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[Barbara Louise]

I’m interested in hearing from others who have struggled with unpredictable bleeding while taking HRT. I’ve been using estrogen gel and micronized progesterone for about 15 months. (I use the progesterone capsules vaginally because I can’t handle taking it orally.) The estrogen eliminated my hot flashes and allowed me to finally sleep, but for the past six months I’ve been having irregular cramps and bleeding. My endometrial lining is fairly thin and a biopsy did not show anything.

My gynecologist recently asked me to double the dose of progesterone and switch to a sequential cycle (only using it for half the month). She wanted to see whether this would be a better balance of hormones and regulate the bleeding to make it predictable. But I seem to be very sensitive to progesterone and I couldn’t handle how I felt when using the increased dose of it (swollen, bloated, and groggy) or how much I bled when I went off it, which was a lot.

Consequently, instead of using double the progesterone I am now back to the continuous use of it and trying to reduce the amount of estrogen I’m using, hoping that will improve the balance between the estrogen and progesterone. So far the result has just been more cramps and bleeding, some hot flashes at night, and discomfort in my vagina. I’m considering giving up on HRT, but terrified of going back to being awake most of the night with hot flashes and anxiety.

Has anyone had a similar issue and managed to find a solution?

[Dotty]

Hi 👋 and welcome.

Where are you in menopause ? Had you gone 12 months without a period before you started hrt ? x

[Barbara Louise]

Sorry, I'm three years postmenopausal. Yes, definitely had gone more than 12 months without a period before starting HRT. (I've only ever used it continuously, so I was a bit surprised when my doctor proposed switching to the sequential program.)

[Dotty]

Hi in that case the advice would be to take 200mg of progesterone daily or switch to Provera or a Mirena coil. x

[sheila99]

Utrogeston doesn't seem to be the best at controlling bleeding and if you can't tolerate 200mg it may be time to try another type. A mirena is usually the best at preventing bleeding. There's also cyclogest or norethisterone.

[Bungo]

Can I ask why the unpredictable bleeding is am issue? Is it the inconvenience, being caught out or is it because it could mean frequent ultrasounds to ensure its not masking anything sinister?  How often should one have an ultrasound in that case? Would once a year be enough ?

[Barbara Louise]

That's something I've wondered about as well. I just assumed the bleeding was an indication that the progesterone wasn't working and therefore the uterus was more vulnerable to endometrial cancer. But I never actually asked my doctor.

[Kathleen]

Hello Barbara Louise and welcome to the forum.

I have experienced bleeding when I have tried a higher dose of Oestrogen and I recall being told that having so many cells proliferate in the uterus is not a good idea plus  there is the possibility of developing anaemia from the blood loss.

I hope this helps in some way.

Take care.

K.

[Barbara Louise]

Thank you, Kathleen, that is helpful. I am trying to reduce my Oestrogen dose despite the physical discomfort. With luck my body will adjust to the lower dose and the bleeding will stop.

[applejack]

Hi Barbara

I started bleeding April 2021 and was on 100mg utrogestan at the time. I reduced my oestrogen but that brought all my meno symptoms back which was awful and the bleeding didn't stop anyway. We tried 200mg utrogestan, and then vaginal utrogestan - nothing worked.

So turned out I had a polyp, which was removed, coil put in. Three months later, bleeding started again, another polyp. I don't absorb oestrogen very well so was on a patch of about 150 at one point and even a mirena couldn't deal with it.

My options were a) keep having polyps/bleeding but control meno symptoms with high oestrogen dose or b) no bleeding, but oestrogen reduced so much meno symptoms make life unbearable. Both options were crap, frankly.

I've had an implant inserted since the last polyp removal, which was back in June.  All I've had since then is the odd teensy weensy smear of blood when I wipe, not even bright red, then nothing for weeks. I probably wouldn't even notice it if I didn't check so carefully as a result of what I've put up with for the past 18 months.

I think I was just very unlucky. It's possible that a mirena might fix your problems. As Sheila says it's the best for controlling bleeding. I would try and get a scan anyway - if there's a polyp in there it'll just keep bleeding and it's just miserable. I had a pipelle biopsy right at the start but that won't pick up a polyp, although obviously a negative result is reassuring. It wasn't until I had a hysteroscopy that she got the full picture.

[Barbara Louise]

Thanks for sharing your experience. I'm sorry you've had such a difficult time. It does remind me of what I've been experiencing in the last little while. I am scheduled for a sonohysterogram (maybe the same as a hysteroscopy?) later this week to look for polyps. Then I see the gynecologist in a month, so we'll take it from there. I'm nervous about getting a Mirena coil; I had a bad experience in my 40s with another IUD. But trying to reduce my estrogen dose is proving to be miserable as well. As you say, both options suck.

[applejack]

Gosh I had to google sonohysterogram!  I hope that goes well for you and enables you to get the right treatment.

Yeah, both options suck. I was really nervous about getting a coil and to be honest I'd still rather not have one but touch wood it seems to be working at the moment.

Menopause really is the pits. Keeping my fingers crossed for you.