Print

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

[laszla]

Ladies in about Jan-Feb I transitioned from sequi to conti. Prior to that I had a withdrawal bleed after my 10 days utogestan days but otherwise no bleeding.

Since then I've slightly decreased my estrogel dose from 4-5 pumps estrogel to 3-4 daily and a utrogestan every day vaginally, testogel most days

Initially on conti I had some spotting but it's worked up to daily bleeding, quite dark blood and periody cramps.

I'm knackered all the time as it's now as if I had a constant period, also sore breasts which I never had on sequi even though I took more estrogel then.

And weirdly, after years of non oestrogen absorption, my serum  estradiol levels are finally up which seems odd given that I've diminished my e2 dose and my estrogen intake relative to my progesterone is lower still.

Testosterone absorption still poor as I have a very high SHBG giving a pitiful FAI (0.5)

Any ideas what's going on, I know some irregular bleeding is common in first year of conti but I am getting a bit worried, not to mention exhausted and ill feeling, by the constant 'period', not helped by being quite underweight and unable to gain.

Had a hysteroscopy in Jan due to thickened endometrium bit it only turned up a small polyp
Thanks

[Dotty]

Hi it could be that you’re not ready for a Conti regime.

You mention using 4-5 pumps and cutting down to 3-4. If you don’t stick to a constant dose then that can cause bleeding.

[DottyD68]

I have tried and failed twice to move from sequi to conti in the last 8 months. Returning symptoms, swelling and the most painful enlarged boobs made me stop. I was still having my own periods albeit short and dry and don't think my body is ready for it yet.

I did wonder if it was the balance of the reduced (daily) dosage of utrogestan versus the oestrogen that was causing the symptoms and next time I try I may ask if i should increase the utrogestan.
I'm back on sequi now and managing most symptoms again.

Hope you get sorted soon x

[laszla]

Thanks Dottie's
Dotty I did the reduction from 4-5 to 3-4 very gradually, over about 3 months which I thought was the way to go but maybe I'm not ready albeit 56 and assume natural periods would have stopped

DottyD in your case reduced utro might explain it, in my case my total utro was higher in proportion than estro but ms said I could increase to 200mg daily, scary idea for those who don't like prog, I'd also want the proper 200mg pessaries, utro or cyclogest, as 2 utro tablets too messy and fiddly.

[laszla]

Thanks for your feedback Poppytoast, I might look into tibolone which I don't know much about, good to hear it's helped you. When I moved to conti I wasn't having real periods, afaik, but withdrawal bleeds after I finished the 10 dys utro.
A couple of things made me move to conti, mainly the fact that my endometrial lining got to 10-11 mm, resulting in a hysteroscopy that revealed a small polyp (polyp no big deal but lining on the thick side) so there was some encouragement from the meno clinic to move to conti or mirena (the latter I refused).

I was also finding a shift in the pattern - previously I would feel good on the oestrogen only weeks and bad on the 10 days of utro but increasingly I would feel bad after I finished the utrogestan, whether this was from utrogestan withdrawal (and my consultant says it is perfectly possible to develop a tolerance to it even after severe intolerance) or feeling bad because I was bleeding I don't know.

I also wonder whether some residue of a mood cycle remains even after we are officially declared postmenopausal. Overall I think even the top specialists understand very little, as evidenced also in this forum.
I don't know what to do, whether to increase my daily utro to 200 or ditch this regime altogether, also my CHelsea meno consultant has left and now there's only a nurse who does phone appointments. Quality of llife is very bad now and it's hard to work.

[laszla]

Interesting what you say about weight gain Poppy, many thanks for the update.
Since I posted I increased utrogestan to 200 mg pessary daily.
I still have erratic bleeding - I thought it had stopped but then it reappeared yesterday with cramps and horrible PMS feeling - when I checked the date I see that it coincided with when I would have got the bleed in my sequential regime.

I think I definitely have a natural cycle that remains whatever I do with HRT despite believing that once I went onto conti and given that I'm 56, I would have no natural cycle anymore but I am sure this is not the case.

I will ask about tibolone but the back-up now at Chelsea & Westminster is worse than ever since Panay left - I need a lot of oestrogen and I have read - probably on here - that some women combine tibolone with transdermal estrogen in case the E2 is insufficient...

[laszla]

Poppy another interesting thing about tibolone from my p.o.v is that it allegedly lowers SHBG - mine is very high which impedes my absorption of testosterone and oestrogen to some extent

[sheila99]

A conti regime won't stop your natural cycle if you still have one. Being 56 is no guarantee of meno either. I was still pretty regular when I started hrt aged 57, some are in their early 60s before they're meno. If it was me I'd use a sequi regime, your problems might be just because you're not ready for conti yet. Or you could try a mirena which will normally stop the bleeding even if you're peri. Tibolone is designed for those who are meno so may not be suitable if you're not.

[laszla]

Poppy it's outrageous to refuse to treat your high blood pressure - what is wrong with these people?!
I would recommend getting your SHBG measured as it's an indicator of how much of the hormones you are probably absorbing. Low weight is one of the causes of high SHBG, oral oestrogen also increases it but not transdermal.
But note that while they use SHBG, whether in private or NHS tests, to measure your 'free' testosterone (ie the amount that is not bound to the SHBG and that therefore is actually bioavailable to help you feel better), SHBG is not officially used to measure 'free' oestrogen.

This is strange as it is recognised even by the NHS that SHBG "binds tightly to the steroids testosterone, oestradiol and DHT and transports them in the blood in an inactive form" https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/sex-hormone-binding-globulin-shbg/

So even if they don't measure your 'free' oestradiol, it seems self-evident that having a high SHBG is going to impede your E2 absorption.
Also came across study that says that there are likley two separate SHBG types, one regulating T absorption, the other E2 absorption, which further complicates things https://eje.bioscientifica.com/view/journals/eje/176/4/393.xml

Part of the caginess and wooliness of the information they give women is, I'm convinced, due to the fact that they know relatively little themselves.

[laszla]

A conti regime won't stop your natural cycle if you still have one. Being 56 is no guarantee of meno either. I was still pretty regular when I started hrt aged 57, some are in their early 60s before they're meno. If it was me I'd use a sequi regime, your problems might be just because you're not ready for conti yet. Or you could try a mirena which will normally stop the bleeding even if you're peri. Tibolone is designed for those who are meno so may not be suitable if you're not.

Sheila I'm now convinced this is the case but was brainwashed by the meno clinic and GP into being told I was post-meno, on no real basis it now seems to me. I might consider going back to sequi, the only advantage I have noticed on conti however is that my mood is more stable (not exactly good but stable) than on sequi where it would plummet, initially on the progesterone 10 days and subsequently after the withdrawal bleed. And that already is a bit of a gain for me. But I will definitely have to consider re-thinking the whole regime.

[laszla]

update: bleeding is getting heavier and clottier (sorry) by the day and worse still the cramps are awful, I can't do anything. Please can someone suggest what is actually going on here?

Could it be that the increased dose of utro (200 mg daily) is stimulating the endometrium to shed more, bearing in mind that I've had a thickened lining for a few years?

On the other hand they suggested I double to 200 as a solution to the bleeding I'd had before?

I know oestrogel can stimulate bleeding but I have actually decreased dose quite a lot, from 4 to 3 or even 2.5 daily pumps which scares me as Ive gone from oestropenia to osteoporosis at last dexa.

So I really don't understand whst is happening and what I can do - no meno clinic appointment til July and anyway the service there has plummeted, and no gp to speak of.

I am not worried about anything sinister, but the current blood loss and cramps and weakness are hell and I can't go on like this.

[sheila99]

It sounds to me like a last gasp from your ovaries before they die as your oestrogen levels went up whilst your dose decreased - so hopefully the roller-coaster is coming to an end. I know it's hard to live with but with a thickened lining this bleeding may be a good thing. If it was me I'd take a few days break from utro to allow the period but medical advice would probably be to continue with it.

[laszla]

Thanks Sheila, I have decreased the utro over the last couple of nights, back to 100 mg, wondering if that woukd help but the bleeding and cramps seem about the same.

I know what you mean about desirability of shedding some lining given that it's been thick for ages, but this degree of pain and weakness aren't sustainable, I don't have the energy, also bearing in mind also that my bmi is very low.