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[Sunnydays]

Hi, I haven't posted for a while. I'm mid 50s, been postmeno for about 3 or 4 years and started hrt a year and a half a go. I have been searching for an hrt that isn't continuous yet doesn't give me an horrendous bleed and PMT type symptoms - yes I've wanted my cake and to eat it!
This time last year I had the womb lining scan 7 days after stopping the progesterone and all was fine at 45mm. For 6  months prior to this I'd been taking estradot patch, and various progestrones on a sequential basis, which usually gave a bleed. Since then I have been using estradot still, but have used the combined element of the Everol patch for a given number of days. Generally on the first of each month put the Evorel patch on for 7 days and then Estradot for the remainder of the month. More recently I've gone to 5 weeks before using the Evorel, but have kept it on for 10/11 days. During this whole time ie a year I've not had a bleed (whoopeee!)
I had a rescan just last week as I had a niggling feeling that maybe the lack of bleed might mean the lining is building up. The rescan was 3 days after removing the Evorel patch and the lining read at 5mm - a minimal difference. I was very pleased.
The regime isn't perfect - during the progesterone phase, sometimes I might get a headache for a couple of days, often my tummy will feel uncomfy during and after the Evorel and then sometimes I turn into an evil witch who can't/won't smile. But the symptoms vary and it's not each month although I think its fair to say, that the longer the evorel, the worse the mood.
So in essence I'm using the Evorel like the sequential but the combined part for a lesser time.
I'm still asking myself if every few months I should replace with say Provera for just one month to give a bit of a clear out? Ideally I would like to use the Evorel for 7 days from the first of each month. So easy then to remember it. Any thoughts from you ladies?
Kind regards, Sunnydays

[Hurdity]

Hi Sunnydays

Interesting! Thanks for posting this!

If you are not getting a bleed on the regime you are using - after several months and you have been scanned and all is OK, then you might be able to go either longer between the combi part (the Evorel conti patches) or as you suggest take it for fewer days - and then you might get a small bleed.

I don't think I've come across anyone doing as you are doing! Norethisterone is definitely better at thinning the lining than progesterone - the synthetics in general are. Well no harm in trying the Provera to see? Personally I don't think I cold cope with the norethisterone side effects but I don't like having a bleed either - eg I am feeling rough today on Day 1 of my bleed - really really tired and pains - but it is only two months - but it takes up 3 weeks of every two months ( 2 weeks for the prog and a week for the bleed). I keep thinking and wondering if I could do something differently after 10 years.... getting a bit sick of it!

Is your doc on board with this - I presume s/he knows what you;re doing ( unless a private gynae?) otherwise you wouldn't be able to get hols of the different meds. Incidentally not sure why you don't use Evorel the whole time ie Evorel sequi but just vary the cycle. Why the Estradot? Presumably because you prefer the small size and ease of use - but Evorel only comes giant size!

Hurdity x

[Sunnydays]

Yes the Evorel patches are ginormous! I only have two thirds of a patch but still, it's big. More importantly I can sometimes get a slight irritation from it, unlike good old tiny Estradot!
I think my side effects from the Evorel were that little bit enhanced this month as I didn't slowly decrease the dose. I forgot to say in my original post that I cut the patch down for a day or so after resuming the estradot and it does seem to help.
I know how you feel about the bleeds Hurdity, I only had them for a few months and I found my life was being controlled by a cycle. I have found, so far, that most months/patch changeovers that I'm unaware of huge changes in how I'm feeling - every so often a wild women erupts (but I guess I did get this a bit in the old days of periods!)

[Patricia]

Hi Ladies - Hope you don't mind me jumping in but I'm interested in your regime Hurdity?  We are similar vintage I think (I will be 63 in May) - I am curious why you haven't tried another system.  I have Mirena and Estrogel and so far so good, touch wood etc etc.  I occasionally have a show of blood - a panty liner is enough to deal with it.  I am on other medications including warfarin but all seem to work alongside each other well thankfully.  The doctors have never told me to stop HRT and I actually think estrogen has been a very positive thing for me with my health.
The Mirena and gel would do away with that draining bleed where you feel washed out. I wouldn't like that either.   I always read your replies and know that you are very knowledgeable and keep well and fit which is why I am curious you haven't worked out a better way for yourself. Please don't come back and tell me what I'm doing isn't very wise and my head is going to fall off!!!
OK ladies, thanks for letting me jump in (interfere Patxx

[Errol]

Hi
I am interested to understand why and how you have your lining checked? i have endometriosis and have had ovarian cysts with 2x laproscopies to laser the endo and drain cysts in the past.  I was cautious about going onto HRT as most of them say have extra checks if history of endometriosis but no doctor has said that, despite me bringing it up.

thanks

[Sunnydays]

Hi Eerrol, the only reason I decided to have the uterus lining checked was from my own accord as I'd read so much on this forum about ladies having it done to check all was ok if they were deviating ( a lot or a little! ) from the standard hrt. I would never have thought of it otherwise. My GP didn't suggest it and I had no bleeding or anything to suggest anything was wrong.
The scan can apparently be done through the abdomen but I understand may not give such accurate results. Vaginally, it's a probe that shows up in a screen (gel is applied to the end of the probe) like the scan for pregnancy. It was painless and lasted 10 mins. They measured the ovaries and a general look around! It was done by a sonographer.
Stella Jane wish mine was £85. I had to pay £260! I could only find one clinic that carried it out that was in reasonable distance to me. This charge is for the full pelvic scan, they won't do a uterus measurement only, even though they do for women who are trying to get pregnant and want to measure the womb lining for which they charge about £160.

[Hurdity]

Hi Ladies - Hope you don't mind me jumping in but I'm interested in your regime Hurdity?  We are similar vintage I think (I will be 63 in May) - I am curious why you haven't tried another system.  I have Mirena and Estrogel and so far so good, touch wood etc etc.  I occasionally have a show of blood - a panty liner is enough to deal with it.  I am on other medications including warfarin but all seem to work alongside each other well thankfully.  The doctors have never told me to stop HRT and I actually think estrogen has been a very positive thing for me with my health.
The Mirena and gel would do away with that draining bleed where you feel washed out. I wouldn't like that either.   I always read your replies and know that you are very knowledgeable and keep well and fit which is why I am curious you haven't worked out a better way for yourself. Please don't come back and tell me what I'm doing isn't very wise and my head is going to fall off!!!
OK ladies, thanks for letting me jump in (interfere Patxx

Hi Patricia - yes I think we "spoke" a while ago didn't we? I have always stuck to the nil-by-mouth bioidentical route for HRT (apart from a 3 month initial foray with Evorel sequi) and it seems to me the most sensible approach to take for long term HRT. I often recommend Mirena to women on the forum (even though I've never tried it!) but my personal view is that I do not want to take synthetic progestogens long term and certainly not all the time as with the Mirena so I keep to a long cycle which minimises the intake of progesterone. Downside is of course the withdrawal (like coming off a drug I imagine) and the first couple of days of the bleed ( part of the withdrawal I think) but after a few days I'm back to normal and enjoying the benefits of oestrogen only. How long I can keep it up I don't know. Each time the cycle comes round I wonder about alternate day progesterone for example but the research seems to point to less risk for the breast if not taken continuously? (Sorry I haven't got refs).

I started on patches because it was 10 years ago and I hadn't heard of gel - not sure it was widely used then - and as they have always worked - I have never thought to change!

We all have to find our own way taking into account our own medical history, the science and the side effects and what we can tolerate to give us the best quality of life - so this is what I have chosen!

Glad your regime works for you and long may it continue!

Hurdity x