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[mic67]

Hi all,

Quick question please. I had an Ultrasound around a month ago which revealed a thickened lining of 8mm. The radiologist said in the context of HRT she wasn't concerned but would have been if I was bleeding.

I was on sequential Estradiol and Utro from Dec 20 - May 20 and didnt ever have a bleed during the breaks. (last period prior to HRT was June 2020.)

My GP suggested I started Conti so started that in May.

When the US showed the lining was a bit thick, I wondered if perhaps I had not been absorbing the Prog (as I do have digestive issues) is this possible? Therefore the estrogen is not opposed?

So after reading a few posts on here, I decided to use the Prog (100mg Utrogestan) vaginally and about a week after I started doing that it has triggered a heavy bleed. I have been bleeding non stop for two days and this has triggered a GYN referral via Gp.

Im not convinced I need this referral as surely the bleed will now thin out the thickened lining? Is this guaranteed?

I really think the bleed is likely due to the change method of taking the Progesterone, therefore don't really want to waste hospital time? Is this likely and can anyone share their experience please?

Thank you.

[Nas]

I don't think you can assume that the bleed will have thinned out the lining of the womb unfortunately. Only because I have experienced this whilst on the Evorel patch during the past few months. Scans revealed a thin lining, but the bleeds were occuring every two weeks. I was told that this was because I was severely oestrogen deficient from non absorption of the patch.

Are you now post menopausal (no period for 12 months +)

You are probably right in that the bleed has been triggered by a change in the delivery of progesterone. However, post meno bleeding does need to be investigated within 2 weeks. Obviously if you are peri, then the bleeds would happen in timely manner anyway.

I am sure all is okay, but for peace of mind, I would have the gynae tests.

[mic67]

Hiya and thanks so much for your reply.

Sorry to hear about your hiccups too!

Yes I haven't had an actual bleed (before this) for 13 months, prior to that was 6 months so I assume I am post-meno but I didn't know if I fit into that category as I've been on HRT?

 i assumed this bleed was a result of the lining going back to normal due to it finally getting some direct progesterone! Strange that I didn't have a bleed in all those months on sequential isnt it!?

You are right and the guyny tests will put my mind at rest but it feels like a bit of a waste of time.

Oh, and I am realising how much I was enjoying life without bleeds! 

[mic67]

Just bumping this to see if anyone else has a similar experience and to ask again if this bleed is likely to make the lining normal mm?

[Hurdity]

Hi mic 67

First  if you start HRT before you reach natural menopause ( 12 months without a natural period) then you don't know if you are post-menopausal or not. Lack of bleeding on HRT does not necessarily mean you wouldn't have bled if you weren't on it though if you were still ovulating naturally you might have expected a bleed at some point as you are on a standard HRT regime.

You haven't said what your oestrogen dose was? Some women do not bleed even on sequential HRT - this happened to me in my later 50's having started HRT before menopause, having withdrawal bleeds for the first few years and then these petered out. However you were on a lower than licensed oral dose (it should be 200 mg oral Utro per day for 12 days per 28 day cycle) so that could also explain the lack of bleed? I would have thought you would have bleed earlier though if the lining was overthickening?

The amount of thickening of the womb lining is dependent on the oestrogen dose so on lower doses the lining may not have built up sufficiently to bleed. Under the normal or artificial (through HRT) cycle the womb lining will build up during the first two weeks of the cycle from the oestrogen. During the progesterone phase the lining changes structure ( ready for a fertilised egg). Then when the progestertone is stopped the lining breaks down and comes away as a bleed - a natural period or the HRT withdrawal bleed.

If the lining doesn't build up very much then theoretically the progesterone may act also to thin it down so when it is withdrawn you don't bleed ( as in my case).

Crucially though - because the thickness of the womb varies throughout the cycle - then the scan will reflect this =- depending on when it is taken. The best time to have a scan is immediately following the beed - or in your case if you didn;t have a bleed - straight after the end of the progesterone phase or a few days later ( if you would be waiting for a bleed). If you have a scan at the end of the oestrogen phase or early in the prog phase (and sometimes for the whole of it) then it will be at its thickest.

So as Nas says - the heavy bleed will not necessarily thin the lining completely and indeed the fact that it happened after only a week rather than on withdrawal of the prog after a complete 12 day course = indicates that the lining had thickened ( as per the scan) and needed to come away.

No its not a post-menopausal bleed as such but usually any unexplained bleeding after a period of time without bleeding - even when on HRT - would be referred. You say you are not convinced a referral is needed - but you went to the doc ( which triggered the referral) so you must have been concerned?

As you say it is most likely to be down to the change in delivery of the progesterone but also indicated that the 100 mg per day oral dose was not doing its job (eventually without change in regime your lining may have overthickened and then you would have bled perhaps randomly or heavily at the end of a later cycle - hard to say?).

I would always go for any consultation offered - because what it the harm in being monitored and checked that all is well - but equally I would be unduly worried because the explanation (change in prog) is reasonable.

However in order to know whether the lining has properly thinned down you would need to complete another cycle eg of vaginal prog and then have another scan immediately post-bleed.

Hope this helps and all the best

Hurdity x

[mic67]

Dear Hurdity, thank you so much for taking the time to write this detailed response. It makes total sense and I am not unduly worried.

I do however think I wasn't prescribed the sequential dose properly after what you have said. From Dec 20 to May 21 I was taking 2 pumps of gel on thighs and 100mg Utro orally on days 1 - 25. I remember thinking at the time that 3 days was likely not long enough to trigger a bleed!?

I am now taking 2 pumps plus 100mg vaginally daily with no break - still bleeding.

Weirldy regarding the recent GP appt, I had made the appointment after my scan result to discuss the thickened lining and to check my dosing was correct..and then coincidentally a bleed had started by the time the appointment came about!

Thank you once again for this, you are right about the appointment for reassurance as I don't think my GP surgery really know much about HRT. I hope they can do a scan rather than a biopsy and reassure me on the current regime! I will keep you posted.

Have a good Sunday! Mic x

[jag2107]

Hello , I’m on utrogesten 100mg oral and 2 pumps of gel , on month 4 of this regime , and each month that has gone by I’m bleeding a bit more , not heavy just the brown muck 🤷🏻‍♀️ Sometimes only on wiping too . Anyone else had this ? Is my dose wrong ? My mood and flushes are no more just this problem ? I had polyps removed from my womb in March this year and a biopsy taken at the same time at that was all good ??