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[Callmemadam]

I'm sorry if this should be somewhere else but I didn't want to hijack someone else's thread and I could really use some advice. Basically, I have been on some form of HRT for five years now. After a bleed at the end of 2018 and an initial scan that showed some thickening my consultant scanned me again and then put me on Estradot 50 and Uterogestan 100 on days 1-10 of calendar month.  I had no bleeding until Feb this year. Back in December I was diagnosed as coeliac and went gluten-free. So when the bleeds started in Feb I thought it might be because my gut was healing and the uterogestan was working so I didn't worry. each of the last five months the bleed has started about four days into the Uterogestan and continued until a day after I stop taking it. I thought this was what it is meant to do but saw the consultant for a routine check today and she says that it's not what should be happening at all as that's not a withdrawal bleed (I get cramps and have to use tampons). She has booked me for another scan. I'm quite anxious anyway and this has sent my anxiety rocketing - should I have gone back to her in Feb when the first monthly bleed happened? Has this happened to anyone else - this kind of regular bleeding like a proper period? I'm 59. I'm thinking of just stopping HRT completely if the scan is ok as I am so afraid of everything going wrong. I saw on another thread that someone said scans only last six months anyway so potentially I could have been sitting on a problem for more than a year! Does this make sense to anyone please and if so please explain. Also the scan is booked for next week but due to date I will probably be bleeding - can they even do a TVS if you are bleeding? I really don't want to wait for ages and we are supposed to be going away. Thanks to anyone reading

[Dotty]

Hi if you are taking Utrogestan on a cycle then you will get periods. I'm not sure what the consultant means by saying that it shouldn't work like that. x

[Callmemadam]

She said that any expected bleeding would have been towards end of the ten day tablet cycle, and brief - i.e a withdrawal bleed. Would also have been normal not to have bled at all. the fact that I have started bleeding each month WHILE taking uterogestan and for several days (around 7) is what she says is not normal

[Callmemadam]

sorry - also just realised that I said I had the initial scare at the end of 2018. I meant 2017. I have been on this estradot/uterogestan regime since April 2018 so just over a year. No bleeding at all on it until Febriary this year. Since then each month I have bled while taking the Uterogestan tablets.

[Dotty]

Is there a reason why you have been on Utrogestan 100mg for 10 days? The usual dose is 200mg for 12 days x

[Callmemadam]

Dotty - not sure, just that's what she put me on. My previous GP had put me on 100g x 7 days so I didnt question it. Consultant now wants me to change to 100g daily.

[Dotty]

If you are post menopause then taking it every day might be better x

[Callmemadam]

I have been taking Omeprazole daily in mornings since diagnosis of coeliac disease - I don't suppose that could affect it could it? I just don't understand why everything would change - and she says my blood test showed relatively low estrogen levels compared to where she would like them to be?

[Ladybt28]

unless you are on utrogestan continuously which tries to balance hormones so there is no bleed - you will get a bleed.
I am on a cycle at 57 because I cannot take progesterone continuously.  My cycle is a bit different I use mine what is called "off licence" but for the purposes of your problem (which actually isn't a problem) I use it for 10-12 days 200mg.  I get a bleed each month and expect to (I get one every 6 weeks for my cycle but I don't want to confuse you so ignore my 6 weeks).

It is a withdrawal bleed and it is designed to shed any build up of the lining of the womb.  I can't work out why your consultant should think this is not normal on 10 days use?  I get a proper bleed just like a period every month which lasts 4 days.
There is absolutely nothing to worry about Callmemam.  It is working just as it should do and I wouldn't expect anything else.

There are 2 ways to take Utrogestan as per the NICE guidelines (1) 100mg continuously every night days 1-25 - break days 27/28/29 and start again
or (2) 200mg every night days 15-26 (12 days) none on the other days oestrogen only.  I got given a leaflet on it showing the charts from the meno clinic.
I think she may have got a bit confused in her prescribing and mixed the 2 methods together because she is giving you 100mg
days 1-10 of the calandar month as in method 1 but thinks you shouldn't get a bleed as in method 2?

It's not the bleeding which has started recently which confuses me, it is why you had no bleeding when you first started the regime in 2018 based on 10 days only?  Thinking out loud, it could be that your own body was producing enough oestrogen to balance out the utrogestan and now it has dropped, so the utrogestan is working as it should.

If you have not had a bleed for so long the periods will be painful and heavy for a while as there is quite a bit of womb lining to shed but these settle down to normal.  You ask in your original post - is this normal - yep - quite what I would expect and it happens to me 
If you want to PM I can send you the copy of the NICE guideline A5 flyer as an attachment - I have it saved - so you can take it with you on your next appointment.  Consultant probably won't be very pleased but it might "un-confuse her"    Also it will put your mind at rest. x

[juliemargaret]

Hi ladybt
Id love a copy of the nice guidelines..any chance.you could send me.a.copy also.

Callmemadam - lots of the ladies advise and opinions sound good...try not.to worry.......im.sure it will.settle.itself.once you find the regime.for.you....or so.i keep telling myself !!!! Im 6 weeks this week hrt....peri and on alternate days 100mg utro and vaginally....been ok so far.but had 3 bleeds in this six wreks.
..bleeding now. Hoping it settles as i like the thought of alternate days over cyclical...i just feel it may be more balanced for me.....x

[Ladybt28]

Hey Birdy...I know what you mean but the leaflet shows a 3 day break and this is classified as the "official continuous prescription" but loads of ladies on here just ignore the 3 day break and some consultants don't bother to talk about it either and say you just keep going without any break.

There is plenty of discussion about those 3 days on the forum - some do, some don',t but the actual leaflet published by Besins shows the 3 day break on a (so called) continuous cycle.

Just saying what I know but anyway loads of us stray from the "official path"...like ladies who do 7 days or 10 days (I have heard of 3 days under supervision).

[Callmemadam]

Love you all but LadyBt28 the most. Thank you for such a clear post. I feel a bit less worried. She did say my estrogen levels have dropped in a year from 220 to 110 (?) which was lower than she likes and that she would have been putting me up to a 75 patch if it weren't for the need to check out the bleeding first. I think she thinks I should either have no bleed or a very faint bleed, not a proper period. But what you say makes sense if my own body's estrogen has dropped over the last year.