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[Anne_N]

Hi.
It's approx 16 months since my last period - I was on sequential HRT at the time. I switched to continuous HRT and had one period approx 6 weeks in then nothing at all. 4 weeks ago I started to get very tender breasts and 4 days ago had bad pain around my fallopian tube area and felt bloated with a hard stomach/pelvic area. I thought I noticed some blood but wasn't sure. Next day I started what seems to be a period and have been bleeding since, a regular flow, some clotting and very painful - wakes me in the night it so painful.
Just wondering if my body is just having one last hoorah before shutting down completely? Has anyone else experienced this?

[skkb]

I think it’s a lot of trial and error with HRT, many GPS aren’t awfully clued up on it unfortunately....but understandably. I’ve taken HRT in various forms (including a nasal spray, which was great but think it’s now been withdrawn) for 18 years and have occasionally had a ‘breakthrough’ bleed when change to something different. Now 70 never thought I’d still need it, but alas the symptoms keep coming back if I stop (which I have tried several times) I’m sure yours will settle, but don’t leave things indefinitely if your gut tells you it doesn’t feel right.

[Anne_N]

Thank you for the reply.
I have been on HRT for approx 4.5 years at this stage and after hit and miss the first year all was going great, really happy with it, I was just not expecting to get a heavy and painful period after so long. I'll definitely be getting it checked out.

[Uptick]

Hi Anne_N, welcome to the forum. If you have been on HRT for 4.5 years you won't know if your 'last period' was 'approx 16 months' ago, because that could have been a withdrawal bleeding from the sequential HRT. How old are you? Maybe you're just having your real last periods now, ie you're still perimenopausal?

[Anne_N]

Hi Anne_N, welcome to the forum. If you have been on HRT for 4.5 years you won't know if your 'last period' was 'approx 16 months' ago, because that could have been a withdrawal bleeding from the sequential HRT. How old are you? Maybe you're just having your real last periods now, ie you're still perimenopausal?

Hi. Thanks for replying. Whilst on the sequential HRT my periods started to taper off to the point that I was not getting a monthly bleed at all after a few months of this I then moved to continuous HRT, had one short bleed at the start of that, which is totally normal, but nothing since.
I thought menopause was considered to be if no period for 12 months? My real concern though is why I would suddenly have a period after so long whilst on continuous HRT which I don't think is normal.  Just wondered if it had happened to anyone else. I'm 54.

[Uptick]

Yes, natural menopause is reached after 12 months without a period, but not when you're on HRT.

What was the sequential HRT regime and what is the current continuous regime? I would be more concerned with the lack of bleeding whilst on sequential HRT than whilst on continuous, which is exactly what is expected.

You say you had a short bleed at the start of continuous HRT (normal) but nothing since (expected), but then you say your real concern is why you would suddenly have a period after so long whilst on continuous HRT... I'm confused, how long have you been on continuous regime?

Anyway, I think you're still perimenopausal and your own hormones are kicking in, unless you're over 60's.

[Hurdity]

Hi Anne_N

 

First - once you start HRT then you don't know when you are post-menopausal. This can be assumed approximately on the basis of age, what your periods were doing before you started HRT, and your bleeding pattern, but you can't say definitely.

Therefore the bleed you have had may or may not be a post-menopausal bleed, but in any case because you are on continuous combined HRT is not actually classed as such.

Having said that, any bleed after a long time without - which includes being settled on continuous combined HRT for that length of time without a beed - should be investigated just to rule out other causes. This could be due to a late ovulation (after all you are only 54) or it could be that the balance between oestrogen and progestogen is not quite right and that your womb lining has thickened, causing the bleeding. It could be because the levels in your body have changed for some reason. What type/brand of HRT are you taking? Finally it could be due to some problem with your womb lining eg fibroids or polyps etc.

Whatever the reason you should report this to your doctor and you should be referred for a scan - ideally abdominal and vaginal, to determine the thickness of your womb lining.

By the way it is not a worry not to bleed on sequential HRT. This is quite normal for women who may become post-menopausal while still on sequential HRT,. It just means that the particular brand of HRT that you are using is controlling your womb lining to the extent that it doesn;t build up during the two weeks of oestrogen only. This happened to me in my late 50's. I was still on a 28 day cycle and my withdrawal bleeds stopped. The doc said to go onto continuous combined but that didnt suit me so I stayed with a cycle (even though I am mid 60's) so I knew I could safely go onto a longer cycle (with her approval). Some women never bleed on sequential HRT. Unscheduled bleeding is always more of a concern than lack of beeding!

Hope this helps

Hurdity x

[Padine]

Hi Anne,
 Maybe it’s a hormone surge (a last hoorah 😃) I had that 14 months after my last period, as had the lady GP who referred me. It was investigated and nothing sinister, no invasive exam. or lengthy wait for results. Try not to worry.