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[Carol7]

Hi I am new to the forum and I am wanting advice before my GP appointment on Monday. I initially started on Femoston 1/10 before moving on to 2/10 as my symptoms had returned - anxiety, hot flushes, brain fog. The Femoston 2/10 has been working well until a few months ago. During the progesterone stage of the cycle the anxiety returns, I have headaches and sometimes my breasts are really swollen and sore. The worse part of it is than the I start to bleed during the last week of the progesterone and then again at the beginning of the month with the oestrogen tablets. For a couple of months I had a bleed for three weeks out of four.
I am 57 years old and whilst I understood that with Femoston there would be a withdrawal bleed I would now prefer not to have to put up with the bleed.
I am therefore looking for advice on an alternative to the Femoston. I am slightly concerned about which option to take as I seem to be sensitive to progesterone as it is during the two week progesterone phase of the Femoston that I have symptoms. I am concerned that an alternative HRT will mean I will be taking progesterone every day and therefore will have symptoms everyday instead of two weeks out of four.

Any advice would be gratefully appreciated.

[Hurdity]

Hi Carol7

 

Sorry to hear about your bleeding and sensitivity to progesterone. Your dilemma is the same as many of us encounter when we become post-menopausal.  Either limit the progesterone exposure by staying with a cycle but having to put up with a bleed, or taking the progestogen continuously in order eventually to become bleed-free, but with all the side effects that entails. There is no easy answer I'm afraid and it has to be the least worst option if you see what I mean!

The first thing is to have an idea whether you think you might be post-menopausal yet? So - what were your periods doing ( in terms of cycle frequency) in the months or years leading up to your starting HRT, and how long have you been taking it?

If you are still peri-menopausal - which is possible although less likely - then a cycle is advised which is supposedly meant to lead to a predictable bleed - not happening in your case.

One option is the Mirena coil - which although some of the progestogen is absorbed systemically - should eventually lead to no bleeding ( after the settling in of a few weeks or months). You would then add oestrogen as tablet, patch or gel - and perhaps a good opportunity to change to transdermal oestrogen as you aproach 60?

Another option is to try changing the progestogen to utrogestan - which is bio-identical progesterone (ie same as produced by our bodies) - first of all cyclically - although this does have a sedative effect and is more effective used vaginally in some women. You would then change your oestrogen to patch or gel ideally.

If you feel you are post-menopausal and you are bleeding excessively on this preparation ( and bleeding 3 weeks out of 4 is not normal on cyclical HRT if you are post-meno) - then I would mention this to the doc re checking you over given your age. For example you might have a fibroid or polyp which can cause extra bleeding - so a scan and if necessary hysteroscopy would be in order, to take a look.

I would suggest you push for this whether or not you change your HRT and actually see if you can get a referral before you do so. If you do have a scan it's best to have it just after your withdrawal bleed has finished - following the end of the progestogen phase of the cycle.

If you are still peri-menopausal then all of this could just be due to your own hormones adding to the mix - and bad luck on your part for this to be still happening at 57!

Hope this helps and let us know how you get on with the doc!

Hurdity x

[Carol7]

Hello Hurdity,

Thank you for your informative reply. The problem I have is how to determine if I am post menopausal. I have been taking Femoston for just over two years prior to going onto HRT my periods were very erratic, having bleeds several times a month. That was why it was suggested that I went onto Femoston as it would regulate my bleeds. The Femoston did work for several months but I now seem to be in the position I was before with the erratic bleeds etc.
I will discuss all your suggestions with my GP and let you know the outcome

[Carol7]

I have just been to see my GP and I am unsure as to the advice I have been given. My GP has suggested that I stop taking HRT altogether for a few months.  I would then be able to determine if I am post-menopausal. I would also be able to monitor any bleeds to determine whether a scan is necessary. I would appreciate your thoughts on this advice.

[Hurdity]

Hi Carol7

You should not necessarily need to stop HRT to determine whether or not a scan is necessary. I had some spotting on HRT at the wrong time in the cycle and my GP said to stop and if no bleeding then no action. However I had an e-mail consultation with Dr Currie and she said I didn't need to stop and should push for investigation anyway - I mean just because bleeding stops doesn't necessarily mean nothing is wrong. For example your womb lining could be overthickened and a doc might decide you needed to thin it or take a different HRT preparation. I went to see another doc in the practice and showed her the e-mail from Dr C, and she went along with it and referred me for scan, while I was continuing with the HRT.

However you might feel you want to stop for a few weeks anyway to reset so to speak and see if some of the adevrse sympotoms disappear - and then possibily restarting on 1/10 or a different type of HRT. However still push for a referral rather than wait I would say, if your bleeding is excessive and abnormal for you, especially at your age.

Hurdity x