mg daily to stop bleeding for 6 weeks. Having previously had no issues with it at all. the bloating and now piles are getting a little too much! (These used to be my signal period was about to start).
I understand I can take vaginally but given this is the area I’m actually having the issue with…. Not sure it will help. Has anyone tried one tablet orally and one vaginally? Or maybe trying to decrease the dose to one tablet one day and two the next? Gyni thinks possibly I’m still not in menopause and this maybe what I’d be doing naturally anyway as I approach. Hopefully I’ll only need this double dose for a few months. I’m on 3 sprays of lenzetto/testogel/vagifem. The full house  :-)

[bombsh3ll]

Absolutely you can take one orally and one vaginally.

However if cyclical worked better for you, going back to that may be a better option.

Alternatively you could try a bleed free progestin such as desogestrel 150mcg daily.

[Flissfloss]

Thanks. Yes I did suggest going back to cyclical. But as I was bleeding every two weeks it was tricky to fit in. I’m quite invested on trying to stay with the body identical progesterone if I can. But never say never! I’ll give a few things a go.

[sheila99]

I would avoid the 1 then 2 approach as reducing to 1 again might trigger a bleed. If it was me I'd go back to sequi, the periods close together can happen in late peri but it's usually short lived. I'm sure you know medical advice is to stick to the 28 day cycle regardless though I changed it to fit my own cycle. 25/28 can be useful in late peri as it allows a bleed if there's a build up.

[Flissfloss]

Yes, at no point was I concerned and was happy to just try different things. But sadly the gp I spoke to wasn’t particularly knowledgable on hrt and wasn’t prepared to discuss anything not on the tin so to speak. I then got swept along into a procedure I didn’t want. They originally wanted to put a mirena in. But given they couldn’t get a 3mm camera in… that went out the window!
I’ve suggested to Gp and Gyni about going back on sequential and they both poo poo it.

[sheila99]

They aren't watching  . I stayed on sequi in my 60s because of side effects, the specialist told me there's a slightly increased risk of endometrial cancer but they agreed to it. I have a mirena now which is great. The gp couldn't get it in but she sent me to a specialist who had smaller instruments. I don't know the size of them but it might be worth enquiring.

[bombsh3ll]

There is a very small increase in endometrial hyperplasia risk when sequential is used long term, however this can be avoided by having an annual private ultrasound scan to check your lining remains healthy.

The NHS hasn't the resources to provide this level of individualised care so have to err on the side of caution and have everyone on high dose continuous progestogen.

Whilst this does avoid endometrial cancers, the trade off is many women being over treated with progestogens, which results in other negative outcomes.