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[TNM45689]

Hi

I have been on HRT for 8 years - it has taken me a long time to get the right combination right in terms of absorption. I am on a high dose and recently I was experiencing bloating etc (no bleeding whatsoever) and had my osetradiol levels tested and whilst not high for some people they were on he higher side for me. I reduced my dose accordingly and thought all would be OK  - this was probobably two months ago and whilst the bloating hasn't really gone all was OK... At the same time I was given some vaginal oestrogen for itchy/dryness.... Today out of nowhere I have started bleeding heavily - I am going to have to pay privately for another oestradial test but can the vaginal estrogen increase your levels too?

[sheila99]

What progesterone are you on? As it's this that should be keeping your lining thin. Presume conti? Are you definitely meno or could this be your own period? Some topical oestrogen can be absorbed before the tissues are plumped up but negligeable after that. Not sure why you need to test your levels again as you can go by symptom control? All post menopausal bleeding should be investigated so I would see your GP and ask for a scan, you may have polyps or fibroids. And tell her about the bloating as you shouldn't have that either.

[bombsh3ll]

Bleeding is normal and expected when estrogen is reduced - this is the basis of menstruation.

You don't need to retest your levels - this is like testing the woods for bear faeces because with bleeding and the emergence of vaginal atrophy the diagnosis of low estrogen can be made clinically.

Vaginal estrogen may help with urogenital symptoms but will not treat the rest of the body or protect your bones. It has negligible systemic absorption and doesn't significantly raise plasma levels.

I would resume taking the dose that you have already identified as the lowest fully effective dose as per guidelines - note the emphasis should be on "effective" and not "lowest".

Bloating can be progestogen related as Sheila said, but I would also be seeking a pelvic ultrasound and a CA125 on the NHS if this hasn't already been done.