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[Ruthie]

Hi all,
I've been using Everol Conti for almost five months,  and all was fine for the first ten weeks.  Since then I've had a full period every two weeks. I assumed it world gradually improve over time,  but it's obviously not going to. 
My GP has just (over an online chat) suggested a Mirena coil, but I have massive issues with my smear tests so cannot even contemplate that. I have an appt tomorrow am to discuss my options,  but would like to be prepared. Does anyone have a similar experience and if so,  what have you changed to please?
Thanks for any advice

[Taz2]

Hi Ruthie.

Sorry that you still have this bleeding going on but you might find it stops once you get to the six month mark. I think we talked before about some women always bleeding on conti HRT and using sequi instead? I realise that any bleeding is annoying but it's a case of weighing up which is the better option if HRT is benefitting you overall. I can understand your reluctance to try the Mirena if you've had problems with smear tests in the past.

Taz x 

[Ruthie]

Thanks Taz. I'm worried that I'm not tolerating them as the bleeds seem to be lasting longer each time,  whereas I assumed that they would gradually decrease.
I can cope with them to see the six months through,  but am unsure if there are other options besides the one that gives a monthly bleed? Saying that,  a monthly bleed would certainly be better than the current twice a month!!

[AnneS]

Hi ... I had exactly the same with Evorel Conti ... 'regular' bleed every 2 weeks ! As mine went on just past the 6 mth mark I was sent for a scan ( all fine ) and then changed onto Evorel 50 patches and daily 100mg utrogestan tablets . My bleeding immediately stopped on this regime but to be honest I think I was better on the Conti patches .... apart from the bleeding   I felt better and my mood was certainly lighter ! Like you .... I didn't really want to try the Mirena x

[Ruthie]

Thanks AnneS,  I'll discuss that as an option tomorrow. I've recently (few months before I started HRT) had a scan and all was well,  so hopefully won't need another one.

[Ruthie]

I've been to see the nurse this morning and she's prescribed a lower dose (25mg) oesterogen patch and separate Progesterone tablets. I had to talk her out of referring me for a scan for 'post-menopausal' bleeding as I'm sure it's caused by the patches, plus I had a clear scan (following removal of lump on cervix) less than a year ago.
 I'll give this a go, although she said my menopause symptoms may return,  in which case I should go up to 50mg. I'm confused as to what's causing the bleeding (too much oestrogen?) and why a separate tablet will stop it,  but I'll give it a go.

[Taz2]

It is common for bleeding at any time during the first ix months of conti HRT so try not to worry as to the cause. It's perfectly normal. At my surgery they don't instigate any investigation into bleeding on conti until the six month date is passed. You may find that you will always bleed on a conti HRT in which case you could ask for sequi which will give you a usually predictable bleed each month. A nuisance maybe but at least you know when to expect it.

Which tablets have you been given?

Taz x

[Ruthie]

Hi Taz.
I've been given Progestan 100mg. I'm not worried about the bleeding,  it was the nurse who was panicking and suggesting I need a scan. I asked her what causes the bleeding (too much oestrogen?) and I didn't get a clear answer,  but she's given me a 25mg oestrogen only patch,  so I assume she thinks I was on too much. I've just read that you need 50mg for oesteoporosis treatment,  so that's annoying as that's one of the main reasons I take it.  I'll start on 25 and see how I go, she did say I could double up the patches if my other symptoms returned.
I'm a bit fed up with it this morning.  I know it's trial & error,  but I really don't feel like I'm getting an explanation or proper rationale for this new regime (other than the other one was causing bleeding) and I'm a very logical person who needs to understand these decisions.  The media portray HRT as an instant cure-all, perhaps they should read this forum! Moan over - keep everything crossed for me.

[Teresa]

Hi Ruthie,

It seems that Nurses, GPs and gynaecologists always assume that post menopausal bleeding in HRT is due to too much oestrogen. Mine was caused by not enough oestrogen and they doubled my Utrogestan which made it worse  I’m a “poor absorber” and I was in a 75 patch.

Perhaps you may be better with Evorel 50 and take Utrogestan seperately? Having an estradiol blood test may also help as you would know if your oestrogen levels were too high - or too low. It’s a shame they have lowered your patch to 25 though. A scan, though I know you don’t want it, could also prove how thick or thin your lining is.

[pepperminty]

Hi,

I think it is when the linning of the womb may not be shedding well enough and be thin enough with the conti progesterone. Some women find that after 6 months it stops as the womb has shed to where it needs to be. It is trial and error.  A higher dose of estrogen gave me a heavier shorter bleed and a slightly lower estrogen dose gives me a longer bleed.

PMX

[Ruthie]

Thanks for your responses Teresa and Pepperminty.
I started taking the progesterone on Sunday and started another 'period' on Monday! I did have a PMT feeling on Sat, so wonder whether the bleed was already underway before I started the new regime. If it lasts a long time, or happens again,  I'll go back to the Dr.
How do you go about getting the blood test for oestrogen levels? Can it be done on the NHS ot do you need to go private? No mention of that from the Nurse, so doesn't look like something they offer at my practice.
 If it wasn't for the massive improvement in bladder control,  I'd stop taking HRT now and give it up as a bad job!

[pepperminty]

The NHS do not tend to test for estrogen as it can fluctuate etc .

But if you feel crap it can be a good indicator as to whether this is an absorbtion issue. Again some feel good on 250 and others need much higher.

I test mine yearly and my levels remain constant. They dropped recently - I am probabaly post meno by now so have none of my own!  So I have upped my dose and had no ill effects. I will test at the end of the year to see where I am after my increased dose. 

Medichecks do an estrogen test - just don't do a finger **** as it can give false readings . It is easy to do if you can afford it and they have nurses for a fee that visit or you can go to thier recomended local  clinic.

Let us know how you get on

PMX