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[phebe22]

So...intermittant spotting for the last 2 years, been on Estrodot and Utrogeston 100 since March 2020.  Estrodot was 25mg for a year, then 35 and now 50 (due to symptoms) Had countless scans and up until this one womb lining was thin.  Since about Nov I've been on 50 mg...cos the doctor thought it might stop my "shows"..which are VERY light, not even enough to wear a pad tbh.... and to be fair no show since then until now.  Vag scan showed thickening so womb is now 6 mm. Not spoke to doctor yet as 3 days later they haven't phoned.  Worried about thickening and worried about coming off as life before HRT was awful  ....anxiety, low mood etc.  Sex drive hasn't returned tbh but at least I feel better in myself and no hot flushes.
Any advice

[Dotty]

Hi were you post menopause (12 months without a period ) before you started hrt ?

[Hurdity]

Hi phebe22

 

First no need to worry! As Dotty hints with her question, if you are still peri-menopausal (and depending on your age) then thickening and thinning of the lining and bleeding/spotting will be normal.

If you are well post-menopausal then it may well be that the continuous progesterone is not sufficient to control your lining growth so perhaps a return to cyclical might be the best option - as you would then get predictable bleeds?  You definitely do NOT have to come off HRT! Glad you feel better overall

Hurdity x

[phebe22]

Thank you so very much for replying......I feel so upset and worried as I don't know what to do..whether to reduce my estrodot (cut the patch) or not etc..and then the chemist phoned to say my prescription is ready...ecirol conti combined 50...which the doc was going to try to see if better if scan was clear ! 😩 Our doctors are HOPELESS..I joined today and after a 45 min hold , predictably no appointments. Said no pre bookable for weeks either and altho tey are aware of my results I'm well down the queue for a call.

I really don't know what to do...I think I am post meno perhaps? As I'm 57 ..but no idea as I had a mirena for 20 years and never had periods. They took it out, pre HRT, due to spotting..it was near the end of it's life, refused me another cos of age, and my symptoms and anxiety seemed to ramp up massively. I did ask about having one again but doc refused..said women my age never had them..even when I said I'd heard they did, for the progesterone.
The wait for specialist menopause clinic in my area is 450 days 😩 ...so that's no good really

[Hurdity]

Hi phebe22

Yes you are most likely to be post-menopausal at 57, especially as  you haven't had any large bleeds, though there is a small proportion of women who have very late menopause

Your doc is wrong and uninformed. As poppytoast suggests, Mirena is used for HRT. Here is the info from this website: https://www.menopausematters.co.uk/to_progestogens.php

"Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

   * Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
   * When contraception is required along with HRT in the perimenopause.
   * When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )

With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs. "

As I mentioned in another thread I have had to refuse  a Mirena twice over the past 10 years after investigations for a thickened lining and I am late 60s! Most specialist docs would prefer women to have one....both times I have been offered one when I've had a hysterosocopy - but you probably don't need that. If you were happy with a Mirena then you should ask for another one and I go with poppytoast's suggestion - ask to see another GP in the practice and if you feel up to it refer the GP to the link above. Otherwise you could write for a consultation with Heather Currie manager of MM (costs £30) and then print out her response to take (I have done this in the past).

In the meantime you could start the Evorel conti if you want to as the progestogen may help to thin the lining, though really it is not excessively thick! You may get further spotting until things settle.

Absolutely NO NEED to reduce oestrogen  and in the meantime book that GP appointment (and if you want a Mirena prepare your case) try to relax and don't worry!

All the best

Hurdity x

[Rosie Roo]

Hurdity
Would it be rude of me to ask why you have refused the coil ?
Im due to have a hysteroscopy and they have already tried to push the mirena …again . X

[Hurdity]

Hi Rosie Roo - not at all rude! Why would it be? We are here to help and share experiences! My personal principle from the start with HRT (in 2007) was always to use bio-identical products and nil-by-mouth. The only time I have strayed from this is the occasional use of norethisterone for the odd cycle (have maybe done this 3 times in the past 10 years?) apparently to try to "strip" the lining - according to my gynae specialist GP, because I have had some thickening and/or spotting on long cycle HRT. The Mirena is recommended to prevent this and because, in comparison with oral progestogens, delivers far less systemically because most of it is absorbed directly into the uterus where it is needed and gives very good protection.  If you don't want one though, you can just politely refuse! But best to say what you propose to do as an alternative. When I was referred recently, the (NHS) consultant, when I refused the Mirena, recommended that I take progesterone for 14 days per 28 days cycle ie stop the long cycle HRT..... Well I've shortened it a bit - to 5 weeks! Even that is too short for my liking.

Does that help?

Hurdity x

[Rosie Roo]

Thank you Hurdity , I appreciate your explanation . So I am right in thinking you are still having monthly bleeds even though  you are in your late sixties ? And the fluctuations of hormones that accompany a monthly bleed ? I am 58 and was hoping continuous hrt would be better for me . Evidently not enough progesterone to prevent bleeding every day though. I am worried about the mirena as provera seems to be the only progesterone i can handle and even that can be problematic  sometimes. The doctors have told me there should be less symptoms with the coil but it is a worry . Thank you x

[Hurdity]

Hi RosieRoo

Unfortunately yes - but not monthly. From 2011 or 2012 I did two monthly but then reduced to 6 weekly and now 5 weeks, as I said, recently due to thickening of the lining. When you say fluctuations - once you are properly post meno you dont get fluctuations as such and the bleeds are just withdrawal bleeds. Oestrogen remains constant so no fluctuations there. However your body does have to acclimatise to progesterone during that part of the cycle, and progesterone withdrawal when you stop can give rise to pms symptos in many women - which can last a few days. With the Mirena you would not get these though you may not get on with the progestogen. One way to see if you can tolerate it is to have Femseven conti for a while - this has the same synthetic progestogen as the Mirena.... The progesterone issue is problematic for many and gets more difficult as you get older in the sense that if you want to be on HRT for the long term you have to find a solution where you feel better for more of the time than not!

All the best

Hurdity x

[VanillaLover]

Hiya

Yes 100mg utrogestan should be sufficient for 50 oestrogen patch. When you say it’s thickened by 2mm…is that compared to a previous scan ? Was that when you were on a lower patch? Do you know the total thickness now?

Have a word with your doctor but I wouldn’t panic!

[phebe22]

Yes, I knew the thickness before as had spotting problems for a while ..hence had a few scams and camera last year...on and off.  Partly why doctor increased estrodot dose. I think the scan lady said it had gone up from 4 to 6 and said doctor would phone within a week to discuss.  Which they haven't ...no appointments. I just Worry as I have known two people who died of ovarian/womb cancers

[Kathleen]

Hello phebe22 and welcome to the forum.


Your story is a familiar one in that the dose that helps with some emotional symptoms can be too much for us physically.

I agree that there is no need to panic but when you see your doctor you may be offered more investigations to check that all is okay and that the spotting is just a result of your HRT. You can then discuss different regimes that would suit you better.

I am sure other ladies will be along to advise you, there are many different types of HRT so all is not lost.

Take care.

K.

[Rosie Roo]

Thank you Hurdity for the detailed and clear explanation .. much better than any doctor has explained it to me . I have some thinking to do. Much appreciated . Thank you x