Periods and menopause?

[Bluebell66]

I've been having symptoms of menopause for over a year now and am on HRT, Elleste Solo 1mg daily, and Provera for 14 days every three months. My periods, while still fairly regular, have changed. They are often lighter, although not always, and tend to drag on, with a brownish discharge, for a fortnight. Does anyone know if this is normal? TIA

There is a menopause forum here too where some of us hang out.

How old are you and had your periods stopped before you started HRT?

The periods with HRT are not actual periods but they are withdrawal bleeds, like when taking the Pill. HRT overrides your cycle and although it's possible to have some erratic bleeding for a few months, if you are not post meno (that's 12 months without a natural period) it usually settles down in 3-4 months.

With 1mg oestrogen and 14 days progestogen every 3rd month you 'ought' to have a slightly heavier bleed, but a lot depends on where you are in meno. 1mg is a low dose but you are going 12 weeks (compared to the normal month) without a bleed.

Why are you on a 3-month regime? Are you very young for meno, or under a consultant? Most women on a 3-monthly regime fall into one of those options because there is a slight risk of endometrial thickening with a 3-monthly regime and many consultants recommend an annual or bi-annual scan just to keep an eye on it .

If you are still not really post meno then it's possible that your own oestrogen levels are still high some of the time and along with the HRT you are getting quite a big build up of the lining over 3 months. If this bothers you, you could drop back to a 2-month cycle but you ought to speak to your GP just to perhaps have your lining scanned.

Thank you for your reply Pink. I am still having a period every month, they became erratic for a while, prior to starting the HRT, but they seem to have become pretty regular again over the last few months since starting the HRT, so I am bleeding every month. I'm 49. I'm not under a consultant. My GP prescribed this routine of HRT, as I couldn't tolerate other forms of oestrogen and progesterone we tried.

If I'm honest, I am quite concerned about it, especially the thickening of the lining of my uterus. Do you think I should maybe have a break from it ( I've been on it nearly a year), and see how I respond? TIA

TBH I think you ought to discuss with your Dr to be on the safe side, but I don't think it's anything to worry about. I don't think it's a good idea to have a break from the HRT because whatever symptoms you had will still be there as you are only 49 and seems as if you are in peri still.

If you are still having natural periods every month then (only in my experience) a 3-monthly HRT regime is not the best because you must still be producing a lot of your own oestrogen some of the time - but if you have had problems with other progestogens then I can see why you are.

It's not likely that you will have a thickened lining if you are also having natural periods as well as the bleed from the HRT. The lining only tends to overgrow when it is not shed often enough or at all.

I was on a 3-month cycle for a long time but reduced it because the bleeds were too heavy for my liking, but I was older than you and my natural periods had stopped more or less, bar one or two very light ones for the final year (at 54.)

I wonder if you have tried natural progesterone- this is under the brand name Utrogestan? It's bio-identical and if you haven't tried it maybe it's worth trying? Many women have fewer side effects with it, and you could try using it every 2 months instead of 3 which would possibly reduce the length of the bleed .

Thank you so much Pink, that's very helpful. I am reluctant to stop the HRT as it has really helped my symptoms, severe chronic headaches, massive mood swings, anger, anxiety etc. I haven't tried Utrogestan, I wasn't aware of it. Would that be available on prescription from my GP? I would prefer to have progesterone every two months rather than every three I think.

Yes, you can get Utrogestan from your GP. It's not the most common type of HRT (progesterone) and they may not know about it- you'll have to ask! It's also called micronised progesterone. The dose is 200mgs ( 2 x 100 mgs capsules) a day if you are using it for 14 days. There are lots of women using it who are on the Menopause Matters website, so might be worth having a lurk there or asking any questions on the forum if you have any problems. Hope this helps.

Thank you so much Pink, I'm so grateful for all the help and advice. Just wish my GPs were so knowledgable. I'll make an appointment to go and discuss it. Thank you again.