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[Tulip]

(Pun intended!)
Hi everyone, the continuing saga of my HRT trials, I really could do with your input girls..
Briefly; I get to see a gynaecologist every few months to a year, (a miserable cow who makes me feel like something she wiped off her shoe, and really doesn't listen). I've been asking every time for blood tests which are always refused because 'we don't tend to do them'.. I was on 75mcg Estradot, and 200mg per two days of cyclogest. The patch was increased a couple of months ago to 100mcg so I could (after much badgering) get some testosterone. However, the debilitating multiple nightly soakings were still happening after a month, so I increased my own dose to 125 - that stopped the night sweats by about 90% - relief!!
After a couple of weeks I had a breakthrough bleed, the first since my last period about 5 years ago, so I increased the Cyclo to the equivalent of 150mg a night and it stopped, so I went back to the original dose. Two weeks later I had another 'period' which was 3 days ago, and though there's not much blood I still have a fair amount of discomfort. (I increased the Cyclo 2 nights ago).
Eventually I got a call back from a GP, who told me I have to just stop HRT completely for 6 weeks, and she'll send me for a scan and an internal.
Understandably, I don't want to do this, but partly because all I've read says progesterone needs to be increased.
I appreciate they have to follow protocol, but it seems extreme.
I've been severely depressed for about a year too, I asked to change progesterone but there's yet another shortage so I couldn't. I'm so scared they'll stop my HRT and I'll be back to a sweaty mess who can't sleep/work/function. I've already been off work since last year, with only SSP to live on.
Please help.

[bombsh3ll]

Bleeding or spotting following a change in HRT dose is not usually a cause for concern as long as it doesn't persist beyond 3-6m.

However I do think that 5 years post menopause a scan is a good idea.

You don't have to stop your HRT whilst waiting for the scan - no expert ever thought it should be stopped but guidelines have been recently updated to reflect this.

Someone posted a link to the specific guidelines here within the last week, so you could search it up and print if necessary.

Assuming your lining is fine, 200mg every night would be a reasonable dose of cyclogest for 125mcg estradiol.

Blood estradiol levels aren't always clinically helpful and I think it's fair enough that NHS resources aren't expended on something that wouldn't usually change management, however I can understand you wanting to check absorption and/or to establish a level at which you feel well - maybe try Medichecks for this.

[Hurdity]

Hi Tulip

It's clear that the progesterone dose is insufficient for the oestrogen dose you are now taking, hence the bleeds. Because Cyclogest is off-licence for HRT the amount to be used is almost guesswork - though the British Menopause Society gives fixed dosages in their recommendations - but with an increase in the case of unscheduled bleeding. However the progesterone preparations available (including those used off-licence for fertility) will absorb differently because they are very different formulations. 

Added to that they progesterone doses for higher doses of oestrogen have not been established through trials so it also involves more guesswork!

A while ago I looked at the progesterone doses given for fertility, and based in that, if I recall correctly I  thought that the Cyclogest dose should be something like half as much again as Utrogestan - but this was just based on the product info dosages for fertility.

Whe I used Cyclogest my gynae specialist GP prescribed 400 mg for 11 days per 28 day cycle - which I used for about 4 years!!! Almost needless to say, I soon stopped getting withdrawal bleeds

Here is a summary of the guidelines bombsh3ll was referring to:

https://thebms.org.uk/publications/bms-joint-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

Hurdity x

[Tulip]

Thank you both so much!
I read the other thread after I'd posted - apologies for the similar question. I'd decided after reading it that I would stay on the same doses until the check ups, but the extra info is really helpful, and I very much appreciate it.
This forum is literally a sanity saver as well as a much better education resource than anything else. 

[seton]

It's so difficult for us ladies to tell the doctors what we have learnt when they're not up to date with latest guidelines..it's so awkward