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[Sarai]

I decided after getting odd spots of old blood every month or so while on evirel conti 50, to write to Dr Currie.
Now I've only been on it just over 7 months but she says over 6 months and it needs investigation.
Hell my anxiety which is seriously bad now has sky rocketed.
I'm in such a state.

[Sarai]

sonka thanks it helps me a bit.
I do believe I had some fibroids when I was checked a few years ago but as I went into meno it wasn't an issue.
Did drs make you stop hrt then?
I only went on hrt for my bones as I didn't want bone drugs so I'm well cross about this as I'm fine in it in every way really.

[Wrensong]

Hi Sarai - easier said than done, I know - but please try not to worry.  It is standard practice to investigate any post-meno bleeding on a conti regime if it continues beyond the first 6 months.  I had this on Evorel Conti too & had a transvaginal USS to investigate lining thickness & check on other gynae apparatus & all was fine.  As my bleeding continued I then had a hysteroscopy after 12 months & again, nothing untoward was found.  The bleeding has been put down to atrophy, but another USS is now in the pipeline just to be on the safe side.

If you haven't already flagged up the bleeding to your GP, please do so, telling him/her what Dr Currie has said.  If you haven't had a TV-USS before, these are a doddle & nothing to worry about.  Assuming all is found to be well with you, it should be possible to find a different conti regime on which you have no bleeding, or if you prefer you could go to a sequential regime & have a scheduled bleed every month.  That said, it's my understanding that some women never settle on a conti regime & continue to bleed/spot, so for peace of mind & to avoid repeat investigations, a sequi regime is the best option.

If you are not also on topical oestrogen for any atrophy & have any discomfort in that area, please ask your GP about that as it is possible for slight bleeding to result from VA alone.  Your GP may want to wait until any investigations have been carried out before prescribing any additional HRT though, as meanwhile the bleeding will be deemed "unexplained".  I hope you won't have long to wait to get it checked out, but please try not to worry - lots of us have been there but it is essential to get these things looked at.

[Sarai]

Wrensong so do you think they wouldn't let me stay in it with just the spotting which is only about 2 days then gone?
I am so mad I'm doing this for bones not meno, I didn't even need hrt.
But I needed bone help and don't want evil drugs.
I suppose if I need a bleed then so be it I might need another sort then.

[Wrensong]

Not sure what your GP/gynae will feel is best Sarai, but have a think about what you feel & discuss it when you go along. 

Bone health is a very good reason to take HRT - I also have osteopenia & was hoping to avoid progression to osteoporosis. 

I have continued to bleed a little on & off throughout 2+ years on Evorel Conti (which I am now stopping) but had also had several trials of alternative regimes to try to find a better fit.  My GP & I agreed, after essential thorough investigation, that the bleeding was very likely due to my being someone who would never settle on a conti regime, but at a later Meno Clinic referral they felt it most likely due to atrophy, as blood tests show I don't absorb the HRT that well, so the atrophy has not been adequately controlled. 

I think it is really best for peace of mind to try to find a regime that doesn't cause problematic bleeding (we can never be entirely sure that something else is not going on) & to avoid all that is involved in repeat investigations.  These are expensive for the NHS which is also overstretched, so I also felt I had a responsibility to try to find a more suitable regime. 

[Sarai]

I'm curious how they keep a check on the sequential regimes if you have a bleed?
Dr Currie suggested an oestrogen patch and utrogestan pill have heard of that or an oestrogen patch and the coil which actually I don't fancy to be honest.

[Wrensong]

Hi Sarai, not really sure what you are asking about keeping a check on sequi regimes if you have a bleed.  With a sequential regime you should have a withdrawal bleed at regular intervals.  As this type of regime is expected to induce a scheduled bleed, the bleeding is usually not a cause for concern, unless it deviates from what becomes the norm for you.  As conti regimes are designed to be "no bleed", this is why bleeding/spotting that persists beyond the initial 6 month settling in stage is considered to need investigation.  Not sure whether that makes sense or answers your question!

As Dr Currie suggested, the Mirena is often offered as an alternative to patch/pill progesterone & many women get on very well with it, but like you, I didn't want to go down that route, especially as I'd already had a bad experience with the progestogen it contains, which is also used in FemSeven Sequi & Conti patches.  There is lots on the forum about the Mirena, so you could have a look & see what other women have said about it. 

There is also loads about Utrogestan - the Marmite of the progesterone range!  Some women love it, others really don't!!  Have a read around & a good think, so you know what you feel might be best for you & you will be well equipped to discuss it with your doc.
Don't delay contacting your doc though - the sooner you get the ball rolling, the sooner you can get everything checked out, put your mind at rest & get your HRT sorted.

[Sarai]

Thank you Wrensong you've answered loads today.
What roller coaster day it's been.
Spoke to a dr and I get to be referred under the 2 week rule, great for anxiety.
That it stop the hrt and see what happens.

[Wrensong]

You're welcome Sarai.  Two week referral is great - you'll be sorted in no time.  Good luck with it all.

[Hurdity]

Sarai - I'm not clear what you mean - and think it's probably a typo "that it stop HRT" ??

Do you mean you have been told to stop HRT now pending investigation? If so this isn't actually necessary and practices seem to vary about this. When I had random spotting after sex (and not on conti HRT) my GP just said to stop HRT and see if it carried on and wouldn't investigate - I didn't want to stop, so I wrote to Dr Currie who said this was not necessary and I should get investigated anyway even while on HRT.

I know my circumstances were different but just saying you should not have to stop HRT while waiting for your referral - unless of course there is a specific medical reason that doc has given or you prefer to do so?

Hurdity x

[Wrensong]

Sarai, as Hurdity says it shouldn't be necessary to stop your HRT while waiting for investigation, unless your GP has advised this.  I continued to use it while I was waiting for both my transvaginal scan & the hysteroscopy.  When I first started to have the post-meno bleeding, my very cautious GP wanted me to stop HRT immediately, but we talked it over & agreed I could continue pending investigation.  I sensed her caution was largely because at the time she had probably had very little experience of prescribing HRT & knowing myself that bleeding on Conti regimes was not that uncommon, I was able to reassure her that I understood the situation & was happy with any risk  pending investigation, so the decision was joint & not entirely her responsibility.  When I mentioned earlier that your GP might not be happy to prescribe additional HRT just at present, what I meant was that she may not want to add topical HRT while the bleeding is considered "unexplained".

[Machair]

How are you doing Sarai? I hope you are feeling better and less worried. Maybe you still have some of your own hormones as you are not long fully menopausal and oestrogen can still peak up to 2 years after your last period. Hopefully the appointment will put your mind at ease.x