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[iggery]

I was on HRT in my forties and came off in my sixties just because I thought I should.  A few years later I saw a gynaecologist and mentioned that I regretted coming of due to brain fog etc, my bones showing some osteopenia following a dexa scan and my water works. From memory I was on Kliovance and then changed to one that I did not have a bleed with.
I am now just turned 70 and he suggested trying Evorol Conti patches, this was in September 2021.   I recently had a pelvic ultrasound etc and transvaginal scan as I was feeling bloated and constantly needing to get up at night often twice to go to the loo which is a new thing for me.
The results were that I had a thickened endometrium 14mm and then had a hysteroscopy which didn’t show anything and the biopsy showed just benign tissue. When I went on the patches my thickness was 2.8mm so a high increase in 2 plus years.
The consultant (not the one that put me on patches) at the hospitals immediate reaction was you are too old for HRT you should not be on it and I strongly recommend that you wean yourself off and talk to your Dr about alternatives to help you.  She was not very helpful or friendly at all. My understanding from her was that if I stop the HRT then the thickening will reduce down.
From reading up it may be that my body is not absorbing the progesterone in the patch.  My question is, has anyone else on this forum experienced this? I may have a consultation with the consultant that subscribed me at first the patches however that was a private consultation and I do not really want to go the private route at the moment apart from a consultation. I need to be armed with the correct information.
Unfortunately, my GP is not an expert in this area and can not refer me to a NHS clinic because of the recommendation of the NHS consultant and will just stop prescribing. I know from reading that you should not cut the patches now but I have done that to wean myself down for the last two weeks. I tried going longer with the whole patch before changing but felt awful. I would like to be able to continue with lower oestrogen.
Any help and advice will be greatly appreciated.  I am hoping that there is a patch or other with a lower oestrogen that maybe I could take!! I know many would just say stop taking it.

[Penguin]

Hi I haven't experienced your situation. However, could you ask for a separate estrogen and progrstrone product where you can adjust the dose of the estrogen down? Estrogel and utrogestan would be potential options and you could go really low on the estrogel as it is in a pump dispenser.

[Hurdity]

Hi iggery

 

Sorry to hear about your issues with HRT and also the difficult consultant.

One question - was the NHS consultant from a menopause clinic, or a general gynae consultant whom you saw in connection with the thickened endometrium and hysteroscopy etc? I'm thinking probably the latter going by the response she gave, which is unfortunate, as she is out of date. Current thinking is that there is no end date for us to stop HRT, but that for over 60's patches are preferred as having a lower risk profile for various health conditions. Ideally HRT should be started within 10 years of menopause (and?)or under 60, but your case is different as you say, because you were on it for some years and have come off it presumably less than 10 years ago.

However if you have no other menopause symptoms then HRT is not necessarily recommended to be restarted at age 70, purely for treating osteopenia - according to the information on this website: https://www.menopausematters.co.uk/osteoporosistreatment.php However if you do have menopause symptoms then of course HRT would help with both.

The thickened endometrium - that is quite a high measurement considering Evorel conti contains a balanced dose - but of course there will be women who fall outside the standard response. It does seem strange that you were absorbing the oestrogen very well but not the progestogen.

In your position and at your age and stage I would not change from patch to gel, if patches worked for you in terms of how you were feeling, but as Penguin says, you would be better off trying a separate oestrogen and progestogen. Evorel do make 50 mcg patches and this is the standard dose recommended for prevention of osteoporosis so I would aim to try to achieve that.

The question is which progestogen?

Utrogestan - as suggested by Penguin is the only bio-identical progesterone licensed for HRT but there can be side effects and I imagine you will want to take  the progesterone every day to try to avoid a bleed, thoigh many take daily progestogens quite happily. I am interested in the fact that you had a 14 mm endometrium yet had no breakthrough bleeding - which is what normally occurs, and what sends women to the doc to get checked out. In your case it is so good that you listened to your body due to unusual symptoms.

Other licensed progestogen options from your inexpert GP, are Provera (tablets) or the Mirena coil, which delivers most of the progestogen directly to your womb. I am 70 and I have had odd bits of spotting so have had a couple of hysteroscopies and biopsies and was offered Mirena both times - when in my 60's - though I declined because I wanted to keep with bio-identical HRT (Evorel patches and Utrogestan).

There are other options but are off label or off licence and unlikely your GP will permit these. For example the progestogen in Evorel conti is norethisterone - which is available separately but only in 5 mg tablets and not licensed separately for HRT, though can be used. There is also a mini pill consisting of norethisterone but you would need to take several to give sufficient dose.

Hope this helps and all the best

Hurdity x

[jacig1957]

Hi iggery

 

Sorry to hear about your issues with HRT and also the difficult consultant.

One question - was the NHS consultant from a menopause clinic, or a general gynae consultant whom you saw in connection with the thickened endometrium and hysteroscopy etc? I'm thinking probably the latter going by the response she gave, which is unfortunate, as she is out of date. Current thinking is that there is no end date for us to stop HRT, but that for over 60's patches are preferred as having a lower risk profile for various health conditions. Ideally HRT should be started within 10 years of menopause (and?)or under 60, but your case is different as you say, because you were on it for some years and have come off it presumably less than 10 years ago.

However if you have no other menopause symptoms then HRT is not necessarily recommended to be restarted at age 70, purely for treating osteopenia - according to the information on this website: https://www.menopausematters.co.uk/osteoporosistreatment.php However if you do have menopause symptoms then of course HRT would help with both.

The thickened endometrium - that is quite a high measurement considering Evorel conti contains a balanced dose - but of course there will be women who fall outside the standard response. It does seem strange that you were absorbing the oestrogen very well but not the progestogen.

In your position and at your age and stage I would not change from patch to gel, if patches worked for you in terms of how you were feeling, but as Penguin says, you would be better off trying a separate oestrogen and progestogen. Evorel do make 50 mcg patches and this is the standard dose recommended for prevention of osteoporosis so I would aim to try to achieve that.

The question is which progestogen?

Utrogestan - as suggested by Penguin is the only bio-identical progesterone licensed for HRT but there can be side effects and I imagine you will want to take  the progesterone every day to try to avoid a bleed, thoigh many take daily progestogens quite happily. I am interested in the fact that you had a 14 mm endometrium yet had no breakthrough bleeding - which is what normally occurs, and what sends women to the doc to get checked out. In your case it is so good that you listened to your body due to unusual symptoms.

Other licensed progestogen options from your inexpert GP, are Provera (tablets) or the Mirena coil, which delivers most of the progestogen directly to your womb. I am 70 and I have had odd bits of spotting so have had a couple of hysteroscopies and biopsies and was offered Mirena both times - when in my 60's - though I declined because I wanted to keep with bio-identical HRT (Evorel patches and Utrogestan).

There are other options but are off label or off licence and unlikely your GP will permit these. For example the progestogen in Evorel conti is norethisterone - which is available separately but only in 5 mg tablets and not licensed separately for HRT, though can be used. There is also a mini pill consisting of norethisterone but you would need to take several to give sufficient dose.

Hope this helps and all the best

Hurdity x

I have much the same problem Hurdity and have read many of your posts always offering great advice.
Can I ask you if you are still on cyclical Utrogesten and if so what regime do you use?

I have just been diagnosed with thickening of 10mm and advised to take 200mg every day.
My GP isn’t very HRT informed and more or less just gave me the NHS suggested dose.

I’m trying to up my utrogesten dose but still need to use it cyclically as I suffer horrendous side effects whilst on it.

Hope you can help 🤞

[sheila99]

If you saw a gynae not a meno specialist you can argue that don't any more about meno than anybody else. Same with the refusal to refer you to a meno clinic. I would suggest to your gp you take 200mg utro daily until the lining is thin and thereafter 100mg daily. That can increased to 300 and 200 if you find you need more than the standard dose. Given you had bloating from the patches and you don't know if it was from the thickened lining or something else in the patch personally I would change to gel. You don'thave to decrease oestrogento sort out a thickened lining, you can increase progesterone instead. Given how awful you feel when the oestrogen in your patch had run out the preferable option would be the latter. It might be worth pointing out the NICE guidelines no longer have an age limit for hrt (it used to be 60). If you were 50 they'd have they'd have prescribed enough progesterone to thin the lining not told you to stop hrt.

[Hurdity]

I have much the same problem Hurdity and have read many of your posts always offering great advice.
Can I ask you if you are still on cyclical Utrogesten and if so what regime do you use?

I have just been diagnosed with thickening of 10mm and advised to take 200mg every day.
My GP isn’t very HRT informed and more or less just gave me the NHS suggested dose.

I’m trying to up my utrogesten dose but still need to use it cyclically as I suffer horrendous side effects whilst on it.

Hope you can help 🤞

Hi jacig1957 - did I maybe answer a post of yours yesterday? I seem to remember typing your name! Can't look now I've started this one so may repeat myself!

So yes I'm still on cyclical Utrogestan aged 71 (!). Now take it on a 5-6 week cycle. Annoyingly I seem to get spotting sometimes even before I start the Utro cycle or sometimes before stopping it. Need to get checked out as this happened recently. Previously ( twice) have had thickened lining but hysteroscopy and biopsy have shown all OK except for a couple of small fibroids though last time I has this procedure about 18 months ago they didnt seem to be there any more.

If your lining was 10 mm on cyclical HRT - this in itself is not an issue because the lining thickens during the oestrogen only part of the cycle, so the point in the cycle that the scan was taken is crucial for understanding if there is a problem.Ideally a scan should be taken immediately following the bleed - though it is sometimes difficult to time exactly. Mine has been 9 mm on TVS 7 days after a bleed but nothing wrong.

I was advised to take 200 mg utrogestan vaginally for 14 days per 28 days cycle and I'm afraid I do not do this. I usually do 12 days of 200 mg and an extra couple of days of 100 mg (all vaginally) to help minimise withdrawal symptoms. It comes round far too quickly!

If you've been taking 200 mg on a cyclical basis ( ie 12 days per 28) then you don't have much leeway and n order to thin the lining should increase to 300 mg per cycle - but that is assuming the 10 mm is a valid measurement. It's all in the detail....

Does this help? Do ask if it's not clear at all.

Hurdity x

[jacig1957]

Hi Hurdity

Thank you so much for your reply. I’m not sure if you already replied to me as I’m new to the site, not at all techy minded and finding it very difficult to navigate the site.
I can’t find my posts sometimes and/ or people’s answers.
I’ve tried using the search icon, but it always comes up with error, so I can’t look up subjects I’m concerned about.
Anyway, back to the subject in hand…

I was on 1 pump eustrogel and only taking 100 mg of utrogesten for 12 days, every 3 months, which appears to be far too little.
I was told this info by a private gyna about 10yrs years ago!!! ( when my ex had free health insurance) and have followed it ever since.

I stopped having a withdrawal bleed at all, around 6 months ago and developed a continuous light but dirty discharge, thus my trip to GP to see what’s going on.
I had the ultrasound scan which showed 10mm thickening, about 10 weeks after  last taking  utro, but no bleed. In the meantime I’ve been advised to take 200mg of utro every second night until app.
I’m never going to manage that due to burning cystitis type side effects and horrendous night sweats when taking utro.

This is why I prefer cyclical….at least there are some great days when just taking my wonderful eustrogel 🥰
I’m waiting referral to gynae. My GP said I would probably need a hysteroscopy and biopsy.

I’m so scared of the pain as I had a failed attempt at having a mirena fitted many  years ago . I felt extremely nauseous and passed out. I never and would never attempt that again.

I’ve read that the hysteroscopy is much the same procedure (but worse) How did you find it?