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[Spadger]

Morning ladies,
Advice needed please...
I'm 55, 6.5 years post meno & finally admitted defeat 2 years ago & asked doc for hrt. I didn't know much about it at the time so didn't query him prescribing Prempak-c sequential until I had the most horrendous bleed, bloated/gained weight/got awful spots etc. I posed a question on here and returned to the doc armed with "the knowledge" 😉
He panicked about the bleed (he obviously didn't realise sequential hrt would cause this) and I was referred to hospital for a transvaginal scan - which showed thin endometrium & fibroids (which I already knew about). The consultant said I would do be fine to take continuous combined hrt for up to 5 years so I went back to the GP who agreed to prescribe Femoston Conti 0.5mg/2.5mg - it worked pretty quickly alleviating hot flushes/night sweats/vag. dryness etc & I was a happy bunny.
Spotting didn't occur until I'd been taking it for 5 months and I didn't really worry as I was fully expecting it - however it still happens and I've been taking it for 18 months now. I also get pmt-type symptoms, low mood etc.
Am I right in thinking that some women never achieve 'no spotting' on continuous combined hrt? I'm wondering whether to change from continuous combined to sequential, as apart from the spotting issue I feel really well - the best I've felt for years actually.
I hope you can help, I don't feel as if any of the GPs at my practice seem to have any knowledge (or interest) on the subject at all and there is no meno-clinic near me.
Love to all,
 Spadger

[Hurdity]

Hi Spadger - sorry your post got missed - bank holiday weekend!

Yes you're right - some women always get spotting and end up staying on or reverting to sequential HRT. I am still having a cycle in my 60's although in my case it is because I don't want to take continuous progestogen.

You are on an ultra low dose HRT so the spotting is unlikely to be due to endometrial thickening and especially if you've had investigations . In your situation it could be due to endometrial atrophy (especially as your endometrium was thin before) which can cause bleeding - due to excess progestogen in the absence of sufficient oestrogen. If it has been going on for that long I would just check with the doc again - I mean have you consulted doc since the persistent spotting on the Femoston?

Because you are also getting the pms symptoms then the cyclical Femoston (1/10) sounds as though it would be the right treatment. This involves double the dose of oestrogen though. I wonder if you would be able to ask about halving the tablet initially and then gradually increasing to the normal dose? The advantage is better bone protection - you are still very young so no problem with increasing the dose.

Hurdity x

[Spadger]

Hurdity thank you so much for your reply - you have no idea how helpful and reassuring it is to have a response from someone who actually knows what they're talking about 
After years of having very heavy periods I don't really relish the prospect of having them again every month, however a predictable monthly bleed would be preferable to never knowing exactly when the spotting is going to happen - it's hardly anything really, just a nuisance & I'm really fed up. 
I will endeavour to get an appointment with a GP (that's a task in itself...)
love Spadger x