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[clp10]

Hi everyone, I’m new to this site. I’m in my 30s and in surgical menopause after having my ovaries removed (still have uterus). In January I started taking HRT which changed my life! I’m now on oestrogen patch 150, testosterone gel, and 100mg utrogestan. Due to my complex medical history I see a specialist at Newson Health.
I was taking the utrogestan continually, but over the months I got more and more bloated and felt ‘hormonal’. It got to the point I just stopped, had a bleed, and felt much better. However, since then I’ve been taking the utrogestan continually again, but have been having constant bleeding (there was no bleeding before) Any advice? It’s been 2 months now and it fluctuates between spotting and light period. My last Newson appointment was 2 months ago and she said I could try taking utrogestan cyclically, but I wanted to get the bleeding under control first.
Do I stop and ‘get all the blood out’ and start again? Do I try a higher dose? I desperately just want the bleeding to end! I’m also a bit concerned about whether the utrogestan is doing its job, as if there is all this bleeding is it really thinning the lining? Thanks

[CLKD]

Morning.  Have you contacted the Dr that you see at Newson Health?

Could you send them an e-mail?  In the mean time, browse round.  Make notes. 

[joziel]

150mcg of estrogen is a high amount to be taking with only 100mg of utrogestan. Newson Health seem to be fans of giving high estrogen with borderline progesterone. The BMS guidance is that if you go over 100mcg estrogen, you need to add in more progesterone to protect your uterus. (Which would also help stop the bleeding.)

Really, you should be on 200mg utrogestan (continuously) according to the BMS with 150mcg of estrogen. Maybe talk to your Newson doctor and ask if you can increase progesterone...

[clp10]

Thank you both for your help.

I contacted Newson- normally I get an email back from my dr, but this time I got a generic response about making an appointment. My next app is Sep so I will see if there is anything before then as I’m really struggling with this bleeding.

Thank you for pointing me to the BMS. It makes complete sense what you are saying about needing to increase the progesterone dose with the high oestrogen. I’m wondering if my doc held off on that initially when my oestrogen dose was increased as I have this progesterone intolerance.

It’s all so confusing!

[joziel]

Here is a link from the BMS: https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

"The dose of the progestogen should be proportionate to the dose of estrogen. While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens)."

[sheila99]

Have you tried lowering your oestrogen? Unless you don't absorb well it's a higher than expected dose. Lowering it may solve the problem (the nhs thinks you should be on the lowest dose that controls your symptoms) . Some bleeding is to expected in the first 6 months but if you're past that you could ask your gp for a scan, it's possible you have fibroids or polyps causing it - and oestrogen makes fibroids grow. If you don't already take it vaginally I would try it that way. You might consider a mirena which stops bleeding for most women. Some women use a sequi regime in meno if they find progesterone difficult. I think it's marginallly more risky but better than unexpected bleeding.