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[Grumpymum]

HRT is keeping me guessing! I have just increased my estradot from 50 to 75, and have been taking the  utrogestan 200mg (day 15-26). I'm now on day 8 of the utro and started a bleed, having been spotting for a few days. I'm rather confused as I was expecting the bleed after the utro had finished. When I was on the estradot 50, I wasn't getting a withdrawal bleed at all, but I also was getting poor symptom control too, hence the increase in the estradot. I've just returned from a week's holiday - thank heavens  the bleed didn't arrive while I was away!

Is this early bleed due to the increase in estradot, and does it mean it is now too high? Or is something else going on?

I'm now 51 and my last blood test did suggest that I am post-meno, although I know that is unreliable, but I have been on HRT for over a year now.

I'm still having problem with anxiety. We have just been on holiday abroad and the anxiety was really hard to cope with. I had great difficulty with packing, I just wanted to stick my head in the sand, hoping it would go away. I don't really know what the anxiety is caused by, as I am not consciously worrying about anything at all (maybe just worrying to not have everything). It seems totally irrational. I need to speak to my GP about this. I had hoped HRT would help this. I also take escitalopram, so had hoped the anxiety would go. Maybe CBT might help. Any thoughts? I feel such a killjoy, my hubby and daughter really get excited about holidays, and I think my anxiety is rubbing off on my son.

Sorry for rambling on with two different threads going here. Any advice on either greatly appreciated. MM is a lifeline for me.

[Dancinggirl]

Grumpymum
I have just been to see my private gynae today with exactly the same problem as you but I am using a very low dose of oestrogen. I had spotting start early on in the last Utrogestan stage.  My gynae said that my very low dose of oestrogen may not be enough to give the right balance of hormones so could be triggering this spotting.  He told me that the balance of oestrogen to progesterone is important so this would suggest to me that by increasing the oestrogen dose you may have unbalanced your hormone levels so the utrogestan dose is now not sufficient.  I know that in the USA Utrogestan (called Prometrium) comes in different strengths probably to accommodate the differing levels of oestrogen used.
Having said this I think it is not uncommon to start the bleed a bit early so I wouldn't worry at this stage - if you get ongoing problematic bleeding then this should be investigated.
If you are trying to control anxiety and low mood, I have to say I am not convinced that raising oestrogen levels will necessarily improve things. I've read so many posts on MM where women keep increasing the dose to no real benefit.
A colleague of mine at work has ended up on a medium dose HRT to control flushes etc. together with the SRRI Citalopram to help with her anxiety and she is doing well on this combo.
I have found Mindful Meditation really helpful so some CBT could be a good idea. DG x

[Grumpymum]

Thanks for your reply Dancinggirl. I think I will give it another month on this dose to see if this happens again before maybe dropping it down again. My doctor seems a bit clueless about HRT. She even tried to refuse me a repeat prescription as she said I had been using too many patches, claiming I should only change estradot once a week, when the instructions clearly say two patches a week. I have to now see her this week to resolve this issue.

I was on citalopram previously and was for a few years and have just changed to escitalopram as my doctor suggested it was better at helping anxiety. Maybe again I need to give it time to really take effect.

Something which does occur to me. Last week on holiday my usual routine was obviously rather disturbed and ate later than usual, and so I didn't allow 2 hours between eating and taking the utro. Would this have an effect on the absorption and result in it not working correctly?

[GypsyRoseLee]

My last 2 cycles on Estradot and Utro my bleed arrived early on day 23 and day 24 of my cycle.

The first 2 cycles it arrived 4 days after finishing the Utro.

[Grumpymum]

It's strange, isn't it GRL? I thought the bleed would be on a reliable cycle. As I said, I'm just pleased it didn't make an appearance until I was home from my holiday.

[Dancinggirl]

My understanding is that Utrogestan isn't as stable as the synthetic progesterones so absorption can certainly be effected if the stomach is not fully empty.  I suspect the slightly erratic bleeding could be a side effect of using Utrogestan.  I saw my gynae yesterday and he did intermate that Utrogestan was a safer option so I think it's worth persevering and perhaps putting up with some ups and downs when using it.  DG x

[oldsheep]

before I was on continuous Utrogestan, I always had a bleed before the course had ended. This seemed to surprise, if not worry, the meno clinic doctors.
I also bled profusely on too high a dose of Utrogestan (the 200mg) which confused them further.