Print

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

[Michelle26]

Hi just after advice I am nearly 54 with long term endometriosis history.
I was on sequential hrt for around 7yrs (patches) in the last year some of my meno symptoms started up again, so I arranged a chat with my gp.
She recommended changing to continuous hrt even though I explained I was still getting bleeding sometimes heavy, she seem to think continuous hrt may help.
I have tried continuous hrt for 8mnths, but I am really struggling i am very progesterone intolerant so could not cope with the utrogestan orally so from advice on here started vaginally but now I am getting a lot of irration down below, on top of that I'm still bleeding quite regularly.
I am honestly considering  going back to sequential hrt has anyone had to do that?
I have never had 12months without bleeding, infact I bleeding regularly.
Really at my wits end any advice would be appreciated thank you

[CLKD]

Morning.  U could have continued your queries in the other thread - the subject line can be altered too 

Why did she seem to think that a change of HRT would ease the bleeding  - have U had any scans etc. to check the womb lining etc.?

Some find that keeping a mood/food/symptom diary of use to chart progress, it gives a record to chat with the GP/Nurse Practitioner/menopause specialist.  How do U feel overall? 

When did U have a full blood count, ESR, VitD levels etc done to check your over all health?

[joziel]

The recommendation for people with endo history, is to be on continuous HRT - even if you are in peri-menopause.

Unopposed estrogen (for half the month) will feed any remaining endo deposits. Ideally you would also be taking systemic progesterone (ie oral or patches) because your endo isn't going to be confined to your uterus. It will be elsewhere, and only systemic progesterone can oppose the effects of estrogen outside the uterus. Using progesterone vaginally isn't going to stop endo growing in other places...

I have a history of endo and I'm in peri. I'm on continuous utrogestan at double the usual dose (200mg/night) orally. I do have a break once a month for a few days, to allow a bleed. This prevents breakthrough bleeding at other times of the month. I am symptom-free for endo and only bleed during that break. Before this, I did try 300mg of utrogestan sequentially (days 16-26) - but this wasn't enough to stop endo pains.

If you are progesterone intolerant and you have endo, you need careful management. A combined patch (continuously) might be an idea so at least you are getting whole-body progestin. If you want to control the bleeding, allowing a few days off each month can help control that.

Persistent bleeding on utrogestan is a sign that it's not a great progesterone for you anyway, so another reason to try the combined patch. If you can't tolerate the progestin in that or if it doesn't stop the bleeding either...

... another great idea to try is the Mirena coil. This almost always stops all bleeding completely. However, because you have endo, you will need system-wide (body wide) progestin/progesterone - the Mirena by itself won't help endo deposits outside the uterus, it will just stop your bleeding. If you can't tolerate utrogestan, you could try a POP like desogestrel as well as the Mirena. That will give you both... The POP is approved to be used alongside HRT as a contraceptive but not as a progestin for HRT - but you would have the Mirena for that, which is approved as HRT progestin. The POP would be suppressing endo outside the uterus.

In short, with endo, you need as few days a month of unopposed estrogen as possible. Women with a history of endo are advised by the BMS to be on continuous progesterone for this reason. And you need that progesterone to operate not just in the uterus (as for most women) but body-wide, so you need a systemic progesterone/progestin.

[CLKD]

    joziel

[Michelle26]

Hi all thank you so much for all the replies,
I do really appreciate it.
My medical history is extremely complicated with lots of conditions and medication,
Added to that I am housebound now so unfortunately I haven't had any scans or anything for a few years.
I have suffered with Endo for 30yrs no children or hysterectomy, so continously.
I was blessed to eventually find an excellent specialist, and it was through her, that we discovered my extreme sensitivity to progesterone.
It was so bad my endo could not be treated through hormone therapy, and was merely controlled by pain relief medication to control the bleeding and yearly laproscopes with laser removal of endo clusters.
I never had thicken of the womb lining as I bled alot!!
When I started menopause symptoms my GP consulted with my endo team about jhrt, I was 45yrs old perimeno, and due to my intolerance of progesterone I was put on patches sequential, as they believed it would be the gentlest option fir more.
I was 50mg oestrogen and 2wks of a combination oestrogen/progesterone patch, I had a monthly bleed.
I was OK on that.
Last year at 53yrs old I started to get hot flushes headaches fatigue and irregular breakthrough bleeding.
My gp that deals with hrt suggested continuous hrt 100mg oestrogen patches and 100mg utrogestan.
She said the increase of oestrogen would help my meno symptoms and the daily progesterone would protect my womb lining.
I was worried as I can not take oral progesterone but was advised on here to take it vaginally and told this actually gives a better absorption I do not take a break.
Bleeding has never really eased maybe slightly light but more irregular.
I did speak to a go after my last post but they were not helpful basically saying I should be through menopause soon so to  stick with the hrt I am on.
But now I have developed an irritation down below so can not use the utrogestan vaginally saw on here that can happen and some people take a break for a few days but this has caused another bleed!!
I could not cope with any higher dose of progesterone but have taken one orally today to try to get some progesterone back in me.
I feel like giving up on hrt as its not making me feel any better now 😪

[joziel]

I think you should not just give it up (that's a big decision in terms of health implications) but you would really benefit from seeing someone privately who specialises in complex cases - like a menopause clinic. You can do a video call with the Newson Clinic, you don't need to leave the house - they mail you any medications. So if you can afford it, that would be a good idea... They can write back to your GP and advise what to continue, so you don't need to stay private if you don't want to.

IN terms of them telling you that you should be through menopause soon so to stick with what you are taking....

Menopause is a life-long condition until death do you part from this earth. You're not going to be 'through' it. As soon as you stop taking HRT, you will very likely get low estrogen symptoms back and even if you're symptom-free and lucky, you will still have increased risk of dementia, heart disease, osteoporosis and more besides, without hormones. So you need to be thinking about it as a long-term thing and an ongoing plan...

You were okay (with endo and bleeding) on 50mcg estrogen and the combined patch. Then you got some low estrogen symptoms back (hot flushes, headaches etc), so your GP was right to increase your estrogen - but going from 50mcg to 100 is a big jump. What about 75mcg? You shouldn't be on more estrogen than you need to be on. It will cause more bleeding and is an endo risk factor.

Did you try 75mcg of estrogen? If not, ask to trial reducing your patches to 75.

Then, your GP also changed your progesterone from the one in the combined patch to utrogestan. If you were fine with the progestin in the combined patch but not with utrogestan, then you could go back to the combined patch - preferably the continuous version of it, with a break for a few days to allow a bleed if needed. And add in one pump of gel, which would take you to 75 of estrogen. You can add in extra progestin by way of desogestrel too - because the amount of progestin in the combined patch is intended for 50mcg of estrogen, so if you are adding a pump of gel, you may also need to increase progestin. (And that might be necessary for endo anyway.)

By the way, desogestrel is available over the counter in pharmacies now without prescription, so it's something you can just go and buy and try any time. Even now, on the combination you're currently on, you can add in desogestrel. It is used by women on HRT as a contraceptive, because HRT doesn't do that.... It stops bleeding eventually. The bleeding becomes dark and slow and brown and then just stops.

If you don't feel confident enough to work out what you need and request it or to try things like this, these are the complicated combinations of things which you need someone knowledgeable and experienced in HRT to work out and trial with you. That's why it would be best to see a specialist.

[Michelle26]

Joziel just a huge thank you for taking the time to reply in such depth honestly I truly appreciate it so much.
And yes agree with you that menopause is for life!!
And I want to be able to protect my joints and mental health for as long as I can!!
I will take all your information and make a plan to speak to my GP again.
And I will definitely look at the clinic as well had been considered private help.
I didn't try 75mg I  did initially ask for just an increase in estrogen, as I was still bleeding I didn't expect my doctor to recommend continous hrt.
She put me straight on the 100mg  estrogen and 100mg utrogestan, whichi was doing OK with using the utrogestan vaginally, but still getting irregular bleeding.
Just the last few days I seem to get an irritation down below and very sore so thought it best to stop the utrogestan for a few days, which made the bleeding worse, so gave in and took it orally today.
I will ask my GP  about a 75mg estrogen patch and I trying the combined patch daily as you advised.
Thank you again so much 💖

[sheila99]

You might be starting with VA, irritation from vaginal utro was my first symptom a few months before the 'normal' symptoms. As you got on with evorel you could ask for a patch and a half (combined). Most GPS will prescribe part patches but there are a few who won't.
 Whilst I agree with the benefits of hrt and I intend to take it for life I think the decision is a bit different for you given the endo. Perhaps something to discus with your gp later on.

[joziel]

You don't want to ask for the 75 patch AND the combined patch daily, because the combined patch is 50mcg of estrogen in itself (it is both combined). If you want a dose increase from 50 and want to use the combined patch, you could ask to add a 25 estrogen patch on as well. That would give you 50 in the combined patch and 25 separately.

However the progestin in the combined patch is designed to work with the 50 estrogen in that patch. If you increase the estrogen by adding a 25 patch, arguably you need to increase the progestin in some way. (I wish they would make combined patches for 75 and 100 estrogen - with the right amount of progestin in them. It's such a pain that they don't.)

Anyway, options are taking desogestrel as well (POP). Or the Mirena coil. (The latter, you'd hope that the progestin in the combined patch would be enough to suppress your endo.) I'd recommend the desogestrel in the first instance because it worked great for my endo before I started HRT. And much less intimidating than getting a coil fitted. And it's very effective at stopping bleeding.

With the discomfort you have: If you are going to keep using utrogestan vaginally, you could ask for the utrogestan pessaries they use for IVF/pregnancy. They are the same drug but they are designed to be put up there, so hopefully are less irritating. Or it might be that you need some local estrogen as well... Sometimes using progesterone vaginally opposes the estrogen too much in that one place and adding some estrogen in locally can help. You can have local estrogen as well as systemic HRT, it's usually Vagifem they prescribe. If the soreness is mainly external, then some Ovestin cream might be better to ask for - you can apply that externally to help sooth it.

[Michelle26]

UPDATE.
Thank you again for all your advice.
I sent a very indepth email to my GP we have one in the surgery who does deal with hrt and female problems!!
I ended up having a pretty bad reaction to the utrogestan, I was try to persevere with it as I had my oestrogen patch on and had been bleeding a lot so knew I needed the progesterone, but my body is really reacting badly to it so I removed my patch yesterday and contacted the doctors.
I was surprised she called the same day, but was pretty dismissive, she agreed I could trail Conti patches, but said I could not have extra oestrogen, I do understand the hormones are perfectly balanced in one patch, but as I was on 100mg of oestrogen for the last 9mnths, I think dropping straight back down to 50mg is going to have an effect, she did say that although it's unusual at 54yrs old I am obviously still having periods, so u shouldn't need 100mg of oestrogen, I do understand that and would rather take the least amount of hormones as possible to control my menopause symptoms, as I do think they flare up my endometriosis, but I think I'm going to feel abit lousy adjusting to the big drop in one go!!
Thanks again for all the help I started the conti patches today so will update

[joziel]

Michelle, you can cut your 100 patch into quarters (best diagonally from one corner to the other) to make 25 and add that to your Conti. Until you have the progesterone situation sorted, you probably can't stay on that long term but if you want to go down more gradually without a sudden drop, it would work.

Meanwhile you can (as I said) get desogestrel POP and start that alongside your conti patches. It is approved as a contraceptive for women on HRT so can be taken with it. It will stop the bleeding and will provide extra progestin, so if you did want to stay on the 75 estrogen, you could do that with the desogestrel.

Your doctor doesn't sound very caring or thoughtful there. The thing about 'not needing 100mcg of estrogen because you're still having periods' is insane. For one, it's a fact that younger women need higher doses of estrogen to be symptom-free. We don't know why, if it's what their bodies expect or if it's because they have fluctuations and the higher estrogen dose helps ride out the fluctuations from their ovaries at this time. So it's actually the reverse - you are more likely to need higher estrogen, when you are 54 than 64 or 74... (I'm on 6 pumps of gel, which is 150mcg of estrogen and I'm 46.)

If you can, I highly recommend having a private consult maybe with the Newson Clinic. They can set you up on something which works and then transfer you back to your GP to maintain it.