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[shrosphirelass]

Today I was soaked through - uck. Not had to change sheets for many years and hardly ever. Surely its not a coincidence that I had a thorough vaginal exam yesterday, manual and followed up with speculum. it makes me think it must be due to atrophy rather than HRT though the dr didnt suggest this.

I can't go on like this. Has any one any suggestions about HRT that will control bleeding? Currently on evorel conti ( and was bleed free for 12+ plus) I don't get side effects but it doesn't really control all my symptoms but much better than without it. Years ago the menopause clinic said if I had bleeding I could use half the patch but given that the HRT doesn't control all my symptoms I don't really think that's an option. It was also suggested switchng to provera for the progesterone part as its good for bleeding but Id rather have transdermal and was told there's more side effects.

I just don't know what to do.

[Teresa]

Hi Shropshirelass,

It does seem to be connected to what happened yesterday. Did they take a biopsy or cut anywhere? A smear? If so, that could cause bleeding, but if it was just looking around it seems strange you had that much blood. Is it the first time you’ve post menopausal. bleeding? (from your post it seems it’s not?) if it’s not, all post menopausal bleeding (if unexpected) should really be checked at hospital? Atrophy wouldn’t ‘soak’ sheets though, I wouldn’t expect there to be that much blood with atrophy. I have also read a lot of threads where people have bled with Evorel conti.

I had bleeding, for the second time,  after being on HRT for 18 months, so it can happen at any time. Both were checked out.

Have you tried Utrogestan? With an estrogen patch?  Provera is synthetic, but Utrogestan is body identical. There is always a Mirena coil too.

[shrosphirelass]

Thanks for your reply Teresa. The problem with utrogesten is that I couln't do it vaginally every day because of the atrophy. Also I think there's shortages. I did contemplate a mirena but am too anxious to have it fitted and have heard mixed reviews.

What I don't understand is if its due to HRT surely the endometrial lining wouln't be as thin as 2 mm.

They didn't do a biopsy just manual examination but was long and felt deep and very uncomfortable. Also speculum. I am still bleeding, and have have had several short episodes of a gush and small clots - still ongoing. Getting a bit worried and concerned if it goes on much longer that Ill get anaemic again.

[Teresa]

Hi Shropshirelass,

I had bleeding with no lining whatsoever, my bleeding was due to low oestregen. The Gynaecologist who did my hysteroscopy was wrong, telling me to increase my utrogestan to double what I was on, as increasing that made the bleeding worse for me. They immediately assume it is always too little progesterone/too much oestregen  which causes bleeding but this is not always the case.

I had an estradiol blood test which showed my oestrogen levels were very very low ( dire) so I have trouble absorbing.  Have you had yours checked?

Are you taking anything for the atrophy? It does sound like your oestregen could also be low? Though obviously I don’t know, but it’s a possibility, especially with the atrophy. I have been prescribed vagifem in the short term until my levels rise ( I’m now on Lenzetto and so far, it’ seems to be improving), there are creams you could use for atrophy. However, as I say, the amount of blood you are losing does not sound purely due to atrophy.

I am on my third mirena now as I was fed up too….try not to take too much notice of the horror stories. A successful mirena is also largely due to the skill of the person putting it in for you.

Utrogestan is back in stock.

My GP arranged my estradiol test. If you are post menopausal, levels do not fluctuate, and are more stable than in perimenopause.

[Teresa]

…also what you are experiencing, sounds like shedding lining….I had gushing and clots too. Mine also caused me anaemia….my red blood cell count went low as my GP asked for a full blood count along with my estradiol. I’d been bleeding for over two weeks, every month since Feb this year, so I do understand how you must feel.

[Teresa]

Also ….how do they know your lining is 2mm from an internal with a speculum?

[shrosphirelass]

Teresa, thanks for your replies. I had a scan following bleeding and that showed a lining of 2mm, the internal exam was part of a follow up on the 2 week pathway. The dr said she thought my HRT needed tweaking as she couldn't see anything else wrong.

It is really strange as I have had constant slight bleeding saince the exam (though was bleeding slightly before too) but every morning for or in the night for the last 7 days since the exam I wake up feeling wet and have soaked through a pad with bright red blood and have what I describe as a gush with small clots. It then settles t a spotting / small amount

I do have problems with atrophy and have been using vagifem for a few years. I recently had a flare up so have doubled that up and also use estriol cream externally a few times a week. THis has helped my symptoms but still not great.

I don't know about my levels. The drs don't seem very clued up with HRT. I still get flushing, nausea and dizzy spells which I associate with the menopause.

I am starting to do worst case scenarios. I haven't had a smear for 4 years (age 61 so only have them 5 years) and looking up bleeding after internal exams it talks about cervical cancer so that is worrying me. Though the dr said from her exam the cervix looked healthy.

[Teresa]

Hi Shropshirelass,
Thanks for explaining how they know you have a lining of 2mm, I now understand.
As you were bleeding before the exam, it is probably a continuation of that bleeding that you are getting. I’d get a day with hardly any, then but would start again the following day. It is only my opinion but the fact that your HRT hasn’t stopped your symptoms suggests to me that it’s not working as it should and I would suspect from what you’ve written, is that your oestrogen is low. The trouble with Evorel conti is that you can’t get higher than 50 and it sounds like you need to increase either the oestrogen and then balance the progesterone with that. If you were getting enough oestrogen you wouldn’t get flushes - or atrophy.
I wouldn’t worry about your smear yet as it is not due for another year. I am 57 and also on the 5 year call up.

I would seriously consider getting your estradiol tested. Don’t let them tell you ‘it’s not worth it’ - as post meno, the levels don’t fluctuate, so you can. If they say ‘you should go by how you feel’ - tell them you feel awful 
Ask for an estradiol blood test.

I ended up going to a private menopause specialist the other week,  as my GP basically said they didn’t have a clue what to do with me, but your surgery can arrange an estradiol blood test for you.
Do let us how you get on? Honestly, you need to know.