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[Lydgate]

After initial euphoria and feeling great for a couple of weeks…. Low mood and erratic period pain and bleeding have taken over. It’s got worse as the 3 months have gone on.
This is my first 3 months on hrt. Just finished a 22 day period, which started on day 25 (month 2) and carried on until day 15 (month 3) when it then came again with a vengeance, very unpleasant, and finally ended on day 19. I felt so low, and tired, with no energy or enthusiasm the whole time.
I have a telephone appointment with a different doc tomorrow, as womens doc is on hols. Is it too soon to ask for a change, or should I give it longer to settle down? I have felt so bad at times, I feel as if I would be better without hrt at all. The only thing which has consistently improved is sleep quality and hot flushes. Thank you friends. X

[Flossieteacake]

Hello Lydgate. If it were me I would ask to try something else. It sounds like your mood is very low and that is horrible for you. They do say to give HRT at least 3 months and you have done that.

[Lydgate]

Thank you!! I have a phone appointment tomorrow, and I have dropped off a 3 month symptom diary at the surgery, so hopefully a miracle will occur!!

[joziel]

What HRT are you on at the moment?

[Lydgate]

I’m on Evorel Sequi. So, the doc has persuaded me to go into month 4, as the specialist gynae doc is on hols. They were also talking about Mirena coil, but I feel really reluctant to have a 5 year fixture put into my body at 53……

[joziel]

You could ask to try separate transdermal estrogen and utrogestan (body identical progesterone). You could still have a patch, only it would just have the estrogen in it - and then the progesterone would be body identical, which is better for your health anyway - instead of a synthetic progestin, as in Evorel Sequi.

Many women find that body identical progesterone (utrogestan) is less likely to cause low mood than synthetic progestins.

Plus, if the utrogestan doesn't stop the bleeding orally, you could also try it vaginally. It tends to have a stronger effect that way, especially if you use the same amount, so it might work better for you.

Otherwise, yes, the Mirena coil and then separate estrogen. I don't get what you mean about your age... If you take HRT estrogen at all, you need something to keep your uterine lining thin - that need isn't going to go away no matter what your age is. You will still need a progestin at age 80 if you have a uterus - and if you don't have a Mirena, it will be another form of progestin. Women can continue to get Mirenas fitted for as long as it is comfortable to get them fitted and removed - way into their 60s and beyond, often. It will probably not be your one and last Mirena if you get one now... And you don't have to leave it there for 5 years either - it's your body and if you ask for it to be removed, it will be.

[Lydgate]

Thanks for your advice Joziel. Very very helpful.
My objection to the coil is not to what it does, it is to its permanence. Does that make sense? Everyone is saying how you need to tweak your hrt to suit your exact needs, but they have only tried me on 3 months evorel sequi, which hasn’t suited, and now immediately want to put something inside me for 5 years. It just doesn’t sit right with me at this point in the process 
I have another appt in a couple of weeks, when I will have done nearly 4 months on evorel sequi. I think your suggestion of separate oestrogen patches, and then body identical utrogestan is a really sensible next step. Can you get that on NHS? Thanks again 😀

[joziel]

It does (sort of!) make sense to be worried about the 'permanence' - except it's not permanent. It's your body, so if you request for it to be removed after a week, it can be. Of course some doctors might try to explain why it's best to give it longer, but if you really insist and are sure, they must comply with your wishes.

On the other hand, if the coil suits you and it lasts 5 years, you put it in and can then completely forget about progestins/progesterone for the next 5 years. You don't have to take daily progesterone and the vast majority of women don't bleed at all with the coil in. That is the benefit of the '5 years' thing!

But for sure, I agree that it is much easier to try the body identical utrogestan as the next thing. And yes, you can get it on the NHS. Some women in Scotland have trouble getting utrogestan on the NHS but I believe that has changed now and it is available everywhere else...

[sheila99]

Utrogestan doesn't seem to be particularly effective at stopping excessive bleeding whereas the mirena is which is probably why they suggested it. No harm in trying utro if you want to but you may end up with a mirena anyway. Was bleeding 'nornal' before you went on hrt? Just wondering if it might be worth asking for a scan in case it's caused by a polyp or fibroid. Hrt makes fibroids grow.

[Hurdity]

Hi Lydgate

Sorry to hear about the bleeding.

My question, leading on from Sheila's, what were your periods doing in the months leading up to starting HRT? How frequent were your periods and how long etc. This is the crucial questions in helping to work out where you are in menopause and therefore what would be best.

I agree it might be worth having a scan because abnormal or worrying bleeding should always at least be checked out.

It's good that your hot flushes have decreased, and sleep has improved. It may well be that your own cycle is coming into play and you're feeling rotten because of the fluctuations in your own hormones, despite taking the HRT, perhaps making pms worse or experiencing it at the "wrong" time in relation to your HRT cycle.

It may also be that your womb lining built up during peri-menopause with skipped cycles ( if you've had these) and the bleeding is a result of it shedding - so eventually after a few more months this may well settle.

Taking separate oestrogen and progestogen patches does enable you to tweak the dosage separately so in your case, actually you may be looking at taking something to give good control of the bleeding at this point in your menopausal journey. If this is the case as sheila says re effectiveness of utrogestan,  I wouldn't necessarily use this, but perhaps something stronger re uterine protection eg MPA - Provera (or norethisterone).

Hope this helps and let us know the outcome and what you decide.

Hurdity x

[flossie fiddler]

It might be worth getting checked out. I had similar, with bleeds of sometimes 11 days. My doc changed me from Sequi to Conti to see if that would help. When I was still bleeding, further investigations were made, and it turns out I had a uterine polyp that was causing the bleeds.

It was a day patient general anaesthetic to whip it out, and I’ve been fine ever since. Sorry to worry you, but it might be worth getting checked out.

[Lydgate]

Thanks All, Hurdity, Flossie, Sheila, Joziel,
Appreciate you taking the time to try and help.
Pre HRT periods had gone a bit erratic, a couple of 50d cycles, mixed in with 25s. My ordinary regular cycle until about 12 months ago was 25/26. Always been really heavy and unpleasant for a couple or 3 days, and then over completely in 5 days. So, I would say I was sick and tired of having periods, but my body was still pretty much going for it at 53 and three quarters!! I had a 26 day cycle immediately before going on hrt. I’ve never had any bleeding at all outside of a week long period.
I’m not saying I will never have a Mirena, but I think there may be other avenues to go down before deciding that is what to have? You’re right, I would be reluctant to have it removed without giving it a go. But, I can remove a patch if it’s making me feel horrific, (did this for half a day last month) but if it’s inside my body I can’t?
I really want to be informed when I see the gp in 2 weeks. All my appts til now have been on the phone, and I am seeing her this time. 🤞🤞🤞
Thanks again for your very helpful advice.