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[Sarah708]

Has anyone heard that the mini pill can destabilise the womb lining in older women? I’m 53.

Over a year now bleeding. Lots of changes continuous, back to cyclical then increased Utrogestan to 200mg continuous and Desogostrel mini pill.

Feel like I’m on too much progesterone and I’m bleeding still. I’ve stopped mini pill and Utrogestan and was thinking to restart Utrogestan in five days.

Any thoughts I’m getting really fed up.

I’d had a nearly a year not bleeding on mini pill before starting Sequi patches. I didn’t bleed on those but I didn’t feel great on them. Moved to Conti and flooded. Utrogestan continuous initially stopped bleeding then it started again. Moved to a cyclical regime but missed the progesterone on the 14 days off and spotted a little. Tried 200mg continuous but symptoms are not nice - waking for a wee again, breast tenderness and spotting.

Then I read that someone’s GP advised desogosteral can destabilise the womb as we get older and cause spotting.

Then I see the BMS say 2 Desogosteral can be the progesterone element in HRT.

I’m really at a loss of what to do next.

[Hurdity]

Hi Sarah

Too much progesterone/progestogen can cause overthinning of the womb lining which can leade to ulceration/spotting. Not sure why you are taking the mini pill as well as Utrogestan? Bleeding though can be caused for all sorts of reasons. Do you know if you are post-menopausal yet ie 12 months without a natural period before starting HRT?

How much oestrogen are you taking and in what form?

Hurdity x

[Sarah708]

Thank you for replying so quickly.

I’m on two pumps of oestrogel and I’ve stuck rigidly to that. Testosterone has sorted my joint pain. I’ve no idea if I’m still Peri because the mini pill stopped my periods around three years ago, until I started bleeding on Evorel Conti.

I stopped the mini pill on Tuesday and Utrogestan last night so I’m getting a withdrawal bleed now, but I do feel a soreness very very slightly which feels like it could be my womb. Now I’ve stopped my breast tenderness has eased.

I did try the Utrogestan vaginally - one vaginally and one orally but that would’ve increased the effects again I guess.

I had read that too much P can do this but I’ve been ‘shot down’ in another forum because everyone says to take more P. But I’m on a very moderate dose of gel.

My womb lining was super thin on my scan too, long before I increased my dose.

I’ve also read on the Newson site that I don’t need the mini pill on continuous Utrogestan, but the GP thinks I need it until 55. I’m writing a letter to her now.

My GP is lovely but it’s me taking the information to her generally as she’s still learning I think. She’s at a loss.

I do have two subserous fibroids which probably caused heavy periods but I believe subserous ones cause less problems. They didn’t seem concerned with them on the scan.

So would you stop the mini pill and re start the  Utrogestan in three or five days on a continuous regime at the normal 100mg?

[Hurdity]

Thank you for replying so quickly.

I’m on two pumps of oestrogel and I’ve stuck rigidly to that. Testosterone has sorted my joint pain. I’ve no idea if I’m still Peri because the mini pill stopped my periods around three years ago, until I started bleeding on Evorel Conti.

I stopped the mini pill on Tuesday and Utrogestan last night so I’m getting a withdrawal bleed now, but I do feel a soreness very very slightly which feels like it could be my womb. Now I’ve stopped my breast tenderness has eased.

I did try the Utrogestan vaginally - one vaginally and one orally but that would’ve increased the effects again I guess.

I had read that too much P can do this but I’ve been ‘shot down’ in another forum because everyone says to take more P. But I’m on a very moderate dose of gel.

My womb lining was super thin on my scan too, long before I increased my dose.

I’ve also read on the Newson site that I don’t need the mini pill on continuous Utrogestan, but the GP thinks I need it until 55. I’m writing a letter to her now.

My GP is lovely but it’s me taking the information to her generally as she’s still learning I think. She’s at a loss.

I do have two subserous fibroids which probably caused heavy periods but I believe subserous ones cause less problems. They didn’t seem concerned with them on the scan.

So would you stop the mini pill and re start the  Utrogestan in three or five days on a continuous regime at the normal 100mg?

Hi Sarah

"I had read that too much P can do this but I’ve been ‘shot down’ in another forum because everyone says to take more P. But I’m on a very moderate dose of gel. "

Heavens - I wonder what forum this is?!!!

The point is we can't know what is the cause of the bleeding and can only make suggestions.

If you think you still need contraception ( ie currently the mini pill) then the best solution is either double mini pill (off-licence for endometrial protection) or something like the Mirena coil which gives endometrial protection as well as contraception.

This is a separate issue from the bleeding, though the Mirena coil will address both.

There are so many different reasons for the bleeding - as you have recognised - fibroids, still being fertile ie still per-menopausal, insufficient progesterone (unlikely in your case if you are taking mini pill and progesterone), too much progesterone etc

I'm not sure that 100 mg utrogestan continuously will be sufficient in your case? Personally, in your position, having had any other causes of bleeeding ruled out through a scan (and if this was recent then you've done this)  I would either try cyclical HRT ( because you may still be peri-menopausal) - which could be using 200 mg Utrogestan for 12 days per 28 day cycle, or as I suggested - double the mini pill if your doc will agree, or Mirena coil.

The British Menopause Society have not suggested double desogestrel - the only thing the say about desogestrel is that if used then additional progesterone is needed to protect the womb:

"Earlier studies have reported that desogestrel 150 micrograms is effective as the progestogen component
of HRT with no increase in the risk of endometrial hyperplasia. There is lack of evidence on the use of
desogestrel 75 micrograms as the progestogen component of HRT. If desogestrel 75 micrograms is used
as contraception in women receiving HRT, it would be recommended to add further progestogen (e.g.
Utrogestan 100 mg daily or 200 mg for 12 days a month) to provide adequate endometrial protection"

Hope this helps and let us know on this thread how you get on.

Hurdity x

[sfreesto]

Hi Sarah,

I am peri and my GP put me on continuous utrogestan 100mg plus 75 mcg Desogestrel to stop me having bleeds at all. (This was to try give me some stability to try and settle my VA symptoms.) This works for me, I don’t bleed, and I am on Estradot 100 (equivalent to 4 pumps Oestrogel). The only thing I don’t like is I’m putting weight on, I think the Desogestrel makes me hungry. X

[Sarah708]

Thank you for replying so quickly.

I’m on two pumps of oestrogel and I’ve stuck rigidly to that. Testosterone has sorted my joint pain. I’ve no idea if I’m still Peri because the mini pill stopped my periods around three years ago, until I started bleeding on Evorel Conti.

I stopped the mini pill on Tuesday and Utrogestan last night so I’m getting a withdrawal bleed now, but I do feel a soreness very very slightly which feels like it could be my womb. Now I’ve stopped my breast tenderness has eased.

I did try the Utrogestan vaginally - one vaginally and one orally but that would’ve increased the effects again I guess.

I had read that too much P can do this but I’ve been ‘shot down’ in another forum because everyone says to take more P. But I’m on a very moderate dose of gel.

My womb lining was super thin on my scan too, long before I increased my dose.

I’ve also read on the Newson site that I don’t need the mini pill on continuous Utrogestan, but the GP thinks I need it until 55. I’m writing a letter to her now.

My GP is lovely but it’s me taking the information to her generally as she’s still learning I think. She’s at a loss.

I do have two subserous fibroids which probably caused heavy periods but I believe subserous ones cause less problems. They didn’t seem concerned with them on the scan.

So would you stop the mini pill and re start the  Utrogestan in three or five days on a continuous regime at the normal 100mg?

Hi Sarah

"I had read that too much P can do this but I’ve been ‘shot down’ in another forum because everyone says to take more P. But I’m on a very moderate dose of gel. "

Heavens - I wonder what forum this is?!!!

The point is we can't know what is the cause of the bleeding and can only make suggestions.

If you think you still need contraception ( ie currently the mini pill) then the best solution is either double mini pill (off-licence for endometrial protection) or something like the Mirena coil which gives endometrial protection as well as contraception.

This is a separate issue from the bleeding, though the Mirena coil will address both.

There are so many different reasons for the bleeding - as you have recognised - fibroids, still being fertile ie still per-menopausal, insufficient progesterone (unlikely in your case if you are taking mini pill and progesterone), too much progesterone etc

I'm not sure that 100 mg utrogestan continuously will be sufficient in your case? Personally, in your position, having had any other causes of bleeeding ruled out through a scan (and if this was recent then you've done this)  I would either try cyclical HRT ( because you may still be peri-menopausal) - which could be using 200 mg Utrogestan for 12 days per 28 day cycle, or as I suggested - double the mini pill if your doc will agree, or Mirena coil.

The British Menopause Society have not suggested double desogestrel - the only thing the say about desogestrel is that if used then additional progesterone is needed to protect the womb:

"Earlier studies have reported that desogestrel 150 micrograms is effective as the progestogen component
of HRT with no increase in the risk of endometrial hyperplasia. There is lack of evidence on the use of
desogestrel 75 micrograms as the progestogen component of HRT. If desogestrel 75 micrograms is used
as contraception in women receiving HRT, it would be recommended to add further progestogen (e.g.
Utrogestan 100 mg daily or 200 mg for 12 days a month) to provide adequate endometrial protection"

Hope this helps and let us know on this thread how you get on.

Hurdity x

Thankyou for your reply.
I’ve stopped the mini pill and gone back to 100mg continuously of  Utrogestan and the bleeding has stopped.

I’d tried going back to a sequential regime but still spotted.

I do still need contraception as my FSH is still about 12 (unless the residue of the mini pill has affected the result).

But it was definitely the mini pill. Now on to sorting bit D, B12 and Testosterone!