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[Pat2121]

Ladies can you advise please.. I want to stop taking my Femoston Conti tabs (taken for 10months) as they are causing bleeds every month. Can I just stop? End of my tether here

[Conolly]

Hello Pat2121,

I'm no HRT 'expert' but what I have read from other's experiences is that if you stop cold turkey you may experience menopause symptoms (hot flushes, dryness, etc) and if you taper off you might get bleeding/spotting. So it's up to you to decide what do you want to face ahead. If you were on the gel you could taper off, but with tabs I guess the only option is to stop taking them or you will continue to have bleeds no matter what you try (taking alternate days for example). Maybe you could try the sequential regimen before quitting, at least you would know when you are going to bleed. What does your GP say about the bleeding? Have you had tests for other possible causes?

I'm sure others will come up with better answers.

Conolly X

[Pat2121]

Thank you Ladies.. I called my GP a couple of days ago and was told he would call me back yesterday, he hasn't called yet. I had a hysteroscopy  10 months ago and all was well.  Previously on Evorel Conti and ended up having a lot of probs with spotting, so GP changed me to Femoston last Feb. I just have a feeling I've become sensitive to Progesterone. I'm not sure if taking a tab every other day would help. I am so bloated and my mood swings are awful now plus the bleeds and period pains. I just want to stop and see where my body is? I can put up with a few hot flushes if nature is kind  to me now ... 

[Conolly]

Pat2121,

I think you have the option to stop asap after talking to your GP. That's the procedure if you were going to have major surgery, so there's no tapering off tablets, taking every other day will only aggravate the bleeding/spotting.

Glad to know the hysteroscopy went well. I was thinking of other issues, such as blood or vascular, have you ever been tested for them?

From Femoston conti leaflet:

"You may have irregular bleeding or drops of blood (spotting) during the first 3-6 months of taking Femoston-conti. However, if the irregular bleeding:

carries on for more than the first 6 months
starts after you have been taking Femoston-conti for more than 6 months
carries on after you have stopped taking Femoston-conti
see your doctor as soon as possible."

I think you qualify for other tests, ask your GP for a referral to a Gynae.

Conolly X

[Pat2121]

Hi Conolly thanks, can you explain the blood/vascular possibilities please?

[Pat2121]

Also, I cam off Evorel a few times in the last 15 years and had no spotting.. just the flushes returned

[Conolly]

Other possible causes of bleeding can be seen in this article https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970656/

"Arteriovenous malformations, endometrial pseudoaneurysms, myometrial hypertrophy and chronic endometritis".

Maybe the bleeding is just the result of changing HRT regimens for a number of times.

Conolly X

[Conolly]

This is a very good article about bleeding on HRT Unscheduled bleeding on HRT - International Journal of Reproduction ...https://www.ijrcog.org/index.php/ijrcog/article/download/.../2805  It's a PDF and it's going to be automatically downloaded.

Conolly X

[Pat2121]

Thank you all so much! you are appreciated. I am quitting today! Wish me luck!

[Conolly]

Good luck Pat2121  and keep us posted!

Conolly X

[Hurdity]

Pat2121

I presume you are post-menopausal if you've been taking HRT for 15 years? I presume also if you have been taking continuous combined HRT for 15 years you were post-menopausal before starting ie 12 months without a natural period (and not on Mirena/mini-pill)?  Also how old are you now and how long have you had the spotting?

When you had the hysteroscopy - was there any reason given for the spotting after so long, and were you given info about the lining thickness?

If you are properly post-menopausal for a long time and have had no bleeding spotting until just before 15 months ago and everything was OK after hysteroscopy ( ie no over-thickening, polyps or fibroids) then one reason for spotting can actually be over-thinning (atrophy) of the uterus lining which can happen with too much progestogen. Norethisterone is quite a powerful progestogen so this could be one explanation. Continuing with continuous progestogens as with the Femoston may not have been sufficient to "heal" this atrophy if this is the cause?

However it is strange to get bleeds every month as this would not be expected on conti HRT unless you were still ovulating. Unscheduled (abnormal) uterine bleeding would usually occur more randomly.

How you tolerate progestogens is a different issue from the bleeding - if you are progesterone intolerant then yes you would expect continuous side effects such as bloating, headaches, irritability etc. Mood swings ( if you are post-menopause) on tablet HRT could be the result of absorption variability as the tablets go through your digestive system leading to different amounts getting into your system and your body reacting to the changes.

You don't necessarily need to stop HRT - once the cause of bleeding has been established then there are different HRT types which may suit you better but still eliminate the bothersome symptoms - notably cyclical HRT which would give you a predictable bleed. Many women do continue with a cycle post-menopause for this reason.

As Stellajane said - stopping suddenly or tapering is unlikely to make a difference to the outcome ie whether flushes return or not ( research has shown this - but more needs to be done), but will of course determine the speed with which they return if they are going to.

If you need any further advice re HRT or if what I've said has made you want to reconsider - do ask again and we can try to help.

Hurdity x

[Pat2121]

Hi Hurdity and thanks for your reply. I am 68 and have been in the meno for 16 years. It has occurred to me that if the spotting whilst I was on Evorel was caused (as is thought)  by the polyp, (they found 2 polyps in my womb one was so big it was protruding through my cervix) it may well be that Femoston is not being absorbed (I have IBS so I suppose that could be a reason why I'm spotting)  .. I'm now thinking I would like to try the Evorel again (I did so well on it for years before the polyp). I will take a break from HRT for a little while I think to clear my system before I start HRT again. What do you think?

[Hurdity]

Sounds like a plan - ie if they found reasons for the spotting (polyps) and you got on well generally with on the Evorel apart from this, no reason not to start again if your doctors are also happy. At your age I wouldn't wait too long off the HRT - unless you are wondering whether you might stop for good?

Anyway hope it all goes well whatever course of action you decide!

Hurdity x