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[matildamouse]

I am 52, postmenopausal and on BHRT, estrogen troches and progesterone capsules 100mg per night since October 2015. I developed sore breasts and just not feeling right emotionally. My estrogen was stopped by the menopause centre and I was advised to increase my progesterone to 150mg per night. Two days later I started spotting which lasted for 3 days which then developed into a full blown period like bleed also lasting 3 days and is still ongoing. My breasts took nearly a week to settle down as well. Started with poor sleep  the last 3 nights (despite the higher dose of progesterone) as waking up at 03h00 and not falling asleep again.

All you knowledgeable ladies...how long can I expect to have this bleed? I informed the menopause centre and still awaiting a response. And why is my sleep affected where it should actually improve? Thanks.

[Dancinggirl]

Hi matildamouse
Your post is interesting - I assume you are not in the UK?
Over the last year I have been on the Oestrogel with Utrogestan (micronised progesterone) HRT regime which is probably the same as you have been prescribed.  I tried this combination on a long cycle but started to get erratic breakthrough bleeding. My gynae then suggested I try using the progesterone continuously but again I got erratic spotting - taking 100mg of this progesterone every day made me feel great. My gynae had told me to increase the progesterone dosage to 200mg every day if the spotting continued so in mid december I did this and initially I was fine but as you describe I got rather disturbed sleep and felt sedated during the day - quite dizzy and sleepy. Like you I got a more substantial bleed after I had taken about 7 days of the higher dose and this lasted around 4-5 days but I continued to get period cramps after this and felt really dizzy and unwell.
A week ago I decided to drop back to using the 100mg every day but again after 3 days the spotting started again so I have decided to take a complete break from everything to let my body recover.  2 days after I stopped taking both the progesterone and oestrogel I got another bleed - not heavy but quite a bit of cramps - this is now petering out and I'm going to see how I feel over the next couple of weeks.
My feelings about all this is that micronised progesterone taken orally is clearly not as effective as the synthetic progesterones so the chance of erratic bleeding is greater. Whilst the lower dose made me feel mentally good (I felt really relaxed/chilled) the higher dose tipped me the other way.  Many women use this progesterone vaginally with far better results but when I tried using it vaginally I got very strange reactions with my bowels and actually felt more sedated during the day. 
There are plusses and minuses with all HRT treatments and finding the balance is difficult. I definitely got more disturbed sleep on the higher dose and I think this varies from women to women. If your bleed doesn't stop within the next week then I'd get back to the clinic for advice.   DG x
 

[Cassie]

Yes you will get a bleed if you withdraw the oestrogen, well I do if I forget to apply it. Not sure how the troches work, can you not ask for a rub on gel that you can adjust up and down as your symptoms come and go. The progesterone you are using can be used vaginally if you prefer as it seems to be better absorbed that way. The 100mg of progesterone def hypes me up and gives me insomnia, can you not go over to using 100mg for just 12 days per mth and have a regular bleed, that seems to agree with some ladies more than a permanent dose of progesterone.....all the best.

[matildamouse]

Thanks for the replies ladies.

Yes DG I am in Australia and treated by a menopause centre 5000kms away from me via phone and emails...not the ideal but BHRT here is a challenge as only a few "enlightened" GP's prescribe BHRT and they are fully booked for months ahead. I have had a few of that moments where I just want to stop everything as it becomes so complex but I could not cope with the hot flushes...especially not in the Australia summer! I also felt good on the 100mg and might ask for that again. My ultrasound showed a few fibroids and they might have become very excited now hence the bleeding.. I am of the opinion that I might be estrogen dominant based on my own research as this is now the 3rd time my estrogen dosage had to be lowered and eventually now stopped.

Cassie, I can not use the cream as my cat got very very sick after being exposed to my cream. At that stage I was still having hot flushes as my cat got half my dosage!  I will discuss that option with my clinical review which is next week. It is only the waking up early which is a problem. For the rest I feel fine so I do not think I am totally intolerant, maybe just sensitive to higher dosages.

[Dancinggirl]

matildamouse - I personally don't buy into the oestrogen dominance theory unless you are peri menopausal and your own hormones are fluctuating.  How on earth did your cat get your oestrogen?  My gynae explained it is about getting the right balance of oestrogen to progesterone and if there is a problem with absorption with a progesterone then this will allow the womb lining to build up and cause bleeding.
Oestrogen gel is applied to inner thighs once a day and one pump per day could be enough for you though you can go up to 4 pumps per day. If you have fibroids then this would explain your problematic bleeding as oestrogen will stimulate these, especially if the progesterone is not being absorbed properly.  Your best option might be to have a Mirena fitted as this will shrink fibroids and controls bleeding problems much better.  The Mirena tends to give fewer side effects as it delivers the progesterone locally.  With the Mirena in place you can then use as little or as much oestrogen that keeps your flushes etc. under control. 
There is currently a strong swing towards using bio identical progesterone (most oestrogen these days is already bio identical anyway) but following my experiences with erratic and problematic bleeding I feel it is not necessarily the ideal for all women. I know that many women have tried micronised progesterone with similar problems as we have experienced and have opted for Provera (medroxyprogesterone ) or a Mirena as it can be more effective whilst still giving fewer side effects than the more synthetic progesterones tend to bring. The Mirena is a favourite option amongst many specialist gynaes.
I don't know where you are in your menopause or what other HRT preparations you have tried but from what you are telling me you possibly need to consider a Mirena because you have fibroids. 
DG x

[Hurdity]

I agree with everything Dancinggirl has said, and additionally I would not want to take any synthetic progestogen on a continuous basis - so if progesterone itself is ineffective, the Mirena is the least invasive/systemic method of getting progestogen where it is needed.

As for oestrogen withdrawal bleeding - this is not a standard phenomenon in the way that normal period bleeding is ie progesterone withdrawal bleeding, as it is not meant to occur - it is one type of dysfunctional uterine bleeding. As Dancinggirl says in your case it is most likely due to be from the fibroids or because the progesterone is insufficient to keep your womb lining thin. Therefore it is impossible to say how long it will last.

If you are truly post-menopausal (presumably your periods had stopped for at least 12 months before you started HRT?) then the clinic should not be recommending that you stop oestrogen because this will be deficient. Yes by all means increase the progesterone to help keep the lining thin, but the lack of oestrogen will cause a recurrence of your menopause symptoms.

The oestrogen dominance idea just refers to the anovulatory cycles which occur during peri-menopause. It is irrelevant during post-menopause when ovulation has ceased and HRT is tailored to give the correct balance between the two hormones. but crucially the right absolute level of oestrogen to keep your symptoms at bay and make you feel well - this is the primary factor that you need to consider.

No-one here will know what troches are - are they patches gel or tablets and what dose are they? We don't have them!! Did this dose deal with your symptoms generally ie flushes sweats aches etc?

Progesterone can cause disturbed sleep at higher doses in some women, rather than a mild sedative effect at low doses which can be helpful in some. Lack of oestrogen could also cause disturbed sleep due to recurrence of night sweats although it shouldn't cause a return of these that quickly I would have thought.

Hope this is helpful and you get some answers soon. Personally I would consult someone else if your clinic is recommending this course of action - I am sure this would not happen here in UK!

Hurdity x

[matildamouse]

Thanks again ladies, I learn so much from you.

Troches is another route of administering BHRT and you put them in your gum or under your tongue where it dissolve . Suppose to be absorbed by the mucosa in your mouth.

DG my cat is very cuddly and is always in my arms, on my bed or near me, hence the transfer of my cream via contact, linen and clothes. It can be deadly if it happens over a long period of time.

The centre phoned me back and told me to stop my progesterone for 5 days. I skipped last night and the bleeding is minimal today. I will then have a full clinical review and speak to one of the doctors next week. Will be interesting to see if and when my hot flushes return.

I had the Mirena long ago and had a lot of side effects, so unfortunately not an option. I actually feel quite good and calm at the moment  despite having a move and sell of house ahead of me which will usually cause me major anxiety issues. Must be the ongoing effect of the high dosage of progesterone still in my system... 

[Hurdity]

I had a look into troches and apparently they can lead to variation in oestrogen dose which could have accounted for your symptoms - according to another Australian company - which also does not recommend them. http://www.custommedicine.com.au/health-articles/the_truth_about_troches/

You may well find that as your oestrogen level drops you begin to experience the claissic menopausal symptoms of oestrgoen deficiency - and if so I would look to using another method eg patches or gel - if you want to avoid tablets.

Hurdity x