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[Teresa]

Hi All,

I wondered if anybody else has been in a similar boat to me and had some advice as to what to do. To cut a very long story short, I had a hysteroscopy in mid April, due to spotting seven or eight months into continuous HRT (post menopausal)  Before the hysteroscopy, I’d had an ultrasound scan which showed my womb thickness was 16mm and apparently it should be 4mm. I also take a medication which is known to increase how quickly I break down progesterone. I’m on Evorel 75 patches and utrogestan 100 mg orally.

Before I had the hysteroscopy ( which I had with local anaesthetic) I was trying to get some advice from the male gynaecologist as to what I need to do to reduce the thickening, as I think I’m not getting enough progesterone and he was very dismissive and unhelpful saying I needed to discuss with my GP. I was so surprised as he was a gynaecologist, I thought he’d help.

My results have come back as normal and they’ve discharged me back to my GP with no advice. I had an appointment over the phone with the only female GP at my surgery earlier today ( who is blatantly anti-HRT) and she said she can’t help me or advise and wasn’t prepared to increase the progesterone without further advice. She said that as I’m on HRT I have to accept the risk of womb cancer, breast cancer and always having a thickened womb  honestly, those were her words. She repeated it about three times during the conversation. She even asked me if I wanted to stay on it and I said I did. She said I needed to ‘go back to the gynaecologist secretary and ask them what you need to do”. I asked her if she could approach them and she said that if I got no help, then I’d have to make another appointment to discuss further with her.

Has anyone else experienced this? Does it sound right to you?

Thankyou,

Teresa

 

[Dotty]

Hi yes I’m in the same position. Had all tests including hysteroscopy and biopsy…..everything ok. Have reduced my Oestrogel, but still bleeding.

Last time I spoke to my GP she said I couldn’t have 200mg of Utrogestan as it’s off licence….even though that’s what the British Menopause Society recommends. I asked the gynae who did my op and she was very dismissive and basically said all they were looking for was cancer. Anything else was nothing to do with them. My GP said I had to wait till after the hysteroscopy….think she just didn’t want to answer my questions.

As far as I know the options are to decrease oestrogen or increase progesterone or change progesterone to a synthetic progesterone or have a Mirena coil. X

[CLKD]

Ask for an appt with a dedicated menopause clinic.

[Nas]

In the same boat here.
Opting for mirena but pretty scared to be honest.
Utrogestan is useless and can’t get provera prescribed.

[Sid]

Hi

I also found that Utrogestan was not effective. I had a Mirena fitted in early March and it seems to be doing the job. It seems that Utrogestan just doesn’t work for all women x

[Teresa]

Hi Dotty, CLD and Nas,

Thanks for all your replies, gosh, there are others also in the same boat after all 

Like Dotty, I quoted the Menopause Society website advising 200mg Utrogestan, but she dismissed that for the same reason. I can’t go lower with my patches as I don’t absorb that great to be honest with any patch, but these are the best I have found. When I was a 50 patch, after four months my estradiol blood test results showed me as still ‘menopausal’ and about 110 nmo/L so I doubt it’s gone up that much on the 75, but I feel better than I did on the combined pills.
Sid & Nas, I can’t have a mirena coil sadly because I have fibroids. A lot of them. I had one before and it was great, but i had to have a hysteroscopy in order to remove it when it was due, due to the fibroids and my tilted womb  it was a right palava, so I assume they won’t put another in.

I do have a menopause NHS clinic appointment CKLD for October and that was arranged last October, when I first alerted the anti HRT GP that I felt I should be taking more progesterone…I suspected back then it wasn’t enough  She reluctantly put me forward to speak to a specialist then, but it’s a year long waiting list. I don’t really want to have to wait another 6 months.  Looks like I’ve got no option. This is very bad for us all isn’t it? It shouldn’t be like this.
 Nas, the mirena coil was really good for me when I had it, you’ll never know it was there. I had it in for 7 years the second time and it was still doing it’s thing. It was just getting it out that was the problem, but that was purely due to me.

Teresa

[Teresa]

Perhaps a combined patch would be better for me…..has anyone considered that? I know Evorel do a combined patch. Does anyone know if this helps a thickened womb and if the progesterone is more effective than utrogestan in it?

Thankyou,

Teresa

[Dotty]

Hi there’s Evorel Conti but it is equivalent to a 50 patch.

Have you tried Provera as the progesterone?

[Teresa]

Hi Dotty,

No I haven’t….I will need to look into it, I think 🤔

Thankyou,

Teresa

[Nas]

Yes the Conti is only a 50 dose.

It’s a right royal pain in the backside, this progesterone dilemma.
BMS states clearly that both  norethisterone and provera are considered suitable progesterone options, yet gps are so reluctant to prescribe. Honesty, it would be easier to get heroin prescribed!

If you do mange to get provera , you are onto a winner I think, as it’s a fairly decent strength progesterone.

I’ve dropped from a 75 patch to 50, due to bleeding, but in truth, it was a bad move. Bladder is already feeling irritated and weeing too much! So that’s why I’m going down the Mirena route as I know I need a decent shot of Oestrogen in my body.

Ask the GP for provera and see where you get to.

Xx

[Teresa]

Hi Nas,

I’m sorry to read about the problems you have been experiencing  yes, it is a dilemma isn’t it? I never realised. I am wondering what to do about it all really as I’m really reluctant to go back to this woman… she is so anti HRT anyway and seems frightened to prescribe me any form of HRT…. She started to raise her voice when I mentioned it was all on the menopause society website, so I think I hit a nerve unfortunately  ..I think I might try another GP there ( all the rest are male) who I know are much more sensitive.

I’m sorry you had to drop to a 50 to put it right as well. You shouldn’t have had to do that. I know I couldn’t do that as I really had symptoms on the 50, mine was loads of dark hair in my top lip and hot flushes again 

Sadly, I wanted to try and stay on a body identical progestorone 
Can you take provera continuously? This is what I don’t understand about progestorone and thickening… how does the lining ever shed if I stay on a continuous?
Xx

[Nas]

I think the Continuous progesterone is meant to keep the lining thin, by breaking it down each day. So in theory, if utrogestan does it’s job, you should never get a bleed.

Obviously if utrogestan isn’t working properly, that’s when you get the bleed because the lining is building and shedding.

Definitely ask to speak to a different GP. That female GP sounds very difficult to deal with! She’s probably anti HRT because she’s ill educated, like so many of them.

I can understand you wanting to stay on body identical progesterone. Unfortunately it doesn’t always  do the job. I think you can take provera continuously. The BMS states the  recommended dose the I think.

I won’t be staying on the 50, I’m grumpy as hell since the drop. Getting the Mirena fitted next week, so I’m going to revert back to the 75 again.

Good luck Teresa, it’s a real battle at times for sure! Xxx

[Teresa]

Thanks Nas,

That explains it.  Yes, you are right and Thankyou so much for your help.
Good luck with the mirena fitting. I’m hopeful that this will be the one for you, if it’s anything like how it helped me for many years. I’d have one fitted again tomorrow if I could. I had zero problems.

Good luck,

Teresa
Xx

[Hurdity]

Hi there - it is so frustrating to read of these stories where women cannot even get the licensed treatments and are having to deal with GPs personal uninformed prejudices.....

There isn't much more I can say - as already said Provera is a standard licensed progestogen - if anyone refuses to prescribe it then go to someone else in the practice or go higher. They cannot refuse if there is no good reason not to!

As I understand - when you take progestogen continuously it actually prevents the lining from building at all - I can't remember the exact biochemical process but to do with receptors ....sorry to sound vague. Would take me a while to revise this. It only works with right amont of prog as it is dose dependent ie more oestrogen = potentially more lining build up therefore needs more prog to prevent it.

Norethisterone as stated is also effective but prescribe separately this would be off licence (which is absurd since it is a component of the combi HRT products!).

Good luck all with your ongoing treatment...

Hurdity x