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[Felix]

Hi everyone,

It would be great if I could get some advice please?
As I mentioned in one of my previous posts I'm 59 and on:

2 pumps Oestrogel
1 x 100mg Utrogestan vaginally alternate nights
1 x Imvaggis pessary alternative nights

I'm bleeding or spotting about quite a lot and it seems to be increasing and I'm getting a lot of breast tenderness.

From the excellent advice I've had off you guys it seems like the bleeding/spotting is probably due to me only taking Utrogestan 100mg alternative nights. I'm doing alternative night because I've really struggled in the past with utrogestan. I was also hoping that as I started this regime on Feb 6th the bleeding might just be about me getting used to HRT again and that it would settle down the longer I took it. However I'm almost 5 months in now and the bleeding is still happening and getting worse.
In Feb I had 3 days bleeding or spotting,  in March 6 days, in April 4 days, in May 14 days and so far this month 11 days.

I did decide, back at the end of May to try upping my vaginal Utrogestan to 2 nights on and one night off but the first time I tried 2 continuous nights of Utrogestan I felt completely floored and exhausted. So I went back to utrogestan every 2nd night. I know I only gave it one day of upping the utrogestan so maybe I need to give it longer and hope that I get used to it - it's really hard to work when you feel exhausted.

If I up my utrogestan to 2 nights on and 1 night off, is it likely that the tired/floored feeling I get from utrogestan will die down as my body gets used to it?

So at the beginning of June I decided I'd try one last thing before upping the Utrogestan to 2 nights on and one off. I thought I'd try cutting back on the Imvaggis to see if that was feeding my small grape sized fibroids and if that was what was causing the bleed. I cut back on the Imvaggis and stopped it on 10th June however it doesn't seem to have had any impact on the bleeding.
However I have felt a bit PMT ish, bad tempered and irritable and I'm wondering if cutting back on  the estriol I was getting from them  (between 00.9 or 0.12 per week as I took them alternative nights) would cause this?

Could such a small change in estriol make a difference to mood?

I've also found that being next to a running tap makes me want to pee so I'm concluding that not being on the Imvaggis is having a negative impact . So I'm going to start Imvaggis again.

My auras/silent migraines have stopped  which is great and I'm presuming that's because my body has settled to me taking the 2 pumps of Oestrogel in the morning.

However, I have been having a lot of breast tenderness, in May I had 4 days of it  but I've had it most days in June, it's worse in the left breast and can sometime feel quite sharp, it's very annoying. I had a routine mammogram a couple of moths ago but I wasn't getting the pain then and the mammogram result came back clear.

Does anybody know please what part of the HRT is causing the breast pain?

Thank you and sorry this is so much information. HRT has brought me back out of the shadows again but with so many side effect - it's so difficult to get the tweaking of it right.

Have a lovely day,
Felix

[Jan1234]

Im on 100mg ultrogeston and 2 pumps of gel siightly different to you i take my ultrogeston every night vaginally and im also 5 months in on this hrt im 58 and have had constant spotting and heavy bleeding was given tranexamic acid last week to stop bleed which as worked but dont think it will for long, im hoping mine will settle but dont think it will im thinking this is just not working for me gp wont send me to gynecology as was seen 5 months ago for removal of polyps and my biopsy results was ok so last try on this jrt for me

[sheila99]

Have you had a scan recently? The bleeding could be from a thickened lining or from the fibroids (or both). I get fatigue on utro so I use long cycle sequi (6 weeks) so I have more 'good' time.
The options really are less oestrogen, more utro or a different type of progestin. Would they consider removing the fibroids if they are the problem?

[joziel]

Breast tenderness is very very common and it is usually caused by estrogen and tends to settle given time on HRT, but many women find Evening Primrose oil or Starfruit capsules to really help with it in the meantime. You should know that pain is not correlated with cancer - most BC doesn't cause pain and breast pain 99.9% of the time isn't caused by cancer.

Have you at least tried to take the utrogestan orally last thing at night - every night? Just because it doesn't always have a worse effect orally then vaginally and I know some women who've been surprised that they've been able to tolerate it orally when they couldn't vaginally - which seems the reverse to most people, but it's worth a try...

And when you say you haven't been able to tolerate it, what is the longest time you've kept on taking the utrogestan orally or every night vaginally? Again, most things settle with time - but it can be some weeks. Sometimes women freak out after 2-3 days and change things, and it's just not long enough for things to settle. It can be miserable in the meantime persevering but at least you can tick it off the list as something you've tried fully then.

I wouldn't suggest fluctuating the amount by 2 nights on, one night off - those kind of fluctuations are likely to encourage bleeding rather than suppress it.

Imvaggis is definitely not causing the bleeding and you should keep taking it if you find it is helping your bladder for sure. It is a tiny amount locally applied and it's not doing anything else...

If you have started HRT in the last 6 months or changed the regime in the last 6 months (and you weren't having worrying bleeding before that) then the bleeding is related to the HRT and you probably don't need a scan just yet unless you want to check if your lining is too thick (which it probably is, if you are bleeding this much!). You need more progesterone really, as not all women can do the alternate night vaginally routine. You could try every night vaginally or you could try every night orally - and give it a good run of at least 3 weeks to see if it settles. Hopefully that will at least fix the bleeding, even if you get progesterone side effects...

If that doesn't work or the side effects continue, you might need to try a different progesterone. You could try a Mirena coil - that would stop the bleeding and give you local progesterone direct to the uterus, which in most women doesn't have systemic effects. It would last 5 years and then you would only need estrogen separately. That is probably your best option to try. Or there are some patches which give you other progesterones along with the estrogen - Evorel Conti or FemSeven Conti. They have the same amount of estrogen you are getting at the moment (2 pumps = 50mcg) so that should work for you.