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[starbuckfan]

Hello
Can anyone help please?
I'm 65 , on HRT patches for 15 years. I've had breakthrough bleeding for 5 months now. Had a scan and hysteroscopy. Results ok. What can I do now? Feeling very tired and emotional. Doctor says they can't check hormone levels and advises coming off HRT. Common sense tells me I need a higher dose. Anyone had a similar issue? Thanks.

[Taz2]

Hi Starbuckfan. You will find lots of help and friendship on here. I'm sure most of us can identify with the tired and emotional feeling  Which type of HRT are you on?

Taz 

[Dancinggirl]

Starbuckfan - welcome to mm
I assume you are on continuous hrt?
Erratic bleeding is common on any Conti HRT - switching to a higher dose might actually make things worse. At 65 it is really important to be in the lowest dose of hormones as possible.
I had this problem in my late 50s after I had my Mirena removed at 57( I used Oestrogel alongside the Mirena which was a great non bleed HRT combination ). I took a break from hrt for a year and then went back on HRT using Utrogestan as the progesterone with Oestrogel. Oestrogel with Utrogestan is considered the safest hrt for older ladies and I tried various ways of using this regime, even trying a sequential regime, but the Utrogestan couldn't control my uterus that well and the erratic bleeding and cramps were bad.
Many women stick with a sequential hrt regime and put up with the monthly bleeds to avoid problematic bleeding but I think I had simply got to a stage where my uterus simply wouldn't tolerate the hormones - it didn't want to play nicely any more!!! If I had had another Mirena that may have solved the problem but I decided at 60?I would just stick with local oestrogen for the urogenital atrophy and donwithout the systemic HRT. I just use Vagifem and I'll use this for the rest of my life.  Now 62 the flushes are manageable and it's a relief to not have all the side effects of hrt - in other words the side effects of HRT were outweighing the benefits.

SO - I would suggest you perhaps try switching to a sequential hrt and preferably use a transdermal form of HRT eg Utrogestan with Oestrogel/oestrogen patches or try combined patches - see options under TREATMENTS on this site.
OR
Drop down to a very low dose Conti HRT eg Femoston Ultra low dose.
OR
Have a Mirena fitted and use oestrogen patches or Oestrogel.
OR
Take a break from HRT to see whether you can manage without?
DG x

[Hurdity]

Hi starbuckfan

  from me too!

Great suggestions from Dancinggirl, and I agree you should not need a higher dose at 65 after 15 years - your body will have long ago acclimatised to the dose of oestrogen you are taking. Why the bleeding though? Did you receive any explanation?

By the way they can check hormone levels - what's that about?! Also you don't need to come off HRT if you have no risk factors and are otherwise healthy (not overweight, low BP, healthy diet, plenty of exercise, not a smoker etc) - that is the doctor giving up on you and somewhat out of date!

As the others have asked - what type and dose of hRT patches are you using - presumably either Femseven or Evorel conti? Do you recall what your womb lining measurement was too? Sometimes you can get spotting or bleeding from endometrial atrophy (lining too thin) when the progestogen dose is too high and works too well in thinning the uterus - the doses of combi patches are balanced to work for the majority of women but the balance isn't right for everyone. Maybe after such a long time on this product you actually need a slightly lower dose of progestogen - although one doe not want to risk over-thickening either.....

Hurdity x

[starbuckfan]

Thank you so much for the replies. I'm amazed . I'm on Fem7 conti 50 oestrogen and I think 25 progesterone. Lining is very thin and no apparent probs. What's coming away is mostly very dark and thick, then every so often I have a burst of fresh red blood. 3 or 4 days break then starts again. I just feel somehow it's not healthy.  Doc Def said no tests on hormone levels, " we don't go into that kind of detail". Young female, but didn't seem to know anything about HRT.

[Moe68]

I was put on HRT when I was 43 and settled with Everol Conti. I was on this for 25 years, but I found that after flying, this would cause me to bleed for about 4 days. It wasn't like a period, more dry black stuff. Told my doctor who sent me for tests on all my openings, scans, x-Ray's, but they couldn't find anything. The next time I flew it happened again, luckily both times I had some Tena Lady pads, not because I've got a weak bladder but I can't stand sweating in hot countries. I didn't rush to the doctors but told her when I went for my review. She said it was quite common but suggested I went on Fem7 Conti. These were fine, but they just don't stay on, and as they are suppose to stay on a week, I had to find a way to stick them on, which I have. The senario now is that I bleed for a week, off for a week, on for a week. Just like before, it's not a heavy period but at least on these patches, I do have more energy, and I don't get an aching stomach. I have an appointment next week to see my doctor as I'm trailing these out and she needs my feedback. I'm also lucky in that she lectures about HRT so unless I stay, she won't take me off them as it's more beneficial as you get older and I can see the difference between myself and my sisters who are no longer on HRT. I'll see what she does say, but these Fem7 Conti patches I think should be changed twice a week like the Everol Conti have to be. I will ask if there's anything that will stop these bleeds.
Update: went to doctors who has put me on tablet HRT which I take st night daily. It's for the over 65 year olds so this should now stop any bleeding. No ill effects yet, but sleep much better.

[starbuckfan]

Thank you that would be great. Fem7 sticks on for me ok but only 1 a week.