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[sap22]

Hi... I was on estradot 50mcg twice weekly from June and daily utrogestan, but at my first review the oestrogen levels were still quite low, so it was increased to 100mcg twice weekly from 27 September.  I still didn't bleed which was what I wanted, so kept up the daily utrogestan.

Today I noticed a little brown discharge starting and a slightly tummy feeling like before you get a period.  I am wondering if that is because of the increased oestrogen in my system having overtaken the progesterone.  But that is just my guess, as I only started HRT in June this year, so fairly new to it.  I am 53 years old...  Any thoughts..?
Many thanks for reading xxx

[Dana]

Depending on how much Utrogestan you are using, it could be that the amount isn't enough to properly oppose the estrogen now that you've doubled your dose. You will need to talk to your doctor. Maybe you might need to increase your Utro dose or change it to a vaginal application (if you are using it orally), or perhaps look at an alternative, like having a mirena fitted or switching to a progestin, if you want to continue with a bleed free routine.

[Hurdity]

I agree - 100 mcg is quite a high dose of oestrogen! I presume you have been taking 100 mg daily - has this been orally or vaginally. If orally it is unlikely to be sufficient to protect the endometrium sufficiently - well the spotting is an indication of this.

I presume you are post-menopausal and have been without a period for 12 months before starting HRT? If irregular spotting continues and you don't like the idea of increasing the utrogestan ( or switching to vaginal use if you are currently taking it orally) - then you might like to think about going back to a cycle. Ideally a long cycle would be better if you are post-meno but this is less easy with higher oestrogen doses as the bleed could be heavier.

Otherwise as Dana says - a different, stronger progestogen would do the trick re protecting the uterus!

Hurdity x

[Dawncam]

Hi Hurdity/Dana  - would you explain why the low dose P causes spotting? I've recently started on conti micronor in an attempt to find a P which is low enough to use conti (currently waiting on jaydess appointment) but after 7 days I'm spotting. I'm on 1 mg Sandrena - is the P just too low? Would I be better to stop P and just wait for Jaydess fitting?

Dxx

[sap22]

I agree - 100 mcg is quite a high dose of oestrogen! I presume you have been taking 100 mg daily - has this been orally or vaginally. If orally it is unlikely to be sufficient to protect the endometrium sufficiently - well the spotting is an indication of this.

I presume you are post-menopausal and have been without a period for 12 months before starting HRT? If irregular spotting continues and you don't like the idea of increasing the utrogestan ( or switching to vaginal use if you are currently taking it orally) - then you might like to think about going back to a cycle. Ideally a long cycle would be better if you are post-meno but this is less easy with higher oestrogen doses as the bleed could be heavier.

Otherwise as Dana says - a different, stronger progestogen would do the trick re protecting the uterus!

Hurdity x

Thanks Hurdity and Dana for your insight... definitely don't want a bleed, as it just changes my PH and irritates down there - my nerves are all heightened at present (vulvodynia) and I have pain.  I wasn't exactly 12 months without a period before the menopause specialist put me on HRT.  My last proper bleed was September 2015, then I had a little discharge in November 2015 and was put on HRT in June 2016. But because of my difficult experience during the last period and the vaginal atrophy/vagitinis it was decided to do continuous and avoid a bleed.  Yes, the Utrogestan 100mg was daily and orally. Will see how it goes. thanks for sharing your knowledge xxx

[Hurdity]

Hi Hurdity/Dana  - would you explain why the low dose P causes spotting? I've recently started on conti micronor in an attempt to find a P which is low enough to use conti (currently waiting on jaydess appointment) but after 7 days I'm spotting. I'm on 1 mg Sandrena - is the P just too low? Would I be better to stop P and just wait for Jaydess fitting?

Dxx

Short or long answer?!!

What have you changed from? Any decrease on progestogen can cause spotting/bleeding as it is the reduction in progestogen which triggers a bleed if there has been sufficient lining built up. It may not be too low - if you remind us where you are in menopause and what you have been taking it makes it easier to understand. Often any changes in HRT will lead to spotting and bleeding but often it takes a while for continuous combined HRT to stabilise the womb lining so that bleeding stops - so it is too soon to say after 7 days probably.

Hurdity x

[Dawncam]

Many thanks Hurdity, I thought it might be too early and just settling in.

Dxx