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[flossie fiddler]

It's a long story, so I apologise in advance.

Been on HRT for 2.5 years after having all the symptoms of menopause (some of which I didn't realise were menopause), and sketchy periods which were infrequent but heavy when they did arrive. I started with symptoms aged 47 (my mum and sis were both 48 when they started peri)

Started on Evorel Sequi aged 49 and within a few days I felt amazing. However I was bleeding every 2 weeks, quite heavily. A routine smear showed a 5mm polyp, and that coupled with the bleeding caused my doc (who is a menopause specialist) to book an internal scan. The scan came back normal, but it was noted that my womb lining was 5mm, however the polyp was not deep, just on the cervix. So the doc sent me to the gynaecologist, who took my history, didn't even give an internal, and wrote back to my doc suggesting that if the bleeding didn't settle down, to put me on a 'no-bleed' prep.

The bleeding didn't settle down and it got to the point where I was bleeding around 3 weeks out of every 4, and had very few clear days in between. Sex would make me bleed, a heavy bowel movement would make me bleed. Other than the bleeding, I feel great in every other way.

My doc started me on Evorel Conti in April after checking that it wasn't the polyp that was bleeding (it was about 1cm by then), and I've been logging the bleeding. It started to slow down a bit over May and June, and I was getting clear for about 5 days at a time, but then in July it was constant. I read that it can take up to 6 months for bleeding to stop, so I stuck it out. August I had about 3-4 days brown discharge, and about 3 days in Sept, both times not enough to even mark a liner.

Been back to the doc today and she says she's not happy that I'm still bleeding. Had an internal and there's no sign of the polyp, it's completely gone. She's given me 8 weeks supply of Conti, but has requested another internal scan, and possibly a histogram (is that the right word?) to rule out endometrial cancer.

She said that the menopause is not a disease, but a life stage and that I should consider coming off HRT and riding it out. But I'm not ready for that yet. I'm a very active, fit and energetic 51 year old and I just don't feel I can go back to feeling like I did before I was on HRT.

Does anyone out there have any advice about anything I can present to my doc regarding alternatives? She's very thorough, and I'm pleased she's getting me tested again, tests I've already had 2 years ago, but I'm at my wit's end. Maybe I'll consider coming off HRT when I'm in my 60s, but I just feel so well, and fit and full of energy ATM that I'm not ready yet.

Any help or advice would be really appreciated.

Tracey 

[Dancinggirl]

Hi Flossie fiddler
It sounds as though your bleeding has pretty much settled now if you haven't had much bleeding or spotting over the last few weeks. See how it goes over the next couple of months. You are still young and meno symptoms can seriously reduce quality of life, so to say you should just 'ride the storm' is nonsense as the GP can't tell you how long it will take for the symptoms to subside - if ever!!!!
Would you consider having a Mirena fitted and then use oestrogen as patch or gel alongside? If the Evorel patches have suited you so well then the Mirena might be perfect for you.  If bleeding is an issue, then the Mirena will often settle this down and, I believe, can often shrink polyps and fibroids if these are a problem. The Mirena is often a big favourite with many gynaes as it often sorts out problems with bleeding.
I had a Mirena in my mid 50s (I was very post meno by then) and it was the best option for me at that time.
The details from this site about the Mirena is at the bottom of the page with this link: http://www.menopausematters.co.uk/to_progestogens.php

DG x

[CLKD]

Was it hormonal or the polyp which was bleeding?  I had one that was sensitive to touch which dried up at peri.  Gynae wanted to remove it but I refused, he was a private consultant  .

You stay on HRT as long as you want to!!!! don't take any flack from your GP. 

Why should you 'ride the storm' ?  I would ask on my next visit?  There is treatment specifically for menopause as there is for other chronic conditions but of course, GPs are 'short' of money 

Welcome too!

[Mary G]

Tracey, I agree that you should not have to 'ride the storm' and this sounds like one for a menopause specialist who can advise you on the right type of HRT at the right dose.  Because of your history of prolonged bleeding, you really need to see someone who specialists in this area and I would recommend you go ahead with all the tests and then seek some independent advice.

[CLKD]

Are you able to explain : "doc (who is a menopause specialist) " ………. 'specialist' is a specific and if she is encouraging you to stop HRT, it makes me wonder why  especially if you feel generally well on the regime.  I would not expect any GP in this day and age to suggest that a patient 'rides it out' regardless of what the complaint is. 

My GP has interest in womens' health [fortunately] but that doesn't make him a 'specialist'. 

[puddlesmum]

"Ride the storm" - wouldn't catch them not giving you damn anaesthetic just to "ride the storm" of an operation would they? Idiots.  It's your body FHS, what the heck has it got to do with them.  We're all struggling with our symptoms - makes me mad when they suggest trying to struggle though it, I mean what do they know unless they've been through it personally.

I for one will take anything for as long as I need to as long as it makes me feel good (not got there yet but hopefully getting there).  Drs can go swing if they want me to come off and I'm not ready.

[Hurdity]

Absolutely

I agree with everyone else. Have all the tests that are going ( it's hysteroscopy by the way) - hopefully if necessary they'll do a biopsy  to be on the safe side ( I had this) - after all you have nothing to lose - but don't ride it out. How very dare she!!!!!

Yes I agree re the Mirena - this may well be better at stopping the bleeding and then you may be good to go...

You have years left of good quality of life - by the way I'm 63, still on HRT, and have plenty of energy, going to 3 exercise classes per week, working part time, do gardening, going to festivals, walking holidays etc. I don't intend to stop (HRT and being active) unless some medical condition happens to stop me. You don't want to have to slow down now and lie around on a sofa mopping your brow and wafting a fan for the rest of your life!

Hurdity x

[flossie fiddler]

Thank you all for your fab replies.

In answer to some of your questions, the bleeding seems to have been hormonal. I did have the polyp checked to see if it was bleeding in touch, but it didn't. Hoiwever that's not to say it hasn't been. Now the polyp has disappeared, I've not had a proper bleed, just brown discharge, very light, not even needing any protection.

A menopause 'specialist', yes maybe not the correct choice of words. She's a doc who is only in the practice once a week, and it seems it's menopause related patients she sees. Does that make more sense? I guess she's a GP.

I would certainly consider any other hormone therapy that would help, even the Mirena. I've only tried Evorel Sequi and then Conti, and there's so much else out there.

If I wanted independent advice from a menopause specialist, in the true sense of the word, can anyone advise how I would go about that?

I'm not ready to quit this. It's sad that it has to become a fight though.

Tracey x

[Dancinggirl]

If you do want to get specialist advice from a gynae then actually asking this GP first is a good start - they may know someone near to you that is particularly good on meno treatment.  It also depends on where you live.  When I lived in London (back in the early 90s) I went to a private meno clinic that liaised with my GP about ongoing prescriptions.  Latterly I went to a NHS meno clinic in Edgeware.
I now live in East Anglia and when I decided I needed to see a private gynae (my GP was being very helpful but felt out of her depth) I did some research on the net and found a gynae based in Norwich who actually specialised in meno and problematic bleeding - I then asked my GP about him, she said he was great and wrote me a referral.  I saw him privately and I have to say he was well worth the money. Unlike many consultants, he listened and explained things to me in a way that really helped me to understand far more about how tricky it was to get our hormones right.

Now 60, having had a difficult time trying to get my hormones back in balance without problematic bleeding and cramps (despite this lovely gynae's help), I am now taking a break from HRT.  I'm still using local oestrogen but it is a bit of a relief not to be dealing with the hassle of HRT - my life is in a calmer place overall now so flushes etc are easier to cope with.
You have had a good time on HRT and you are still young - so if I were you I'd definitely push to go back on HRT for the next few years. If you are a bit prone to getting polyps then the Mirena could be a very good option for you.
DG x

[Ju Ju]

As to riding out the menopause.....well I did that until I was 6o and look where it got me. I had to retire early. I'm now on HRT and shall continue, so that I now have some quality of life.

When I was pregnant my boss told me I had an attitude problem, when I had a difficult time, sickness, pain etc. Pregnancy is natural process she said.

It's funny how some of those who sail through these stages of life think they do so because they have the right attitude, rather than that they are very fortunate. They miss out on empathy though.

[GypsyRoseLee]

Hi Flossie

I see Prof Studd, who is considered a world expert, and he told me he would be perfectly happy for me to take HRT into my 70s. In fact he strongly advocated it. He said all the hype about 'stopping at 55' was " b*llshit".

[Hurdity]

Hi again Flossie Fiddler

As your doctor sounds so thorough and is discussing things with you - I would definitely read up as much as you can about hormones and HRT - while going for the tests for which you have been referred, just to check all is OK.

Then depending on the outcome - if all is OK and no treatment is required - well from what you reported here in your first post below:

"She said that the menopause is not a disease, but a life stage and that I should consider coming off HRT and riding it out. But I'm not ready for that yet. I'm a very active, fit and energetic 51 year old and I just don't feel I can go back to feeling like I did before I was on HRT."

I would go back to her and say that you have considered it, and decided that you do not want to come off HRT having read all the info etc etc, and for all the reasons you have given - wanting to be fit and active etc. Then tell her the type that you want to try and don't be fobbed off. If she refuses then ask to be referred to a meno clinic - if there is an NHS one near you? Hopefully you will be able to be treated by her as you are entitled, without having to resort to private care.

Hurdity x

[flossie fiddler]

Hi all, I don't get on here that often, but once again, thank you for all your replies. Tomorrow I'm going for internal and external ultrasound scans. Have had these before about 2 years ago after being on HRT for 7 months, but everything came back fairly normal, apart from slight thickening of womb lining. Subsequent referral to gynaecologist, and nothing further was needed.

It's interesting that about a year ago when I walked in to the GP surgery and my doc saw such a positive change in me as a result of HRT, she actually said that there was no reason why I couldn't take HRT into my 70s, so long as I was aware of the risks involved.

Not sure why she's changed her mind on this. Maybe it's cost, maybe she's not sure what direction is next for me.

So, I've decided that I will take every test offered, and depending on results, will do lots of research into other types of HRT and make suggestions. If I dont get any joy I will ask for a referral to a meno specialist.

I think my doc is being very thorough regarding investigations into the slight bleeding on what is supposed to be a 'no bleed' prep, which I'm happy about. We'll see what the next few weeks throws up.

I've always been proactive in my medical treatments (I was with my asthma, I think I was more clued up than my doc - he used to ask me what I thought we should try next!). At the end of the day a GP is exactly that. A GENERAL practitioner. So it might come a time when I need someone who specialises.

Sorry for the long waffle. Just sorting things out in my head. You people have been invaluable with your knowledge and experiences. Thank you again for that.

Flossie x