Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[RebJT]

Hi Ladies

Not posted for a while (you can find my varying degrees of demented previous posts here!)

After a hellish time of it, I FINALLY settled on sequential HRT, and went from dreading utrogestan bit to counting the minutes til I could take it, as I felt so much better at last in second half of cycle (symptoms used to be other way around, feeling cruddy once on utro, but lately it's the utro free days that are just the hardest).  I've been on some form of sequential since I was 46 /47 post polypectomy and D&C and I've now just turned 50.  I was suffering very heavy bleeds and terrible problems with histamine and anaemia, it truly was hellish.  I'm under Dr Tina Peers, she's lovely.

So I fixed the iron, decided against a coil (was thinking Jaydess, but decided against), had histamine under control, was tolerating alternating 200mg utro orally one day, and 100mg vaginally the next for 14 days, and was on four pumps of oestrogel and feeling like my old self.  Medicinal herbs (not for everyone, but worked for me) added on top around my bleed alongside all the rest, and I had a scant bleed, was virtually symptom free.  Lost weight, exercising, back to working at full capacity, all good.  Felt utterly and totally FINE.

Then in May I got Covid ....

Dr Peers says Covid (and some say the V also) affects the ovaries.  This would seem to be my experience, I had hellish uterine and ovary pain, dreadful period during infection, and I've never been the same since.

Regardless of how shitty things have been, I've always been 28 days on the nose (unless I've been experimenting with some new HRT, and my cycle always resets afterwards).
 For the last four months I've had a 23 day cycle and the heavy bleeding is back (I just can't have this, iron is a massive life wrecking issue for me).  I've had several private scans and they literally cannot find anything at all, totally normal (I use those baby scan places, really nice people, and not expensive, about £70)

My question is how do you know if you are ready for continuous?  Having gone from hating utrogestan, I'm now literally counting the days until I can take it and finding it stops dead the jittery feelings, the histamine symptoms that are now peaking at day 5 - 7 ish and the horrible scraping, tight, painful uterine pain, I sleep like a log, I no longer bloat or gain weight through utro days, I just feel so much better on it than not on it, I'm wondering if I'd be better trying continuous and stopping the bleeding all together?  I'm wondering whether my dominant issue is now a lack of P??
 
According to Louise Newsom any woman who has been on sequential for at least a year, regardless of age, can switch to continuous https://www.nhmenopausesociety.org/resources/ten-tips-for-prescribing-hrt-remotely/

I've also read elsewhere on her site that you'd tell quite quickly if the endometrium wasn't stable enough for continuous (due to the whacky FSH stimulating the lining erratically) and switch back to sequential, but having searched MM, I see that some women have worse heavy bleeding on continuous, which is what I'm trying to avoid.

I also read here that there's a kind of adapted continuous regime where you could come off utro for a short time every so often, and have a withdrawal bleed to ensure the lining has fully come away?

So frustrating, as I worked so bloody hard to get myself sorted out, and was finally, finally feeling teh benefits of a steady HRT regime and now it's all gone to pot post Covid.  I'm on my sixth cycle post infection, and still having the same issues, and wondering whether to tough it out another one to see if I get back in synch on a 28 day cycle, or whether to just chuck in the towel and try continuous.

Also, Dr Peers told me that if a bleed comes early on sequential, to stick to the calendar not the bleed, but I've had to readjust my day 1, as no matter what I do, the bleed turns up on day 23 or 24 if I count from first day of bleeding.  These short cycles don't seem to be a blip, I don't think, unless it's covid still and might settle?

Thoughts?

Thanks

[RebJT]

PS Newsom who I mention above is referencing Panay's "The British Menopause Society & Women’s Health Concern 2016 recommendations on hormone replacement therapy in menopausal women"

In the section "Routes and Regimens" quite a way into this document https://journals.sagepub.com/doi/full/10.1177/2053369116680501 

He says:
A recent systematic review by Stute et al. (2016) assessed the impact of micronised progesterone on the endometrium. Forty studies were included in the systematic review and it concluded that oral micronised progesterone provides endometrial protection if applied sequentially for 12–14 days/month in a dose of 200 mg/day for up to five years. In addition, vaginal micronised progesterone may provide endometrial protection if applied sequentially for 10 days/month in a dose of 45 mg/day at 4% or every other day in a dose of 100 mg/day for up to 3–5 years.

....

After a minimum of one year of HRT, or one year after the last menstrual period (two years in women with POI) women who wish to avoid a monthly withdrawal bleed may attempt a switch to a continuous combined regimen which aims to give bleed-free HRT – this will also minimise the risk of endometrial hyperplasia. There may be some erratic bleeding to begin with, but on persistence with continuous combined regimens 90% of women become bleed free.
Alternatively, women can be switched to the tissue selective agent tibolone.
Progestogenic side effects may be reduced by using micronised progesterone in the form of oral capsules, transvaginal pessaries or gels. In addition, data from large observational studies have suggested that the risk of VTE and breast cancer with micronised progesterone may be lower compared to that with synthetic progestogens.
If breakthrough bleeding occurs following the switch to continuous combined HRT and does not settle after three to six months, then the woman can be switched back to a sequential regimen for at least another year.
If bleeding is heavy or erratic on a sequential regimen, the dose of progestogen can be doubled or duration increased to 21 days.

So that's good to know!

[laszla]

Reb I can't give you any definitive answers but am very interested to hear that you experienced an inversion of the common pattern of feeling good on first half and lousy on second half of the cycle.

This was also the case with me: the dreaded progesterone 10 days are now tolerable, the withdrawal bleed week quite ropey and the first two previously good weeks are now quite unpredictable.

It's true that I have difficulty in absorbing estrogen which has gone down again despite a high dose and I need high serum levels of it so that could account for not feeling so great in the first two weeks but I am tempted to go continuous as well because I'm starting to think fluctuations in progesterone can  be a trigger for feeling bad rather than the progesterone itself (check out the article Progesterone: friend or foe which is a real deep dive into progesterone with absolutely no clear answers because essentially little is still known about we react to hormones and what is responsible for what).

I am going to discuss this further with my consultant next week but at a brief meeting last week he told me that it is perfectly possible to develop a tolerance to progesterone even if previously sensitive to it.

So if you are feeling better in the progesterone half of the cycle it sounds like going onto conti might well be good for you.

[Clarella]

Place marking till I have time to reply - I may not have answers but can share experiences

[sheila99]

You can try conti but as your own cycle overrides the hrt cycle I think it may be too soon. It can be useful to take utro for 25 days out of 28 which allows for a bleed if there's been a build up. It isn't unusual for cycle length to change as you head towards meno so it's nothing to worry about and may not be covid related. I had a longer than normal cycle and the advice to stick to the hrt cycle didn't work for me, I just got further and further out of step as my own cycle was always stronger than the hrt one. I slightly suspect those that give that advice haven't actually lived through it! As you're bleeding anyway I'm not sure what they think utro is going to do (it's the withdrawal of prog that brings on the bleed). I'm probably post meno now but I could tell when I ovulated so I started utro a couple of days after that.

[RebJT]

You can try conti but as your own cycle overrides the hrt cycle I think it may be too soon. It can be useful to take utro for 25 days out of 28 which allows for a bleed if there's been a build up. It isn't unusual for cycle length to change as you head towards meno so it's nothing to worry about and may not be covid related. I had a longer than normal cycle and the advice to stick to the hrt cycle didn't work for me, I just got further and further out of step as my own cycle was always stronger than the hrt one. I slightly suspect those that give that advice haven't actually lived through it! As you're bleeding anyway I'm not sure what they think utro is going to do (it's the withdrawal of prog that brings on the bleed). I'm probably post meno now but I could tell when I ovulated so I started utro a couple of days after that.

Sheila, thanks for this, I have a feeling we spoke about this before and I have a feeling you might be right.  I've been starting taking my utro earlier in my cycle (day 10) some months anyway as I can't bear the jitters that now dominate the first half of my cycle, and had been wondering if that what was causing the bleed, but like you say it's the withdrawal of the prog that's meant to trigger the bleed, and mine period is overriding the HRT timetable.  It's so confusing!!  I've even read the entire Utrogestan leaflet and that doesn't tell you what to do if your bleed comes early.  It's a fairly basic question isn't it!

So do you think I'd just benefit from taking a longer cycle of progesterone, and a higher dose like Nick Panay says in the guidelines?  Maybe that's the next step as I get further into peri?  I don't mind particularly having a short cycle, but what I can't have is the massive iron/blood loss. 

Thanks

[RebJT]

Reb I can't give you any definitive answers but am very interested to hear that you experienced an inversion of the common pattern of feeling good on first half and lousy on second half of the cycle.

This was also the case with me: the dreaded progesterone 10 days are now tolerable, the withdrawal bleed week quite ropey and the first two previously good weeks are now quite unpredictable. ...

I am going to discuss this further with my consultant next week but at a brief meeting last week he told me that it is perfectly possible to develop a tolerance to progesterone even if previously sensitive to it.

So if you are feeling better in the progesterone half of the cycle it sounds like going onto conti might well be good for you.

Hi Laszla

Thanks for this.  Yes I've had a total reversal.  I used to feel so ill, buzzy, miserable, and deranged on utrogestan, could tolerate about five doses vaginally, and now I can take 200mg by mouth no issues at all, in fact it's a sweet relief to take it, as I'm now buzzy and high histamine in the first half of my cycle (I usually had my worst symptoms day 14 and just before bleed, but now it's early in the first half, as oestrogen rises I think). 

I'm also getting uterine symptoms (I can FEEL something is going on in there from about day 5!) of twinges, feeling a bit tender in my abdomen, some ovary pain sometimes etc.  I suppose I'm having anovulatory cycles or something.  But what is so upsetting post covid is the really heavy bleeding as that really and truly was gone, and that was what was causing all the misery (including urgent iron infusion, I was so anaemic).  I really can't afford to lose any more iron, but the only bloomin' answer they give you is ablation (absolutely NOT), coil or hysterectomy.  Now is not the moment to rant about the appalling lack of research going into women's wellbeing, but you know what I mean!

So I guess other than conti, perhaps I could try what Panay talks about in the guidelines, increasing the utro dose for those 12 - 14 days a month, or taking it for 21 days a month, but like Sheila says my own cycle seems to be over riding the HRT.  Perhaps a higher dose of prog would help???

I just wish there was someone to ask!  My gyane is brilliant, but even she says, 'well, you could try and see' as like you say, they don't really know enough about what is going on for women.

If you get time would you mind reporting back what your specialist says?  I'd be interested to know.

Thanks

[RebJT]

Place marking till I have time to reply - I may not have answers but can share experiences

Hi Clarella

Yes I'd love to hear your experiences, that'd be great.  I think I've figured more stuff out (with my iron issues, thyroid issues, histamine stuff and meno) by sharing with other women and getting our heads together than I have from any doctor.

Will wait to hear back from you.
x

[RebJT]

Hi All

Well after reading the national meno guidelines (penned by Nick Pannay) I dropped down to three pumps, and tried the 21 days of utrogestan (adapted sequential regime for heavy bleeding) and my period reset to 28 days and wasn't too awful.  The jitters were better too.

This cycle I've done the same again but after three days of horrible fatigue, pain and a bit of spotting I'm bleeding (day 17).

Any idea what I do now?  I know breakthrough bleeding is common but iron loss is my worry.

Do I just carry on and stick to the calendar and do my 21 days, or do I reset and count today as a new day 1?

The frustration of this time of life is nothing stays the bloody same.  I just wish it was a bit more predictable!

Thanks

[Nicola Winter]

I'm in a similar situation, uterogestan days were once unbearable but now its the opposite. Plus I've just started testosterone and everything seems out of kilter again. What are your histamine issues, how do they present, and do they seem linked with low progesterone or low oestrogen? I have terrible sinus issues and pain in my temple which I used to suffer with before HRT. I had covid at Xmas and now my sinus issue and head pain is back. I think the pain is actually a migraine. At times it's so bad I want to drill a hole in my head!

[RebJT]

Hi

Bless you.  My histamine issues are quite extensive (have posted elsewhere on here) but if you google Dr Tina Peers (she's my gynae) she has some stuff on her website about it and the connection with covid.  Progesterone is histamine calming, oestrogen is histamine aggravating.  Dr Louise Newsom also has some factsheets on covid and histamine int the resources section of her website.

One other thing to mention is might be worth getting your Gp to rule out Temporal Arteritis, my mum's just been diagnosed with that, after same symptoms as you.

Reb
x

[Nicola Winter]

Thank you. I will deffo read up on the histamine. I did see about temporal arteritis when googling before, but because it went away when I started HRT, I didn't need to pursue it. If it persists I definitely will make an appointment 😱

[Clarella]

Place marking till I have time to reply - I may not have answers but can share experiences

Sorry I never came back to this, will try to this week!

[kittywells]

After being on cyclical HRT for 6 years (I'm 49 but had very extreme early onset peri) I switched to continuous a few months ago after developing long covid following infection last March. After covid the estrogen-only days were unbearable, I couldn't sleep and was miserable. Consulted with Dr Sarah Glynne at Claire Mellon associates who is particularly good on menopause/covid links & treatment of lc in menopause. Weirdly, as soon as I went continuous I started having normal bleeds again on roughly my old cycle. So - for me, continuous seems to have been the right choice, though I'm just a few months in.

[RebJT]

Hiya Kittywells

Thanks so much for this.  And thanks for sharing your doctor's details I'll look her up.  It's utterly crap isn't it!  But really really pleased to hear you are doing better.  How long did it take before the relief kicked in?

Do you mind me asking what dose and type of HRT you are on, gel and utro or another kind?  I'm hanging on for an apt with a new specialist (as after reading I realise I'm not as clued up on HRT generally as I thought as I was, and need a steer), but currently attempting 100mg utro a day continuous / 3 pumps until I see her (I used to tolerate 200mg sequential) and wondering if I need a bit more progesterone. 

I started bleeding on day 17 and it's is still sputtering along but I'm now 7 days after it started and have just the worst jittery high hitamine vibratey, tired, can't sleep symptoms last few days (which is what I usually get, day 5 to about day 10 post bleed is just a living nightmare as E starts to rise, and these early cycle crippling symptoms are new since Covid).  Im wondering if I need more progesterone, but don't really know what I'm doing.

And I'm assuming you take your prog every day (not the three days off continuous regime) - I think it's the ups and downs, and days of too much unopposed E that are driving me demented.

I'd be grateful for any info you are willing to share, but thanks, you've given me hope.

Reb
x