Hi Autumn27
Thanks for the update
Sorry to hear that you have not had satisfactory treatment from the menopause clinic and you had to see someone less experienced.
I quite understand your not wanting to increase the progesterone further. Most women do not want to take this high a dose - with the exception of women undergoing fertility treatment who take high doses vaginally - but this is for an entirely different purpose so a clear greater willingess to put up with side effects if a baby could be the outcome!
Are you using 200 mg vaginally?
Normally when using continuous combined HRT, as you know eventually bleeding stops for the majority of women and especially if post-menopausal and should be invesitgated if not. There is cearly something amiss with the way the uterus lining is dealing with the effect of progesterone. From what I've read, under the influence of oestrogen and progesterone, different parts of the endometrium can be proliferative ( the effect of oestrogen alone) as well as secretory (the action of progesterone on the stimulated endometrium) and when this all works properly - there is no bleeding.
Often when it's not working and the balance of oestrogen and progesterone is out of whack - the lining can thicken and can cause spontaneous bleeding as these thickened parts of the endometrium break away. Abnormalities such as fibroids and polyps and as I understand (I think) - adenomyosis - can also cause bleeding.
As your lining was not thickened then this can't be the case - however as I suggested in my previous post I would still ask the GP to refer you for a hysteroscopy - not involving the menopause clinic - especially if you are not able to tolerate such a high dose of continuous progesterone.
Once this has been done then take it from there.
My suggestions thereafter and provided all is OK, are firstly as the menopause clinic - a Mirena coil, or as I suggested earlier - going for a cyclical regime when your bleeding will be most likely predictable. To start with you would take 200 mg utrogestan 12 days per cycle and see how you got on - and would be good to have your doc's approval of this - at least if s/he doesn't seem to have much of an idea you can propose what you would like to try!
Hello Autumn27,
I don't get it. If you have to increase progesterone to counteract oestrogen, wouldn't it be wiser to decrease oestrogen instead? You have gone back to your previous regimen, 75 patch and 100 mg Utrogestan, right? After so many years on this regimen I would decrease to 50 patch and 100 mg Utro.
Also, increasing prog to counteract oestrogen would be useless regarding the osteopenia. Are you on other medication or exercises for that?
Conolly X
Conolly - just to explain - the progesterone does not counteract the oestrogen in the way you are thinking. The systemic levels of oestrogen and its effect on target tussues - such as its effect on bone resorption - is entirely dose dependent, and independent of the progestogen which does not diminish it (and from what I dimly recall some prog preparations may even enhance it ie oestrogen + prog combo had even greater positivie effect on bone density in one study - but I might be remembering that wrongly!). Progestogens are only used to "counteract" oestrogen with respect to endometrial protection and as such, in a dose dependent manner.
Autumn27 has been told she is osteopenic despite 75 mcg patch and testing of oestrogen levels confirm lack of absorption. Therefore her bone health will only be improved by an
increase not a
decrease in oestrogen ( systemic levels) and it is stemming the bleeding to enable higher oestrogen levels to be achieved which is the main focus of any future treatment.
Hurdity x