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[Mainecoon1]

Hi Everyone! I'm new to this site, and as many woman have mentioned, hoping to get some insight into particular issues regarding HRT.
54 years old - through the menopause by March 2012.
Been on a couple of HRT combinations since Dec 3016 and as of 3 weeks ago, began Evorel Conti + Evorel 25 (2 separate patches twice a week).
Having read various literature I am aware Evorel Conti can cause intermittent bleeding up to first 6 months. However I have now been bleeding every day for 15 days. It does begin to tale off, but once new patches are in place it begins again big time.
I've been given conflicting advice from GP's i.e. too much oestrogen which may be causing the bleeding, or not enough progesterone to balance the combined oestrogen of 75.
Any advice or anyone with similar experience on this combination would be very much appreciated.
Thank you 🙏...

[Dotty]

Are you using the Evorel 25 as well as the Evorel Conti?

[Mainecoon1]

Yes I'm on both as suggested by a Specialist Menopause Dr.

[Dotty]

Bleeding can be expected in first 6 months of any new hrt so it might just be that you have got to give your body time to adjust to the new regime. X

[Hurdity]

Hi Mainecoon1

 

The thing is both docs are right  - in other words it's the "wrong" balance between oestrogen and the progestogen which can lead to bleeding. The first thing to do is to get the dose of oestrogen right that eliminates your symptoms to the level you want - so if it's flushes and sweats - then you need a high enough dose to ensure they are banished. You won't be able to tell this ( if this was what led you to restart HRT) for a few weeks maybe - although you should begin to feel the benefit in days. Once you've got the oestrogen dose right the progestogen dose needs to be sufficient to prevent bleeding and keep the endometrium ( womb lining) thin.

Unfortunately this can take up to 6 months. You are taking an unusual combo ie higher oestrogen dose than is licensed for the patch, so it may well turn out not to be enough progestogen even if the oestrogen dose suits you. Only time will tell. Perhaps your specialist or GP will refer you for a scan earlier?

May I ask when you last took HRT, what was it and did you have a bleed afterwards or perhpas you had a sacn at some point? The reason I ask is maybe your womb lining built up a little on the previous HRT unbeknownst to you, and the addition of progestogen is causing it to become unstable and shed.

Hopefully you are feeling better and your bleeding will stop soon

Hope this helps and do let us know if we can help further!

Hurdity x

[Mainecoon1]

Thank you for getting back to me.
There was no break between changing my HRT. I have never bled before (i.e. before 2011) and never had a scan.
I primarily saw specialist to get advise on vaginal dryness issues, but on looking at my prescription she decided it could be improved.
I was previously on Evorel 75 + Norethisterone 350 microgram (one table per day, patch twice a week).
Specialist advised progesterone was too high and potentially cancelling out benefits of Evorel 75.
I currently have no major menopause symptoms, but bleeding is constant and I feel it's taking it's toll, but this could be psychological as I didn't think I could ever bleed again having gone through the menopause 6 years earlier, and didn't understand that one could bleed for weeks -  ignorance on my part!

[Hurdity]

Hi again

350 mcg norethisterone is not a high dose though! In fact it is lower than the dose given as part of tablet HRT which is either 500 mcg for continuous combined HRT ( low dose 1 mg tablet oestrogen) or 1 mg (1000 mcg) norethisterone for 2 mg oestrogen - medium to high dose oestrogen. In fact it this could explain the bleeding - ie the lining could have built up on that amount of oestrogen and now you are on a higher dose of norethisterone this could account for the bleeding although it's still more oestrogen compared to the licensed dose of progestogen ( for 50 mcg patch). If this is the case it should settle down but do ask your GP (or doc at menopause clinic) to refer you for an endometrial scan if you feel it is not settling or you are worried.

Did your symptoms suggest to the consultant that the progestogen dose was cancelling out the benefits of the Evorel 75? Some women also find that there are continuous low grade progestogenic side effects when progestogens are takne continuously and norethisterone is one that can have this effect.

The answer could be to revert to a cycle ( when bleeding would be predictable) or have a Mirena coil fitted ( which would eventually limit the bleeding and hopefully stop it altogether).

Hurdity x