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[jorainbow]

Update received letter from clinic. Consultant still saying I have disordered proliferative endometrium despite my third biopsy saying appearing normal. Either the biopsy results letter is wrong or he is but I'm at a loss. I haven't started the hrt and right now a bit of aching is preferable to this. His letter said my mood was improved in one sentence then he'd suggested oestrogen based foods to improve my mood in another. Do they not actually read the notes? 


After stopping HRT in July due to utrogestan side effects and my GP refusing to review due to past hyperplasia, I was eventually seen at the meno clinic again yesterday. They agreed to prescribe lenzetto 1 spray and utrogestan pessary every other day. I've done a search on here and everything seems to say this is a regime for post meno ladies which I aren't. Has anyone in peri had this combo and what would I expect in terms of bleeding. Currently 3 months with out a period. Thanks in advance.

[CLKD]

Morning.  Why does this have to be so difficult !

Sorry haven't any advice: mayB put the product name into the search box to see what pops up?

[jorainbow]

I know! Ive had a look and it all seems to point to every other day being post meno which I aren't

[CLKD]

I'd give the Clinic a phone call on Monday to put your point over.  Let us know how you get on.

[sheila99]

I agree with speaking to the clinic. Using a conti regime in peri is likely to lead to breakthrough bleeding though perhaps they've prescribed this way because they've given you a low dose of oestrogen.

[Mary G]

One pump of Lenzetto is very low dose.  To give you an indication, when I used it several years ago, I could only get to 300 pmol oestrogen with three sprays whereas I get that level with just one pump of Oestrogel..

You only really have two choices, taking it as prescribed or taking it on a cycle and having bleeds which means taking Utrogestan for 12 days each month if you have to adhere to NHS guidelines - not something I would want to do.

If possible, it would probably be more bearable to take it continuously as prescribed.

[jorainbow]

Thank you sheila99 and maryg
I was originally on utrogestan for the last 2 weeks of my cycle with 1 spray lenzetto daily but I felt like the utrogestan was way too much - drowsy to the point of feeling unsafe driving etc. I think this is to try space it out over the month?

[jorainbow]

Updated thread following clinic letter

[Kathleen]

Hello jorainbow


I am sorry that you are still experiencing some confusion after your clinic appointment. I hope you manage to find a regime that is right for you.

As for inaccurate letters from consultants I feel your pain lol. Several times I have read comments that bear no resemblance to the conversation I recall having or indeed the reason the appointment was arranged in the first place. The last follow up letter said that my current dose of Oestrogen was ' working well ' so why was I sitting there talking about crying spells and panic attacks? Along with the daily flushes of course. This was all NHS but the private clinic Newson Health was no better. The first doctor I spoke to asked if I would consider taking an AD. She clearly hadn't read my notes because I was already taking one. The next doctor emailed me after our appointment to suggest that I take my AD and testosterone at the same time of day, even though we had just finished discussing that I haven't used testosterone for about two years and I do not want to use it again.
The third doctor I saw also asked me if I have ever considered testosterone. Do these people actually take notes or do they just not bother reading them? The most recent NH appointment was for twenty minutes and cost me £267.

Sorry to rant ladies but it does make this stage of life so much more difficult. Btw  the first two NH doctors told me that they were leaving NH and both had been working for them for about a year. I wonder what the staff turnover is generally? I hope it isn't just me being a difficult patient that is driving them away lol.

Take care ladies.

K.

[jorainbow]

Thanks K. I'm amazed at the lack of understanding and competence you had to endure! I often think they'll see me as difficult but if something isn't right I'm not going to stay quiet. You're right. It doesn't help at all.
 

[Hurdity]

Hi jorainbow

What dose has been recommended every other day? I am thinking this must be 200 mg because the 100g dose doesn't come as pessaries officially though can be used as such.

I think the consultant is being cautious because of your past hyperplasia. I was recommended a higher dose and shorter cycle than standard due to a thickened lining even though biopsy and hysteroscopy showed it was normal.

I would suggest, if posssible you ask the consultant what this means "a disordered proliferative endometrium" if the biopsy has shown everything is normal? How I see it, the biopsy will have been taken to test for hyperplasia and presumably specifically atypical hyperplasia - in the proliferative part [the endometrium is proliferative when it is growing as a result of oestrogen, and in the absence of progesterone] - but the endometrium could still be proliferative.  This will depend on what was happening when the biopsy or scan as taken ie what the situation was in your body when the consultant arrived at that view.

If you are post-menopause and not on HRT then if the lining  was stimulated from past hRT - I'm not sure what happens to it when you stop? It shouldn't continue to grow...if peri then your own cycle will cause intermittent proliferation and then this will change after ovulation. But what makes it disordered?

The main problem is, if it is still thickened as well as disordered (and again to emphasise try to understand what the consultant meant by this), there is a danger that it can continue to thicken and potentially lead to hyperplasia again which can lead to endometrial cancer. Hence their caution.

In your position I would want to explore what progesterone options you can tolerate that will protect the womb, get the docs to  agree to this because of how you feel on high doses, and if you can, insist that they monitor you regularly to check the thickness of the lining?

Let us know what you decide and how you get on = best to do this by adding a post to this thread rather than editing the original - so we can follow your story more easily.

Alll the best
Hurdity x

[jorainbow]

Morning Hurdity

Dose is 200mg every other day.  Back in July I started on lenzetto one spray daily and then 200mg days for last 14 days of cycle.  I managed 3 days of the Utrogestan before I was hit with the drowsiness impacting on my driving, anger, bloating and very low mood. The suggestion is now lenzetto one spray plus 200mg every other day utrogestan.

My first biopsy showed a mild case of hyperplasia no atypia following irregular bleeding (following covid jabs though Im not blaming that I do know it did cause issues in some ladies).  Six months later, no hyperplasia but disordered proliferative endometrium. Last biopsy in March the letter just said normal. I hadn't been on any HRT whilst these biopsies were taken or before - even the consultant said he didnt know why it had happened.  My cycle went back to normal after the second, in March I had the coil fit and I had a four week bleed but had it removed at the six week point.  After that I had no bleeding until I took the utrogestan and then started pretty much straight away for about a week.  Since July nothing.  So I dont think I am post meno as I have never been 12 months without my natural cycle though both the consultants keep telling me I am because I am 54!

I wrote yesterday asking for an explanation of why the meno consultant says I have disordered proliferation when the consultant in charge of the biopsies says not and will review with a phone call in a year (Mar 24).  I do understand the need to protect the womb and if I can tolerate the utrogestan day on day off that would be great but don't understand how that would impact on bleeding and mood with a stop start approach?

Thank you for your input

[jorainbow]

And 10 days later I'm still waiting for a response. His secretary is so helpful fortunately and chasing him. Meanwhile I got my period at the weekend which would explain how I nearly dumped my lovely partner last weekend in a rage and the migraine! I haven't started the HRT yet until I have the response.

[jorainbow]

Response as below:

The biopsy from March is within the limits of normality. If you were not on HRT, we would not require any further vigilance

@hurdity having just had a period, my query is re taking utrogestan every other day and the affect on my cycle which is still regular but he doesn't seem to want to commit to comment other than it'll cause bleeding