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[flutterby]

Hi - I am 63 and have been on HRT for 15 years. Half this time on Evorel Sequi (every time I tried Evorel Conti I had breakthrough bleeding throughout month). Unfortunately 6 weeks ago I started bleeding and spotting as well as the usual monthly bleed. I had this checked out, luckily no endometrial hyperplasia or cancer.
However I have been advised by consultant to find a new preparation or come off HRT. GP says just stop, but I don't feel this is right and even if I just cut down over 2 months I feel this may not be such a shock. Do I just cut bits off the patches? Has anyone done this with Evorel Sequi or similar?

[Taz2]

Hi flutterby - I'm sorry that you've had this scare but pleased that you have no cancer causing the bleeding.

I have tried to come off HRT three times. The first time I just stopped and the flushes etc came back within three months. The second time I took a year to gradually cut down but the result was the same. The flushes began to break through after around four months of reduced dose, gradually increasing in intensity and frequency, until by the time the year was up I was back to square one. The third time I just stopped as I couldn't be bothered with the slow withdrawal only to find myself back in the same position. It took around four months for the symptoms to gradually increase to a stage where I managed to persuade my doc to prescribe HRT again - I'm almost 62.

Some women don't get a return of symptoms at all. Do you know why you have been advised to come off HRT if there is no sign of hyperplasia or cancer? My doctor has researched quite thoroughly and patch or gel HRT is considered to have an even balance between risks and benefits up to the age of 70.

Good luck with coming off HRT whichever way you decide to do it - hopefully you will be clear of symptoms. I was told that you should give it three months after any return of symptoms before deciding whether to go back onto HRT.

Taz x

[Dancinggirl]

Hi flutterby and welcome to MM
I do agree that going 'cold turkey' wouldn't be good.  I am 59 and have recently been getting spotting on HRT which I didn't have before - I had investigations and like you all was OK.  I am using a very low dose of HRT - I use one pump of Oestrogel with Utrogestan every day - so a continuous regime.
Might I suggest you switch to using Oestrogel which allows you to adjust the dosage more easily - you could gradually reduce over a year or more?? Take a separate progesterone either sequentially or continuously - either Utrogestan ( which could cause some spotting as I experience) or Provera which is a bit stronger and might be better. 
Do bare in mind that when starting any continuous HRT, break through bleeding and spotting is normal for the first few weeks or even months until it settles down.
You could email Dr. Currie (small email consultation fee of £25) to ask advice.  If you are generally well then there shouldn't be any real reason why you should come off HRT, especially if you are still working and need to be able to function well.   DG x

[flutterby]

Thank you so much Taz2 and Dancinggirl for your replies. It is always good to hear other people's experiences.
The GP I saw was sure that the consultant would tell me to come off and I was in a complete panic that as long as I didn't have cancer then I took it as a warning that I should come off. I don't think the GP would prescribe it now
When I had the scan they said my endometrium was 6.3mm thick and they would have expected 4 to 5. However I thought this was probably due to the HRT,but they did not say so. Also the biopsy said that there was oestrogen present, which seemed strange as the slides they would have made would just be for malignancy ( I am a biomedical scientist) My friend in Histology said they probably meant that they could see the effects of oestrogen- so it was all a bit confusing.
As I retire at the end of January I thought I might be able to cope a bit better if I don't have to go to work. This could be a double edge sword as it was brain fog that started me on HRT and without the mental stimulation I do worry about my memory.
I have written an email for Dr Curry but I am a bit of a technophobe and I will have to sort PayPal out first.

[Joyce]

Like Taz, I've tried 3 times to stop HRT. Just restarted again. Makes no difference coming off gradually or cold turkey, results were the same. I'm 59. My GP said life quality was more important than suffering the flushes & sweats.

[Mary G]

flutterby, welcome to MM!

I can understand your dilemma. Having had breakthrough bleeding and spotting on your current regime, I can see why you would want to change it.  I do think it would be a pity to stop taking HRT altogether when you retire, it would be nice to feel at your best when entering this new phase of your life.

It must have been worrying to have the build up problem but good that you have had it checked out and all is OK.  I agree with DC and Taz2 and would suggest a separate transdermal bio identical oestrogen with bio identical Utrogestan progesterone for either several days per month (cyclical) or every day like Taz for a continuous combined regime.  As Taz said, this is a perfectly safe form of HRT that carries very few risks and there is no reason why you can't take it for several years and reap the health benefits that it offers.  Having been on the 50mcg patches, you could probably get very good results with just one pump of the Oestrogel every day.  The gel is flexible and you can adjust your dose to suit your needs.  The Utrogestan is more effective when taken vaginally and you may find that it stops your spotting and breakthrough bleeding - I only had breakthrough bleeding when I tried to go for a long cycle. 

Being a scientist, you probably already know this but re the lining measurement problem, it is worth noting that women who take cyclical HRT will always get a greater build up than those using a Mirena coil or taking continuous combined HRT.  When I had my uterine ultrasound scan the other week, the gynaecologist was saying that the thickness level depends on where you are in your cycle and how much oestrogen you are taking - obviously, the more oestrogen you take, the greater the thickness mid cycle (it is thickest from day 13 to 23 of the cycle) and the heavier the period will be.  Where were you in your cycle when you had your reading of 6.3? 

[flutterby]

I am glad you mentioned endometrial thickness and where in the cycle I was, Mary G - I was probably at about  day 20. I have to have another scan as they found a very small ovarian cyst which I think is coincidental (CA 125 normal range) I will hopefully get another measurement then.