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[Jaz]

I had subtotal Hysterectomy 2007 and been on Evorel patches 75 x 2 per week for 10years which worked fine.
However I recently had very light bleed, fortunately MRI, Hysteroscopy and biopsy came back clear, but my Gyni said they could not rule out malignant change to Endometrium from unopposed estrogen.
I’ve been taking 200mg Progesterone tablets (12 day cycle) for last 3months and although they make me drowsy in first few days, i later feel anxious/ flat mood especially towards end of cycle.

 I’ve  been having a very light bleed at end of cycle so been told have to continue as there must be some endometrium left in cervical stem.
Apparently its hard to remove this as bowel can get stuck to stump.
Has anyone else had this issue, seems strange as i had my op such a long time ago without any problems.

I’ve now been advised to try 100mg Utrogestan daily vaginally as may not affect mood.
I’ve read a few posts on here and some women are also having a break when taking vaginally, please do share any experiences, I’d like to be armed with this before i agree best option.
I have reduced my Estrogen by 25mcg for now.

Thanks Jaz

 

[CLKD]

Who did your surgery?  R U able to get a referral or access to those surgical notes?   Your GP should have a record of the Consultant's letter from that time.

Did U have endometriosis?

[Jaz]

The surgery was back in 2007 at a different hospital to where I live now. I’m 62 now.

I remember the menopause clinic saying they would check the records before starting me on hrt which must have been ok. It was a gynaecologist that did the surgery and i’ve never had endometriosis or any spotting/bleeding until recently.

My current gynaecologist is from meno clinic who said what i shared below, they all seem to be saying regardless of the success of the op the situation can change but there is no actual evidence and even scans and biopsy cannot rule out future risks. I kept my cervix  and ovaries.

[CLKD]

Morning.  I believe that ovaries can pump out hormone = bleeds which may be the reason.  As oestrogen levels drop too, we can see changes in patterns.  Hopefully some1 will be along today with more knowledge.

[sheila99]

Worth trying vaginally but although it sorts out digestive issues it often doesn't help with others, it still makes me drowsy and for me 100 is as bad as 200. If you're staying on 50mcg oestrogen it gives you the option of conti patches so you may find one of them suits you better than utro. Or there's cycligest but that's off licence for hrt.

[CLKD]

Tnx sheila99 

[Hurdity]

Yes you can take utrogestan cyclically at any stage - whether taken vaginally or orally, even when post-menopausal and it will allow shedding of any endometrial lining of tissues that are remaining.

I presume you have been referred for investigation to check for malignancy? If all is well and the lining from the stump (if that's what it is) is just thickened, then you should be able to continue HRT as normal but with progestogen as if you still had a uterus, I imagine. There are always risks - those of us on HRT do so in the knowledge that we need to protect our uterus from potential cancer, and the licensed dosage regimes are designed to minimise that. I should add that I know nothing about this situation but just applying principles of HRT.... together with the information on this website:

https://www.menopausematters.co.uk/aftermeno.php

"Sub-total hysterectomy

If the main part of the uterus has been removed but the cervix retained, it is currently uncertain whether HRT can be given in the form of estrogen only or estrogen combined with progestogen. The slight concern of using estrogen only, is that there may be some of the cells of the lining of the uterus in the cervical canal which could become thickened from the estrogen. This thickening can be prevented by adding in progestogen. To find out if progestogen is required, it may be suggested to use estrogen combined with cyclical progestogen for 3 months after your operation. If there is monthly bleeding in this time, it means that cells are present which are responding to the hormones so estrogen and progestogen should be used thereafter. (These hormones can however be given together continuously to avoid monthly bleeding). If there is no bleeding in the first 3 months, then estrogen can be given on its own thereafter. "

Hope this helps

Hurdity x

[Jaz]

Thank you for responses ladies, I had an appointment at Newson clinic today and they agreed I should have been given progesterone at the time I started hrt back in 2013 rather than now. But it’s clear I need to take it while on hrt but can have lower dosage of 100mg and you can use oral progesterone as a pessary as they don’t currently do pessary in less than 200mg.
I will try the 100mg which my gynae is prepared to prescribe via gp.
Feel a bit more reassured  I have a plan, thanks again…such a great website!