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[Zar]

Hi there

I hope someone can advise. I need to call the GP, but through experience, I know they will say they aren't menopause experts and will need to refer me to the specialist which will take weeks/months for an appointment, so I thought I'd seek advice here in the meantime.

I've been on HRT since March 2019. It has been up and down and I have tried different variations trying to find the perfect solution. I've been on continuous utrogestan (100g) + Evorel 100 patch since January 2022, when I turned 54. Since then I've put on around 2 stones. That's not why I'm writing though. I thought that going on continuous would stop my withdrawal bleed, but I seem to have a bleed every time I have my 3 day break from utrogestan, which is fine. The problem now is that for the past few months, I'm bleeding more frequently, infact I had a bleed last week, and this week it started up again. It feels like a proper period as my boobs get sore beforehand, I get bloated and I get stomach cramps. I do know I need to call the doctor, but as mentioned, I know I'll be waiting months for a specialist appointment. Although perhaps my GP will want a scan.

This is the pattern of bleeding since January 2022 - usually around about when I have my 3 day break:

15 Jan 2022
17 Feb 2022
1 Mar 2022
19 Mar 2022
12 Apr 2022
25 Apr 2022
15 May 2022
7 June 2022
21 June 2022
2 Jul 2022
QUITE A LONG GAP WITH NO BLEED
22 Nov 2022
STARTED TESTOSTERONE
21 Dec 2022
9 Jan 2023
JUST OVER A WEEK BETWEEN BLEEDS
19 Jan 2023
19 Feb 2023
2 WEEKS BETWEEN BLEEDS
3 Mar 2023
1 WEEK BETWEEN BLEEDS
10 Mar 2023

I just had a bleed on 3 March, and that's it started again on 10 March. It's quite heavy this time. Looking at the timescale, I started testosterone in December last year, and within 8 weeks was told to come off it as my testosterone levels had gone through the roof. I wonder if that kicked off this unsettled spell with my bleeding?

I have also cut my 100 Evorel patch down to 3/4 of 100 (75) a few weeks ago incase I was getting too much estrogen. A few days ago I cut it in half to 50.

My question is, while I await an appointment with the GP, can I go back to a sequential regime? I feel that continuous hasn't been good for me, with the weight gain and now with the irregular bleeding, can I make that decision myself to change to back sequential?

Thanks for any advice you can give. You have all been such a great help on here.

[Hurdity]

Hi Zar

Sorry to hear about the bleeding.

Yes continuous progesterone should stop bleeding eventually - but only if the balance between oestrogen and progesterone is right. It is dose dependent ie more oestrogen requires more progesterone (dose, duration) to protect the womb.

It is NOT one dose fits all ( ie not one dose of progesterone for all doses of oestrogen). That licensed dose of utrogestan is really I think intended only for medium dose oestrogen and for some women may well not be sufficient, although some are fine.

Yes you should go to your doctor straight away. It sounds to me like your lining is too thick - firstly the fact that you mostly bled on the 3 day break, definitely indicates build up, and now you are bleeding unpredictably - this is abnormal breakthrough bleeding.

You do not need to wait for a specialist appointment as this is a clinical  problem - ie abnormal bleeding when you should be Your docotr should refer you for a scan under the 2 week rule. Even though they are not experts - you need to tell them that you are having abnormal bleeding on your HRT and you are concerned about uterine wall thickening. You should gave a scan - ultra-sound and Transvaginal.. If it is thick then they should refer you for hysteroscopy and potentially biopsy. Not wanting to sound alarmist and hopefully it is just a thickened lining which can be thinned down with increased progesterone and/or reduced oestrogen.

You have reduced the oestrogen but you could also consider increasing the utrogestan to 200 mg per day. You are actually on a cyclical regime if you have a 3 day break so you could just double the prog and allow yourself some good (predictable) bleeds until the lining thins down - maybe take it for 21 days per 28 - but you do need to have it checked.

The other possibility is a fibroid or polyp but either way a scan is the first step.

All the best
Hurdity x

[Zar]

Hi Hurdity

Thanks so much for your reply. I had a phone call with the nurse at my surgery, she is the one who has been dealing with my HRT so knows my history. She suggested the same as you, that I double the Utrogestan to 200 mg. She said that on 100 Evorel patch, there’s not enough progesterone to counteract it. Not sure why that wasn’t picked up on before. I told her that I’d now cut my patch to 75 mg but she suggested I go back up to 100 if I’m now on 200 progesterone (continuous with 3 day break (or that’s cyclical as you said?)). But I had forgotten to mention to her that my boobs have been sore, which is partly why I decided to drop to 75 estrogen patch. My question now is (why is there always an endless stream of questions with this), can I stay at 75 patch with 200 Utrogestan? Or is that now too much progesterone for the amount of estrogen?

My aim is always to be on as low an estrogen level as possible. I was given a blood test after being on 100 patch for some time only to find my estrogen levels were still quite low so the menopause specialist said I’m perhaps not absorbing well from the patch so gave me Lenzetto spray to top up. However, I think I then started getting too much estrogen (with only 100 Utrogestan) which has led to all this bleeding. I’m not taking the spray now and have cut patch to 75.

To summarise - my question is: can I stay on 75 Evorel patch with 200 Utrogestan continuous (with 3 day break). 200 continuous Utrogestan is recommended for high doses of estrogen - so is 75 patch considered high?

Incidentally, the 200 Utrogestan is completely zonking me out - never had such a deep sleep! Every cloud …..

Ps - nurse said if the 200 utro doesn’t stop the bleeding I’ll get a scan. It is stopping now.

Thanks again for your help. 🥳

[Bandango42]

Hi

Just to let you know that I'm on the 75 patch and take 200mg utrogestan and have been for many months. That's what was prescribed to me by my gp and I have regular bleeds so it's totally fine x

[Zar]

Hi there - oh that’s interesting! Are you taking 200 Utrogestan continuously? 🥳

[Bandango42]

Hi

No, I take it for 2 weeks of the month. Sorry, I'm not sure about taking it continuously. Hopefully someone else will be along to advise on that! X