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[Flossie]

Hi, I started HRT a few months back and things haven't gone too well in terms of the fact that after a month I get a period. I hadn't had a period for a year and the hot flushes got too much. So my GP put me on elleste duet conti. Because I had a bleed (like a proper period with period pains) my GP changed me onto Kliovance which is a lower mg. But after a month of taking this HRT, I've had a period again. My GP said we have one more shot at trying a different HRT and if the same happens then I've basically got to suck it up and deal with hot flushes.
Apart from anything else I'm worried as to why I'm having a bleed ? Is this normal ? I have a fibroid and when measured (about 18 months ago) was about 3cm and the consultant didn't think an issue. I'm 52 next week and about 2st overweight (since my hormones went bonkers ! ) I have NO metabolism.

[Taz2]

Hi Flossie - how long did you take the Elleste duet conti for? It's common to get bleeding with a conti for up to six months. I had the same as you - bleeding on and off that felt like proper periods - and gave up after six months. Kliovance gave me the same result so I changed back to a sequi regime. There is no reason why you can't use a sequi (bleed) HRT if conti gives you this problem. I was still using sequi in my late fifties and the periods were light and only lasted three days so weren't a problem.

Also, HRT can cause fibroids to grow.

I'm not sure what you mean by "no metabolism". 

Taz x 

[Hurdity]

If you have a fibroid,  perhaps it would be better for to have the Mirena coil which gives continuous progestogen to the womb lining and then you can add in oestrogen only patches, gel or tablets? Here is what it says on this site about fibroids and menopause:

Fibroids   
    Fibroids are benign smooth muscle tumours of the uterine (womb) wall and are dependant on estrogen. They tend to shrink after the menopause but shrinkage may not occur, or they may even increase in size with HRT use. Increase is thought to occur in 25% of HRT users and mainly occurs in the first six months of therapy. There is some evidence that transdermal (patch or gel) but not tablet HRT nor tibolone may promote fibroid growth. [ref 24] Fibroid size can be monitored by regular examinations and sometimes by ultrasound scans. There is some evidence that the use of the progestogen releasing intra-uterine system, Mirena may cause fibroids to reduce in size. Mirena is often used in the perimenopause by women who have heavy periods and/or require contraception and can provide the progestogen part of their HRT.

http://www.menopausematters.co.uk/atoz.php#GlossF

Have you had blood tests re your thyroid if you are putting on weight and can't explain this ie not over-eating the wrong foods or becoming more sedentary?

Hurdity x

[peegeetip]

Hi Flossie

normal hit or miss approach from your doc then, no surprise there.

Not sure what they mean by one more chance as you have lots of different types of HRT to try.

1) bleeding with 2mg Elleste Conti : this is completely normal with Conti HRT and it can take a while for it to settle things down. Some ladies no matter what HRT will still get periods. Unless you'd been on Elleste more than 6 months I'd say its too quick to have changed to new one.
2) going to a low dose of estrogen : this can help but will often fail to mask the symptoms in the longer term.
3) period pains : this is very normal as your waking up parts of you that have not been working for over a year in your case. these do calm down and as the conti works its magic this should calm down and for most disappear. But it needs time to work.
4) fibroids tend to shrink with tablet form HRT but can increase with Patches. This should shrink after 6 months on Conti.
5) nothing to worry about having a bleed. your body is getting used to estrogen again but the prog part of the Conti has not had time to kick in. It might be good if you look at some of the info on this sight on what Conti options do.
6) you can go back to sequi (monthly period) for a while just till you get used to the feelings/benefits and then move to Conti.
7) Conti has the benefit of further reducing the risk of cancer of the uterus further than the reduction being on sequi gives.
Stick with it longer first, dont chop and change, calm down
9) Dont let the doc bully you into think there are no options for you left!
10) Weight and metabolism can go wonky at the same time. For me since being on HRT my weight has stabilized. Also there is a chance that Thyroid and Ovaries can start playing up at the same time at peri/meno. Not what you want to hear but best to be aware of it. Thyroid issues often involve many more symptoms but might be an idea keeping an eye on things or asking for tests just to be sure.

Hope that helps
 

[Spadger]

Hi Flossie,
I'm in a similar situation to you at the moment, and it's very worrying isn't it - I've just started taking HRT (5 weeks ago) after no periods for 3.5 years - low and behold I am now in the middle of a heavy period. 
The doc's told me to stop taking HRT (Prempak-C) and has referred me to the hospital to see what's going on.  Not sure what advice I can offer, but have a solidarity-hug 
love Spadger x

[peegeetip]

Hi Spadger

your doc is really not aware of the facts.

They have put you on older HRT (not the newer identical type). So thats wrong for a start.

They have sent you off for tests?! What do they expect if they suddenly give you Estrogen and Prog after 3.5 years.
Thats wrong also.

Your body without HRT will continue to slowly build up the uterus but with lower levels of Prog you'll never get a bleed (hence 3.5 years). This is part of the reason that those without HRT have a higher chance of uterine cancers.
 
Those on Sequi and Conti options have both lower your chances and Conti is the best to prevent that.

In terms of the side effects of suddenly going back onto HRT - conti in your case - is that you may experience a bleed or many bleeds. The prog will cause your uterus to thin and eventually the bleeding will stop. But initially the sudden surge of Estrogen and Prog might cause you to have periods. Have a look in the HRT documentation, its clear in there that this normally happens to a lot of us.

This can take a long time to achieve (6 months+) and some ladies will never get Conti to work without spotting from time to time. A lot of us stick to Sequi over the long term as we can predict and control when we have our periods.

1 dont panic 
2 DONT PANIC!
3 get back to the Doc and get onto a newer type of HRT thats not made from horses pee!!!
4 get your tests done
5 don't worry about taking HRT in the meantime

Hope that starts to help you

 

[Pollie]

This is part of the reason that those without HRT have a higher chance of uterine cancers.

Peegeetip I don't understand this bit.....?

How, why ? I thought Hrt increased the risk of endometrial/ovarian cancer  because of the exposure to oestrogen for longer than considered natural - no ?

Surely those not on hrt are not getting the oestrogen that triggers the growth of cancer cells.. I am soooo confused 

Pollie

[peegeetip]

When we reach menopause and have no periods for 1 year -> things don't just stop.

The point at which our body can give enough prog to force a period has passed.

However that is not to say we completely stop producing hormones!

We still produce lower levels of both. Just not enough prog to produce a monthly bleed.

Therefore woman who continue into menopause are in effect in a situation where any further estrogen is potentially unopposed.

That is there is not enough prog in our system to stop its action and produce a healthy monthly bleed.

When estrogen only is given (not something done very often) then that increases the risk of this uterine cancer if no prog is given.

Therefore if we take away that unopposed risk by using either sequi or conti HRT then we further reduce the risk of long term unopposed exposure due to naturally remaining estrogen in our bodies.

If we look at the conti option the reason that its even better than sequi is that its continual giving prog and completely opposing the estrogen all the time.
This is why conti in most ladies using it thins the walls of our uterus.

So to summarise we are basically relying on luck without HRT after menopause and hoping that behind things we are not seeing a build up thats quietly growing away (potentially giving rise to a greater risk).

This is why a lot of ladies find themselves having severe periods once they commence HRT (after either a short gap or longer gap in periods).
I've seen some posts blaming it on the HRT, when in fact its just their bodies have been quietly building up awaiting enough prog to come along



Just a followup quote from Cancer Research UK's site:

"Oestrogen without progesterone to balance it increases the risk of womb cancer. Doctors call this unopposed oestrogen. The body stops making progesterone after the menopause, but still produces a small amount of oestrogen. So this explains why womb cancer is much more common in women after the menopause."

[Flossie]

Thank you so much everyone. It's all so confusing ! If my GP is not going to be much help is there another source I could go to ? I have private medical cover so would I get more informed help there ?

[Pollie]

Thanks pegeetip for the detailed reply !

Flossie - many private healthcare plans do not cover HRT use as menopause is not considered an illness so double check to be safe. I have no experience mod this but I imagine it will depend on how your GP words the referral eg 'menopause symptoms' or  something else such as fibroids/unexplained bleeding.

Pollie

[Kittycat50]

Hello Ladies, I've just joined up and finding out so much from the forum - recently on HRT Femoston 1/10.  This discussion is so so helpful - Pollie and Peegeetip you explain things so clearly 

[Mary G]

Flossie, I take it you are on a continuous combined regime which is why you are not expecting to have periods?

This business of HRT and periods is complex.  I took Angeliq (continuous combined) for a while and did not experience any bleeding but I didn't get on with it so I changed and starting using the oestrogen gel.  I asked if this would mean periods again but the specialist said "no, you shouldn't get periods" but I do and even if I don't take the progesterone, I still get a bleed every 5 weeks. 

Another MM member kindly put me in touch with an expert on natural progesterone and when I told him about it, he was very surprised and said "if you are post menopause, you should not be having periods".  I have been thoroughly checked via internal ultrasound and all is normal so it would appear that fairly high doses of oestrogen make some women shed naturally and without the use of progesterone - you could call it a kind of inbuilt defence mechanism against the lining building up too much.   Perhaps some people start producing their own progesterone when they take high(ish) levels of oestrogen?