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[HappyHooker]

Hello - hoping for some thoughts and advice. I'm on oestrogel and utrogestan. I had been on three pumps gel per day and 12 days utrogestan per month. Bleeding had stopped and I felt good. The HRT clinic (in Belfast) advised me to change to 4 pumps of gel per day and continuous 100 mg utrogestan every day. I was just 54 when I changed to this continuous regime and am now in the 5th month. I have had a fairly regular monthly bleed - a proper one with cramps and fairly significant bleeding every month so far. I know some bleeding is expected with the change of regime but this is not showing any signs of calming down. I'm wondering if I am simply not past the menopause yet and if my own remaining cycle is still in action. I am feeling like either switching back to cyclical or giving up HRT completely to see what happens. Would love to hear what you think and interested to see lots of you have stuck with sequential.

[Hurdity]

Hi Happyhooker. How long have you been taking HRT and what was your cycle doing before you started it? Were your periods still fairly regular or had you started skipping them?

If you've been taking HRT for a while then yes the recommendation is to try to change to continuous combined HRT when you reach the age of 54 but if you then still get breakthrough bleeding which persists after 6 months then usually the recommendation would be to go back to cyclical, or possibly increase the progestogen if this is possible and is tolerated.

I am still on sequential HRT in mid 60's having started when I was just under 54, because I don't like the progesterone. It does sound like your own cycle could be coming into play but the other reason is that actually 100 mg utrogestan especially taken orally is just not sufficient to keep the womb lining thin when you are on a high dose of oestrogel. 4 pumps is a high dose if you are absorbing it well.

That being the case I would contact the doctor because ideally you should really have a scan just to check that the lining is not overthickened, if the bleeding is significant. If it's your cycle then that's fine. Cyclical hRT will sort it out so you know when it's coming. If it's too little progesterone compared to oestrogen (and your womb lining has thickened as a result) then ideally after undergoing treatment to shed the lining, you should take a higher dose of progesterone if you still want to be on continuous combined HRT.

Hopefully you can have a phone consultation with your doctor and perhaps move to cyclical HRT in the first instance with their permission, even while ( maybe?) awaiting a scan, if this is suggested?

Does that make sense?

Hurdity x

[HappyHooker]

Hurdity, many thanks for this which is useful. I've been on HRT for about six years and as I had a mirena fitted I'm not really certain how my natural cycle was - my gp did. Looks at that point when I was 48 and was of the opinion that I was menopausal. When I was on the sequential gel and 12 days of utrogestan I had no bleeds after the first couple of months at all. At the minute the HRT clinic in Belfast is suspended due to corona and my gp knows little about the regime I'm on (they referred me to the HRT clinic). Will maybe give things a further month (which will be six) and hope it settles.

[Hurdity]

Hi there - Your doc could not have known if you were menopausal if you had a Mirena as you would need to see what your natural cycle was doing for 12 months ie if no period then you were post-menopausal. However the lack of bleeding on a high dose of gel and sequential HRT would indicate you were probably late peri or maybe post-meno but not definitely. I think in view of your saying the bleeding is significant in the 5th month of a continuous regime of 4 pumps gel and only 100 mg oral utrogestan, and you may well be late peri or post-meno, on balance I would want input from a doctor, especially as you say that you stopped bleeding on the sequential regime of 3 pumps and 12 days utro. In your position - at that point I would have discussed with the clinic to go onto a longer cycle which is what I did ( when my bleeds petered out on monthly sequi regime). Why did they suggest increasing to 4 pumps if you felt good? Did you still have symptoms?

Covid-19 ir not, other conditions still need investigating. In England the practice I am registered with is now doing e-consultations, but I haven't tried it yet. I would want to push for a U/S scan if possible. They can't have suspended all of these?

Hurdity x

[HappyHooker]

Hurdity, thanks again and agree with all that you say. The 4 pumps was suggested as I had slightly low mood but not sure it's made much difference! I will get in touch with my gp next week for a chat.