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[Bluebirdie]

Hi,

I'm 53 and as far as I know, perimenopausal. Started on HRT about 3 years ago. Saw new gynaecologist for heavy periods as was hoping they might just adjust the HRT.

He wants to do hysteroscopy, biopsy and Mirena insert.

This feels a bit rushed to me. But I'd appreciate some other opinions because I don't know too much about things.

I haven't actually ever STOPPED my periods, only had erratic ones, and went onto HRT for wider symptoms. They've always been fairly regular but increasingly heavy/clotty. I didn't think TOO heavy and don't really have any intermittent bleeding regularly, although I did sometimes have very weird lengths of cycle when not on hrt.

I have really waterfall like periods in the first couple of days, like 6-8 really full mooncups a day, then very little after that. I guess typically about 200mls loss with smallish clots (like cherry size)

I had an ultrasound some years back which found small fibroids.

The gynae appt just felt really rushed and designed to push me down this particular pathway. I said I wondered if there was a less invasive place to start, like maybe adjusting the HRT, or testing my hormones.

I also said that I wasn't keen on the Mirena as I also have chronic bladder problems and I've known some have a problem with this. The gynaecologist just kind of scoffed and said thats just menopause. He really wasnt interested in hearing me explain I'd had these issues since I was 17...

Of course he mentioned checking for uterine cancer and of course I'm not wishing to avoid investigating that. But is there not a more humane investigative way of exploring first.

I'm afraid to say I really don't trust (male) gynaecologists, where everything looks like it can be fixed by their surgical intervention. This may be outdated and naive these days.

But given this was in a private clinic, clearly brought in by NHS to clear a backlog (even though he's also an NHS gynae) I wondered about the economics of this also.

And then I thought I can't be the first woman in this forum to ask these questions?! Does anyone have any experience or advice to offer? Thanks x

[Jane50]

Hi Bluebirdie,

I know exactly what you mean. I am on HRT and have also had heavy bleeding. Like you,  just for a couple of days and no intermittent bleeding during cycle. I also felt 'pushed' down a particular route - hysteroscopy and Mirena. I said I didn't want a hysteroscopy until results of scan . Turns out I didn't need a hysteroscopy as lining was fine so it would have been unnecessary... I am really not keen on the Mirena so have declined that for the moment.

 I have increased my vaginal utrogestan to 200mg and this has reduced the bleeding significantly and for me is a much easier, less invasive solution for the time being. I don't know whether menopause has made me more assertive but I just don't want to be pushed into medical 'solutions' I'm not comfortable with. I think every woman's experience of menopause is unique to them and they should be entitled to deal with it their way and have choices available to them. I've also developed a lot of health anxiety with meno and am not comfortable with certain procedures . I find trying to do it my way helps keep anxiety levels down. It may be an illusion of control but it helps!

That's why this site is so great because it gives you access to lots of different women's experiences and educates you on options available.

What HRT are you on at the moment?

x

[Bluebirdie]

Thanks for your reply. Encouraging to know I'm not alone in feeling resistant to procedures that may not be needed. Or may but...

I'm taking 3 pumps of oestrogel daily and 12 days of utrogestan 100mg orally. My previous gynae who prescribed this retired. I'm thinking I need a second opinion really but no idea how to go about finding a more gentle menopause specialist, ideally a woman without a surgery need!? Argh.

[Jane50]

It was my gynae who suggested  increasing the utrogestan. At the time I was taking 200mg orally which he said to increase to 300mg. Didn't make much difference orally so I tried it vaginally as lots of women on here have said it increases absorption rate. 300mg vaginally definitely reduced the bleeding but gave me a whopping headache! Reducing to 200mg vaginally is working at the moment... I'm on 4.5 pumps oestrogel.

Have you considered taking the utro vaginally to see if that helps reduce bleeding?

Or maybe get a referral to a menopause clinic for advice?

x

[Bluebirdie]

I asked my GP about a specialist menopause clinic. He just looked confused and said gynae all deal with menopause anyway.  I'm going to have to find the right person myself I think. Argh.

[Bluebirdie]

Also, yes, tweaking the progesterone was exactly the kind of starting out advice I was hoping for from the gynae appt, but clearly no... I'm reluctant to try the increased dose without supervision though. But maybe if I can't find a medical person who I do trust then I'll have to!

[Shannonplussed]

The licensed dosage of progesterone is 200mg orally for 12 days. That’s likely a big factor.

[Bluebirdie]

Thank you. That is really helpful. I wonder why I was prescribed 100mg inthe first place. Perhaps because I was still having regular periods or to see if I tolerated it.

I've put myself on the waiting list for one of the female-led specialist private clinics that I found searching other posts. So if I can manage to get an appt before the gynae comes back to me, hopefully I'll be able to make a more informed decision about whether to go ahead.

[Hurdity]

Hi Bluebirdie

Until I got to shannonplussed's comment I was thinking exactly the same. 100 mg orally for 12 days for 3 pumps of gel is way less than the prescribed dose. Firstly if you are absorbing it that is on the higher side for an oestrogen dose and yet the progesterone dose is half of what you should be taking.

Also I;m a buit confused as to whether you are talking about your natural cycle or the artificial cycle from HRT.

If you are taking HRT with 12 days of progesterone you sho8ild be getting regualr bleeds anyway although, unless you ovulate they are not proper periods as such.

You said your cycles had gone a bit awry before you started HRT - how long were your cycles? Were your periods becoming few and far between?

If you do still ovulate fairly regularly then your own progesterone should help to keep the lining thin. If not then it;s down to the progsterone in the HRT to provide the protection.

The usual route would be to do a scan first - abdominal ( like when pregnant) and then a transvaginal. The thickness of th elining and its appearance should give an indication of whether a hysteresocopy or biopsy is needed. However to giv e atrue picutre this must be done immediately following the bleed and before the lining has started to thicken - otherwise the thickness could just part of the normal cycle and won;t tell you anything.

Maybe that's why gynae offered hysteroscopy and biopsy. I mean if you;ve been on that dose of oestrogen and prog for 3 years I would welcome proper investigation although delaying it a few weeks while you wait for a scan shouldn;t actually make much difference.

Provided the hystersocopy is done properly it's really not bad. I was in and out in 10 mins i would say. Just took the painkillers beforehnad, put my legs in stirrups (bit undignified), peered at  picture of my womb as doc did it and hey presto, done. They did want to put a Mirena in but I was having none of it....

Do let us know what you decide....no need to go privately - you can always make your own suggestions I would say?

Hurdity x

[Bluebirdie]

Hi Hurdity,

I am fairly sure I was still ovulating when I started - my periods were pretty regular, although I'd have the odd missed one or super short cycle. I've been monitoring it back from 2014, a few years before I started HRT, and my average cycle was then (before HRT) and is now, typically somewhere between 22-30 days, but mostly 26ish.

I've had a couple of v short cycles in that time, and one or two before HRT where I went for 100 days etc  without a period.

I had assumed that the low dose was because the previous gynae was trying to help with perimeno symptoms which, as he put it, I was v sensitive to"!

But since he retired, I haven't really been able to get anywhere with my GP.

I did ask the new gynae about scanning first but he dismissed this idea completely. I not sure why and I now wish I'd pressedthis more. Not quite sure what to do to try to get that back on the (NHS) agenda? Maybe I should go back to my own GP to discuss that further...

[Hurdity]

Hi Bluebirdie - apologies for late reply as I've been busy and not on the forum. Also for typos in previous post. I do read them through before posting but I need better glasses! I've also answered your pm.

If you have any issues at all with bleeding etc on HRT then your GP should be able to deal with it although if the HRT itself is from a private prescription it might confuse matters. Nevertheless the NHS is there to sort out health issues. I would definitely have a hysteroscopy and biopsy if you are worried about the bleeding and your own GP should refer you for a scan if this is warranted. You are entitled to be seen by an NHS menopause clinic although there may not be one in your area ( there isn't one in mine so I've never tried asking to be referred to somewhere distant - anyway I have a v good specialist GP so have no need to).

Let us know how you get on and what transpires - if you see this post!

Hurdity x