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[applejack]

Hi there

I'm post menopause, been on HRT for over 2 years and have had bleeding on and off since Feb.

Investigations 6 months ago found a thickened endometrium (8mm) and a polyp which was removed. biopsy performed, results clear.

Bleeding did not stop so further scan yesterday and a hysteroscopy next week. My oestrogen dose has gone awry so is being tweaked a lot at the moment and I'm now on a very high dose (estradot 150). Utrogestan got upped to 200mg daily, conti, which has reduced the bleeding but it's still there.

My menopause specialist was concerned that I hadn't had a hysteroscopy in the first place, so now I'm panicking about that.  Also the scan yesterday showed that the endometrium had actually reduced to 6mm despite the high dose of oestrogen I'm now on (perhaps the increased utrogestan has helped).  Obviously I'm pleased that it's gone down and not up, but I'm not sure I want to be on 200mg utrogestan long term. Also there's another polyp in there.

Really not sure what my options are.  If I drop the utrogestan dose the lining will probably thicken again, especially with such a high patch dose. I'm also really worried about the hysteroscopy, even though my biopsy was clear, because it sounds like the hysteroscopy is more thorough and I didn't have one.

Is provera a better bet for keeping this thin on a lower dose?  And can it help with polyps?

Also the doctor I''m seeing for the investigations told me to come off oestrogen completely for a bit and just keep going with the utrogestan to thin the lining out and reduce risk, whereas the doctor I saw in April told me not to stop HRT. If I stop my oestrogen I will literally cease to function and I've never heard this kind of advice before (I've ignored it).

[CherrySG]

From what I've read on here, and I haven't experienced having to thin a thickened endometrium, Provera is more efficient at keeping the lining thin. I was mostly on Provera and never had bleeding. There is someone who posts on here sometimes who mostly takes Utrogestan and once a month or so takes Provera to avoid thickening.

No idea about polyps, sorry.

[applejack]

Ohhh, that’s interesting- thank you!

I’ll ask about that - I really want to avoid a mirena if I can unless as a last resort.

Thank you!

[Floo36]

Could taking one utrogestan orally and one vaginally be an option? Don’t stop the Estrogen, bad advice and not considering the impact it could have on your well-being.

[applejack]

Yes, I was taken aback when she suggested that course of action. Sudden cold turkey for two weeks while they do the scans and investigations when I'm already stressed enough as it is?

No way, Jose

[Hurdity]

Hi there

My female  gynae specialist GP used to suggest I take a course of noerthisterone once a year as she put it "to strip the lining" because I used long cycle HRT with utrogestan, so this was to ensure the lining could be thinned should it have built up. I have to say I have only done this a couple of times but then I never get any abnormal bleeding (so far).

What you could do is as suggested - maybe take a course of Provera for two weeks or so and then stop - this would enable a proper bleed rather than an abnormal one, and then your lining could be scanned again. I would hope a doctor might suggest this as a course of action.

Re the hysteroscopy - the fact that you have had a biopsy and all is well is grounds for not worrying! I would have thought they would have needed a camera to guide where to take the biopsy from? I'm guessing this was just taken from any part of the uterus? A hysteroscopy would explore the whole inside of the lining to check for abnormalities - and the fact you have polyps shows that they must have checked for this ( maybe they show on the scan?). The biopsy is actually taking a sample of the cells to check for abnormailities whereas the hysteroscopy just takes a look around.

In terms of the lining thickening - the amount of progesterone needed to protect the endmoetrium is dose dependent relative to oestrogen - so the higher the oestrogen dose the more progesterone is needed.  As you are on a high dose it is not surprising that the lining has increased. 100 mg utrogestan daily esepcially if taken orally - is not up to the job probably, for many women and so yes, a higher progesterone dose is needed. You could go onto a cycle though this might need to be monthly with a high oestrogen dose and then you would have to have a monthly bleed.

And to add also - no need to stop taking oestrogen while you sort the lining out...

All the best with your decision and hope the hysteroscopy goes well!

Hurdity x

[applejack]

Hi Hurdity, thanks for the reply

Ah, no - the first time in April there was no camera. The reason she found the polyp that time is because it was right at the top of the cervix so she could see it. The biopsy itself - she just took a random sample, which is why I'm now so worried and why my meno specialist has pushed for one.

The scan this tuesday showed a polyp - she said she was very confident it was a polyp and not something sinister when I asked several times because I was so anxious!

After the scan (wednesday) I felt fine and the spotting just carried on in it's own sweet way, but yesterday, my goodness!  Full on period levels with pad. I wondered if the probe might have dislodged something but then wondered if it might be the effect of the doubling of the utrogestan dose.  It went from 100-200mg three weeks ago (but surely a rise in progesterone holds the endometrium in, not pushes it out?)

Gah!