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[Hurdity]

Thanks - yes I agree meno lesley. You shouldn't have to come off yet anyway. The info on this site says at age 60 the risks = the benefits and provided you are healthy then under 60 the benefits outweigh the risks.

Here are the magic scales
http://www.menopausematters.co.uk/balance.php

What is the two week rule? Maybe I should be subject to that?

What dose of oestrogel are you on? Maybe the dose of Utro isn't quite enough in your case to keep the lining thin.  Do you get bleeding after you stop for the 3 days ie was it a type of withdrawal bleed? That would indicate the dose of Utro would need increasing or the oestrogel reducing so that the prog is enough to oppose the oestrogen without causing thickening.

I think provided you (ie we) have no problems they are happy for you to carry on with HRT generally - as I said my GP was happy for me to carry on but because I had the spotting now says well I would expect to have problems as I am on HRT at the age I should stop. That's no attitude I must say. She said it very nicely of course.

I am almost certain it is not the uterus lining because it wasn't red blood  (although GP said this wasn't necessarily the case), and as I said earlier my bleed every 2 months is not heavy - but yes I would have thought I should be offered a scan. I suppose what she was saying is that my lining would be thickened due to the HRT and therefore how would they know if there was anything amiss - and I presume they don't want to do a biopsy or hysteroscopy until they have checked with ultrasound.


I'm still awaiting a reply from Dr Currie so I will decide what to do after I hear from her.

I am not especially worried but perhaps I should be - more annoyed at lack of investigation until I stop HRT.

Sigh. Think I'll do some gardening...

Hurdity x

[Hurdity]

PS Have just found this - the NICE referral guidelines for suspected cancer

When a woman who is not on hormone replacement therapy presents with postmenopausal bleeding, an urgent referral should be made.
C
1.7.7 When a woman on hormone replacement therapy presents with persistent or unexplained postmenopausal bleeding after cessation of hormone replacement therapy for 6 weeks, an urgent referral should be made.

That explains why I wasn't referred.

Interesting that you got referred anyway meno lesley and you are on HRT

Hurdity x

[meno lesley]

Hi

Bit surprised i was referred in that case. I had a feeling of an impending period which i hadnt had for years and then i started to lose some brown and then red blood. It only lasted a few days but the period type pains have carried on. It didnt happen when i had the break in progesterone but in the middle of the 25 days which is odd. I am on 2 pumps of Oestrogel and Utrogestan 100 25 days out of 28. They were going to do a hysteroscopy but the gynae said that the lining was under 4mm and it wasn't necessary.

I have felt much better on this hrt than any other apart from feet problems which im not sure if is hormonal or not.

I wonder what Dr Currie will say. Perhaps you could go back and fight your corner stating that you want an investigation before plunging into coming off of hrt.

I'm fed up with being a woman.

Lesley

[Hurdity]

Hi all

Update - have now had a reply from Dr Currie (using the consultation facility on the home page of this website) and she is happy for me to summarise her response:

She recommends that the additional bleeding should be investigated but sees no reason to stop the HRT, while acknowledging that stopping HRT in this situation is recommended in some parts of the UK.

She therefore does not recommend stopping HRT as this should be a woman's informed choice.

She pointed out that a cyclical regime for oestrogen and progesterone like I am on is less effective at protecting the womb endometrium from over thickening especially after 5 years of using HRT.

She recommended, in common with this recommendation for all post-menopausal women, that I go onto continuous combined HRT with 100 mg Utrogestan taken daily (without the need to stop for 3 days) and to go back to my GP to discuss this further, and to arrange investigation of the bleeding.

She also suggested I could try a lower dose of oestrogen to see if it was still effective for me – Estradot comes in 37.5 mcg and 25 mcg doses.

I must say I am so relieved to read her response but now have the tricky issue of going back to my GP and telling her I have had a second opinion and asking for investigation. This sort of thing makes me feel somewhat uncomfortable because of course it implies I don't trust her judgement – but will have to be done.  After all there is often more than one way of responding to symptoms and situations.

Anyway I started by cutting a bit off the patch when I changed it last night and see how I get on... I have already started my scheduled course of Utrogestan and will continue it, have the withdrawal bleed and then see how I feel on 100 mg Utrogestan continuously.

Thank-you so much Dr Currie for your help!

I hope this information is also helpful to others.

Hurdity  x

[Cassie]

Interesting Hurdity, glad that you had a response. Any idea whether this would apply to women under 50? I have been on cyclical for years but would not like to go onto continuous Utrogestan if I can help it? I do have regular scans to look at my lining so I guess that is something, just wanted sure if the 5 year recommendation was for any specific age group as I started meno early so in effect have been on cyclical prob for over 6 years.
x

[Hurdity]

Hi Cassie

Dr C recommended going onto conti HRT after 54 or when definitely post-meno.

However if you think about it - since the average age of menopause is 51/52, most women are experiencing cyclical hormonal changes all through this time naturally, and in fact with oestrogen levels peaking far higher than given with HRT, so personally I wouldn't worry atm, as long as you make sure you get unusual bleeding checked out which you are doing, and sounds as though you are in good hands - scanning is the answer! If your gynae wanted you to go on conti HRT, he would suggest it - and it isn't practical for prog intolerant women who want to remain on HRT.

Also remember I am being given general e-mail advice about general principles that would be applied in my case. All GPs/gynaes will give an individualised response and treatment, if seeing a patient on a regular basis, and when she can be monitored face to face.

Having thought about it I will see what happens after my investigations (if I get them after returning to doc) reveal the cause of the bleeding and hopefully take it from there - with advice from a specialist if possible.

Hurdity x

[Hurdity]

Just giving an update

Went back to a different doc today who agreed to refer me for investigations so will probably get a scan and maybe some other internal thing - not sure what - maybe hysteroscopy or biopsy - in due course.

She looked up in her manual and confirmed that her guidelines were that the two week rule is only used if you are not on HRT so still interesting to hear that some of you have been referred quickly even if on HRT. Not sure whether her guidelines were national or just the NHS Trust here in SW England.

I can understand that if you are post-menopausal and not on HRT then any bleeding is unusual so good to have a referral (although if within 18 months - 2 years of last period can still be due to hormonal blips!) whereas if you are on HRT and post-menopausal then I suppose bleeding is not so unusual.

She agreed it was fine to be investigated while I was still on HRT and that it was fine to continue with HRT! I've started snipping a bit off my patch to give a slightly lower dose and if I feel OK after 3 months, and all OK after the investigations, then maybe will go onto 37.5 mcg in the long term.

So I am happier now and will just wait for the referral whenever that may be - which I am not unduly worried about but feel should be done in the circumstances

Hurdity x

[Hurdity]

Well I got two appointments in the post a couple of days after my second visit to the GP asking for a referral. One for today (scan) and the other for a month's time (gynae consultation).

Have just come back from the ultrasound scan at local community hospital. First she did a normal one but because my uterus is tilted she couldn't see it all properly and wanted to look inside. The she asked if she could do a transvaginal one - never had one of these before, but it was fine (ie the experience was fine).

It turns out that the lining is not thickened (even though I am on HRT and if I was on a monthly cycle I would be due to start taking it now) but she could see a small "irregularity" in the womb lining  which she showed me on the scan - about 8 mm which she said was very small. She thought it could be a small fibroid or polyp (or nothing at all?) but said it didn't look like anything nasty and I shouldn't worry!

Anyway the results will be sent to the gynae.

I've had more spotting (after  ) but she she said she couldn't see the cervix nor the ectropion so still couldn't say what was causing the spotting though.

Another thing she said which was interesting - that for women on HRT they accept as normal a lining up to 1 cm (ie 10 mm) which is thicker than others have said - but I can see it would be different on and off HRT. Off HRT any undue thickening could be problematic.

So I'm going to have to wait until July to find out - that hopefully none of this (the cervical ectropion and the irregularity) is anything to worry about and hopefully I can continue with HRT.

Anyone else experienced this after a scan (irregularity thing on the womb)?

Hurdity x

[meno lesley]

Hi Hurdity

I did have some spotting after transvaginal scan but it cleared up and I haven't had any since.

Lesley x

[Rosebush]

I had external & internal scans last week, did not have any bleeding afterwards  but had break through bleed again yesterday & today, not much and stopped now..have hysteroscopy & biopsy booked for 1st July  

It was suggested after scans showed to be okay, that maybe break through bleeds were due to hormonal blip, and checking back through my diary, my break through bleeds (March April & June) all occurred on 5/6th of my patch, sort of indicating the HRT had run out 1-2days before change of patch was due, I also notice day sweats sometimes occur on 6th day of patch.. x

[zelda]

Yes I had something similiar, they thought they could see something and then a month or so later on the next scan it was gone, never found out what it was.

[Hurdity]

Thanks all

Stellajane & zelda - I just have a gynae appt but I don't think that is to do anything except talk about it and look at the scan pictures - I certainly don't want a GA - never had one of those!! I'm pretty sure the spotting is to do with the cervix but the radiographer couldn't tell, but annoying they have found something in the uterus.  Maybe they will decide on a hysteroscopy for a later date? Hopefully like in your cases it will be nothing important and this is encouraging news!

menolesley - the spotting was the reason for the scan not the cause of it - ie I had abnormal spotting when I wasn't supposed to, (which occurs after  ).  Interestingly no further spotting after the scan. Glad you haven't had any more.

Rosebush - good luck with your hysteroscopy & biopsy. Interesting if it is a hormonal blip - I am sue this is not the case for me. Are you post-menopausal and what's your HRT? I still get random sweats - minor - now and again, especially now i have reduced the dose, and hoping they don't get worse!

Hurdity x