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[Embear]

Hi,
I'm after some advice.  I am 40 years old and struggled with severe PMS, night sweats, and my periods were more frequent and very light.  I saw my GP who did bloods which showed I had very low oestradiol levels.  They refused to consider HRT as said I was too young (39 then and said I was too early to go through the menopause).  After a lot if research, I decided to go to Prof Studd's clinic and saw Dr Neale Watson. He looked at blood results and history and said I was peri-menopausal.  He did a bone scan and found I was severely osteoporotic.  He started me on 3 pumps oestrogel, testosterone and utrogestan 100mg for 10 days each month.  I have been doing this regime since May 2018 and feel so much better in myself.  The only problem is since January I have started spotting about 4 days before even starting the progesterone and for the last month I bled for 3 weeks passing large clots.  I saw my GP who referred me for an ultrasound scan which showed 12mm thickness.  They have referred me on a 2 week wait to gynae. 
I'm concerned they may say I need to come off treatment or won't be sure what to prescribe as it was a private consultant who started me on the treatment.  I can't really afford to go privately again.  I wonder if I need to increase the progesterone?  Any suggestions would be really welcome x

[Hurdity]

Hi Embear

 

It does sound to me like the progesterone is not sufficient to protect the lining from the extra oestrogen you are taking? You are taking much less than the licensed dose - as is typical with the Studd regime, which is 12 days x 200 mg per 4 week cycle.

However in terms of the U/S scan - it really depends when in your cycle the scan was taken as it goes through the normal process of growing and shedding so will be at its thickest towards the end of the protgesterone part and just before your bleed starts. Also will depend on how it fits with your natural cycle. Sometime Prof Srtudd prescribes even higher doses of oestrogen with the aim of suppressing ovulation in which case the bleed would usually be less - not sure if he was aiming for this in your case?

It is good to have been referred but hopefully the gynae is also a menopause specialist and will understand and interpret what's going on re your uterus lining. For example you may have fibroids or a polyp as these can cause extra bleeding.

The most important thing is that you are able to continue with HRT due to your age and especially due to osteoporosis if your bone denisty has reduced to this extent.

Depending on the outcome of your investigation, if all is well the gynae should be able to suggest a modification of your HRT to keep your lining thin but ensure you are taking enough to protect your bones - and hopefully increase bone density. You should absolutely not need to go privately for this treatment as you have a proven medical need. If your doc does not understand this and the gynae is not an HRT specialist then please do ask for a referral to a menopause clinic. However even though funds do not permit another consultation, do please contact the Studd clinic to inform them of what is happening to you on this regime because it continues to be prescribed and for women who have one-off visits as you have - it can be difficult to deal with the consequences for those for whom it is not suitable. HRT does need to be individualised - but on NHS!

There are various options - a Mirena coil will be most effective to deal with the bleeding - but not body-identical. Otherwise there are Provera tablets, or higher doses of utrogestan.

Alternatively at your age - if you tolerate the progestogens there are two birth control pills that are similar to HRT in that they contain body-identical oestrogen - same as HRT ( estradiol). QLAIRA in one such - has variable doses of oestrogen and only two tablet free days so should minimise  the incidence of pms.

Hope this helps and do report back on how you get on

Hurdity x