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[Sarai]

I'm sure people are sick of my questions. Basically after dits of bleeding monthly on Evorel conti and finding it was not low dose but medium, I am going to have to change HRT.
My lining showed up at 6.6mm should only be 6mm. Hysteroscopy was too scanty so dr wanted me back this month to put me to sleep to do again which I am declining. I will agree another scan though. Dr Currie said 6.6mm was not worrying.
I want to just get on, see GP and change. Dr Currie recommended an oestrogen patch plus prog by mirena or pill.
I can't do mirena but struggling to decide on ways to get prog. Is it feasible to do a prog pessary all month for no bleed?
Or should I do a prog pessary part month and have a bleed? My mind is in a whirl as I have some much other health and mental health stuff going on.

[Hurdity]

Please don't worry about asking questions! Members like to try to help each other!

Just to say firstly that the 50 mcg oestrogen dose in Evorel is the dose licensed for osteoporosis - any lower does not give as much bone protection - so you are on the right dose in that respect (remembering your situation I think?).

Secondly I had hysteroscopy once and like you did not want a GA (have never had one of these) so just took painkillers an hour before as they suggested which was fine - and had it done as outpatient in local city hospital. Can you have another one in the same way rather than with GA?

Re prog pessary (by this I presume you mean the Utrogestan?). Yes you can use it vaginally all the time but not many women opt do it this way continuously all month, because it can irritate the bladder a bit and also affect and be affected by intimacy - not sure how well it is absorbed after these events  .  It is not licensed in UK to be used vaginally but many women do use it in this way, and many gynaes and some GPs are happy for vaginal use because more gets to the uterus through the vagina (limited research trials demonstrate this), and there can be fewer side effects than with oral use.

You could try taking it (progesterone = utrogestan) orally (the 100 mg dose) with your 50 mcg patch - but you may also have the bleeding you describe especially as you are still getting it (and a slightly thickened lining) with Evorel conti (presumably after being on it for longer than 6 months).  If you want to continue with continuous combined HRT ultimately aiming for no-bleed then you could use the Provera progestogen (tablet taken orally) which may well be more effective at thinning the lining - although you would be taking a progestogen all the time ( although you are doing that now anyway).

Otherwise you could change to a sequential preparation as you suggest - which could be Evorel sequi, or an oestrogren patch with utrogestan x 200 mg for 12 days per month (or Provera). This should also help to thin your lining. The preparation are all listed under the top tabs - pale green benner - Treatments/HRT preparations.

Sorry to hear about your other issues too

Hope this helps and good luck

Hurdity x

[Sarai]

Thanks Hurdity, I got a letter today trying to rearrange the hysteroscopy with another Dr like I had already agreed it.
I explained I didn't want another as I am definitely going to change the hrt.
I'm meant to be on the lowest oestrogen dose due to blood clotting risks and Dr. Currie did say they found even a tiny dose can help bones. I think I found the cause was very low vitamin D and calcium.
Is it possible to get a low oestrogen patch like 25? I'm thinking I may try the having a bleed, I must be mad, at least then I can see the prog is working that way. Do you actually put the oral tablet in the vagina for 12 days or do they make a pessary?
Another weird question please since the hysteroscopy my boobs have been massive and painful, just like being 30 but with no monthly relief, does that actually mean the oestrogen is too high? I know for sure I can't live with them like this.

[Hurdity]

Yes oestrogen patches start at 25 mcg and there is also a 37.5 mcg dose ( with Estradot). They are all listed here:

https://www.menopausematters.co.uk/treatafter.php (scroll down for patches).

Re the utrogestan - yes you just poke up those little balls of progesterone inside!! Annoying tiny things they are too! There is a 200 mg version for vaginal use (exactly the same as the ones that were used orally previously) but now seems no longer prescribed for HRT so women on cyclical HRT ( like me) have to make do with the 2 x 100 mg capsules.

Re the painful boobs - are you definitely post-menopausal? It would be surprising suddenly to experience this several months after starting HRT, I would have thought, unless you have a bit of a cycle going on? Progesterone can increase boob size and make them painful (remember the second part of your menstrual cycle - this is when oestrogen is low!). Hopefully this will settle?

Hurdity x

[Sarai]

Oh no Hurdity, progesterone? No way.
Dr Currie said that spotting was often due to oestrogen being readily absorbed and progesterone not on the patch.
So I assumed I had too much oestrogen. Man I'm scared of having 12 days of prog on that basis.
Yes I'm definitely Post meno last period Feb 2016. And yes I do feel a cycle going on, even the spotting is a month apart.
I'm scared hrt is not right for me now. I have to say my boobs exploded as soon as I went on hrt, but the pain settled. The procedure has upset things again.
I certainly can't deal with massive sore boobs. I had that for over 20 years.