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[Spangles]

Hi Ladies
I've just completed my first 3 month cycle and still no bleed! I'm not complaining but it's 7 months now. I did think the progesterone would give me a bleed but it hasn't. What does this mean I wonder? Today I feel like just stopping the HRT to see what happens but I daren't. Do you have to get doctors advice to stop or can you do it yourself?
Thanks
Shellb
xXx

[Sarah2]

How long is it since you took the last Norethisterone tablet?

It can take anywhere from 2-5 days for the bleed to start after taking the last tablet.

When you say it's 7 months since you had a bleed, does this mean you have had no bleeding with the previous cycle either?

Or do you mean this is your 1st 3 month cycle on HRT and you had no periods for 4 months prior to this?

Why do you feel like stopping HRT? Is it not suiting you?

You ought not to stop suddenly. For a start you may get symptoms quite badly- my gynae says it should be reduced over 6 months- and the other reason is that you always need to stop after a bleed so that the lining is thin.

It's possible that the oestrogen you are using has not been enough to thicken the lining enough to come away, though I'd say this is unlikely on a 50mg patch over 3 months.

[Spangles]

Hi Sarah
I had no bleed for 4 months then I had 3months on long cycle still no bleed so that has taken it to 7 months. I just wonder sometimes if I would be better with or without HRT.
xXx

[Sarah2]

I'm still not sure what you are wanting advice on. Is it whether you should now have a bleed- or come off HRT? These are 2 different questions.

How long is it since you took the last Norethisterone tablet?

[Spangles]

Sorry
I was wondering if I should be having a bleed and also wondering how I would go about coming off hrt.
I took the last norethisterone yesterday.

[lubylou]

Dear Hurdity and Sara2
I am a bit confused about the long cycle HRT and the issue of preventing the risk of over thickened the endometrium lining. I was told that my lining of 7mm (it is now  2mm) was thick and due to the Tibolone I took for a while, and not the Tridesra long cycle which I took for much much longer.

Does the fact that the lining is shed on the bleed prevent the risk of thickening of the endometrium lining as it is shed via the bleed? If not, I wouldn't want to go back to Tridestra for anything but a short time to a process of elimination to establish my problem is meno related or something else.

LubyLou

[Sarah2]

shellb- the bleed does not usually come for at least 2 days and anywhere up to 5 days after the last tablet- there is plenty of time for it to happen.
If you want to come off HRT then you ought to stop all oestrogen at the same time as you take the last Norethisterone otherwise the oestrogen will continue to build up your lining and it won't be shed if you don't take any more progestin. Best to check with your dr.

Luby- as far as I know the amount of progestins taken does 2 things- keeps the lining from building up indefinitely because it affects the oestrogen receptors in the uterus and sheds it once it's stopped ( in a cycle.) I assumed- but again am not sure- that all the lining was shed at the end of each cycle, but maybe there is a residual level which stays even though there has been a bleed.

My lining has always been 6mm on long cycle HRT ( thicker at the end of a cycle - 7mm) and my gynae felt this was acceptable. I've had 2 biopsies with a lining of 6mm and it was normal ( touch wood!)

 I understand from the scans I've had that it's not just the thickness that is the issue, but how the lining looks - is it uniform and without any irregularities for instance.  I read somewhere that a lining of up to 10mm is acceptable on women using sequential HRT- but don't quote me on that.

I don't know what effect Tibolone has compared to Tridestra- sorry. I'd have thought in theory that Tibolone was less likely to give you a thicker lining because it has androgenic properties as well- but I don't know.

[Hurdity]

Hi lubylou

I commented on your other thread before I saw this one - was out all day/eve yesterday!

The point is (as I said on the other thread) if your lining thickens on a conti HRT the progestogen is not doing its job so this could be a worry because of the potential for endometrial hyperplasia and possible cancer. If over-thickening does occur then women can get oestrogen breakthough bleeding but not always ie it could thicken by a considerable amount before this happens I understand.

Clearly in a cycle the lining goes through the cycle of growing - proliferative (oestrogen), to secretory (when the progestogen is added) and then shedding. As I mentioned below ( I think - can't see my post - must be on the other page) the progestogen acts on the oestrogen primed uterus lining in a dose dependent manner so all the lining (that has grown due to oestrogen) is not necessarily shed each time if the dose of progestogen is not sufficient relative to the oestrogen. It should be (shed), because the doses of progestogen are calculated to be more than sufficient - but we are all individual and there are bound to be one or two women for whom it doesn't work exactly as it should.

Sarah - the endometrium is made up of different layers of cells. The biology of it all is quite complex!

Therefore lubylou you are asking different things - it would be much more of a worry to get an over-thickened lining on a conti HRT, but cyclical thickening on a cyclical HRT is normal, and the way to test for over-thickening in this case would be following a bleed when the lining has been shed - ie scan the thickness of the residual lining.

As I think I mentioend Tibolone is associated with some increased risk of endometrial hyperplasia - the manufacturer's information states this:

Endometrial cancer
•
The available data from clinical trials are conflicting, however, observational studies suggest that women who are prescribed tibolone in normal clinical practice may be at an increased risk of having endometrial cancer diagnosed. The risk increases with increasing duration of use but shows no significant increase during the first 2-3 years of use (see section ADVERSE REACTIONS). Tibolone increases endometrial wall thickness, as measured by transvaginal ultrasound.

I hope this helps!

Hurdity x

[honeybun]

Resent it...I bloody hate it 

Scuse the language ladies but I could not think of another word.....Well I could but it was way way worse.


Honeyb
x

[lubylou]

Dear Sara2
Knowledgably put as always, thanks for the info. My GP wasn't concerned about a 7mm lining, I think this may have been as a result of the time I was changed to Tiboline (continuous witt no bleed) and he put me back on Tridesta I assume his thinking was that my lining would shed on Tridesta and the thickening lining would reduce, but I am not sure and he has retired so I cannot ask him!

I was told the regularity of the lining is important, fortunatly all the scans I have had say my lining is both thin and regular in appearance. 

Are you on an HRT with a bleed? I hope you don't mind me asking.

Hurdity, more knowledgeable information – I don't think my brain can keep up! I am beginning to get a much better overview of things and this is helping me so very much.

Big thank you
Lubylou

[Sarah2]

luby- Yes I am on a regime with a bleed and have been for 5.5 years (I am now 59). This was the regime my consultant advised when I began HRT and it is one which I have continued with.

[Spangles]

Morning ladies,

After 7 months I finally got a period last night! It has totally floored me, the pain in my back legs and tummy is probably some other worse I have ever had, not to mention the nausea, feeling shakey and a little anxious.
I really had forgotten what it was like. I'm gutted now though as I believe I have to start counting towards 1 year again, is this true? I actually feel very teary and a little low now.
 
Shellb
xXx

[Taz2]

Isn't a long cycle hrt designed to give you a bleed Shellb? Once you start on a bleed HRT then there is no point in trying to go a year without a period as you are giving yourself oestrogen and progesterone which overrides your cycle if you still have one.

Taz x

[Sarah2]

'Long cycle' means you will have a cycle- a bleed.
This is different from saying your own periods stop and you are classed as 'post menopause' a year after having no natural periods .

The only way you will not have a bleed is if a) you are on a continuous combined HRT ( oestrogen and a progestin daily) or b) you don't take any HRT and are post menopausal naturally.

See this info here from the green menu on the left
http://www.menopausematters.co.uk/postmeno.php

You can't have bleed-free HRT unless you are either over 54 or have not had a natural period for at least 12 months.

[Spangles]

Thanks ladies
I am so confused, how will I ever know if my periods have naturally stopped or not, when I started using HRT I hadn't had a bleed for 4 months, I know this isn't a year. I was surprised to get a bleed after 7 months though and yes I do understand that my HRT is designed to cause a bleed, prior tot his I was using femseven sequi and had no bleed at all on that for 4 months. This has progesterone and oestrogen in too so it's all completely baffling me. I'm so sorry if i sound silly but this whole meno thing confuses me more the further I get into it!
Thanks
Shellb
xXx