HRT confusion over bleeding

[52Poppy52]

Hello

I am truly confused by my own googling and would appreciate any input :)

History ; Age 52 next month. Mirena first fitted 9 years ago for contraception and heavy periods. Periods continued but were lighter. Mirena replaced 4years ago, periods continued. Last period Feb 2012, had been regular each month give or take 7days but then just stopped suddenly. May 2013 due to overheating at night causing poor sleep pattern GP did one blood test which revealed high FSH and started HRT ( elleste solo 1mg oestrogen tablets ) . Changed to patch (elleste solo MX 40ug) in April 2014 as occasional spotting thought to be related to me forgetting to take pills. Dec 2014 mirena removed at my request as 4+years old and changed to femseven conti patch.

Very Heavy 'period like' bleeding occurred in May, and I had scan revealing 8mm lining increasing to 13mm in one place with cystic appearance and simple 18mm follicle on one ovary the other ovary could not be seen. The bleeding is recurring every 10 days or so and lasting 5-8days

My hysteroscopy today revealed a thin lining and nothing sinister. Biopsies were taken.

The consultant today said nothing wrong with uterus, PMB sometimes caused by atrophic vagina and sent me home with Vagifem prescription.....

Now I KNOW my bleeding is from my uterus and not from my vagina because it is heavy and clotted and accompanied by period pains so I am disappointed to have been treated by her flowchart...... However I do not understand why my lining is thickening and what causes it to shed and when I asked her she pretty much said its a mystery.

Could I possibly still be cycling some of my own hormones and should I be on cyclical HRT ? What would be my best course of action now? I am not confident that my GP or practice nurse is expert enough to answer my questions so am hoping for some insight here.

Many thanks

Just a quick reply. Conti HRT is renowned for causing irregular bleeding for up to 6 months; you have only been on it for 2 months.

At 52 it is quite possible you are not post meno and will continue to override the conti regime with your own hormones.

You don't have to have conti HRT at any age. I am quite a bit older than you and both myself and another poster I know here (much older than you) is on sequi HRT with withdrawal bleeds. I choose not to use conti HRT because I believe from research (and does my dr) that keeping progesterone to the minimum decreases some of the risks (breast cancer) with HRT.

sorry- misread your dates. You've been Mirena-less for 7 months.

It's quite possible that you're still having natural periods because the Mirena would have masked these.

If you are happy to, would you think about another Mirena and oestrogen as a patch or gel?

Thank you so much for your quick reply.

I was put on continuous HRT in May 2013 (progestogen from mirena in addition to oestrogen tablets) so had it for over 2 years now but but I appreciate your thoughts regarding keeping progesterone to a minimum.

is it possible that my periods stopped, not because I was post meno, but because the ratio of progestogen to oestrogen changed as my own natural oestrogen levels fell ? In which case the '12 months since last period' is meaningless.....

But I still don't understand why my lining is building up now - I have progesterone in my patch to surely prevent that ?

Crossed post !

The consultant did today suggest mirena again, but after her prescribing Vagifem I said I would need to think about it ....

It's not straightforward with the progestogen side of things.
There is still no definite research on different progestogens but some research shows that natural progesterone is safer than synthetic. The progestogen in the Mirena is synthetic but is contained locally in the uterus. This is still considered very safe. The 'best' option is natural progesterone ( not progestogen which is synthetic) and brand name Utrogestan. The least safe appear to be synthetic progestogens.

If you had the Mirena, you'd not know when your periods stopped because many women (not sure of the percentage) have NO periods when using the Mirena (even though they are ovulating.) Maybe now you have your own hormones overriding the conti regime. It's possible that you have your own oestrogen still, but that plus the oestrogen in the patch is not balanced by the progestogen (in other words it's too low a dose). As we get older we sometimes have anovular cycles which means we have oestrogen but the cycle is not completed so we don't produce progesterone. This causes a build up of the lining which results in a heavy period eventually. Basically you sound as if you are not ready for conti HRT and need to go back to sequi or another Mirena.

Thank you pink frocks that's really helpful.

In the scenario you describe above with my own hormones and a conti patch -I understand why my lining would build up but not what would trigger it to shed .... My bleeding is not cyclical every 2/3/4 weeks - it is bleeding for 5/7 days then a break of 10 or so days then bleeding again. Can you guess at what causes the lining to shed if I am not producing progesterone?

As an aside, the more I research this the more I realise how utterly ridiculous and inappropriate the prescription for Vagifem (even more oestrogen) was for me !!!!

But you are having some progestogen ( that's synthetic- progesterone is what we make ourselves and given in HRT only as Utrogestan capsules) in the patches.

You also don't know if you are not producing progesterone, do you? You might still be ovulating and having very short cycles. But it's more likely that the balance of oestrogen / progestogen is not right for you at this moment. The most obvious solution is to use some type of HRT with a higher level of progestogen. This might work best for you if you go back to sequi types so you get a cycle with 10 days of progestogen each month.
As I said before, breakthrough bleeding on conti HRT is very common - for as long as 6 months. It is for women who are 1 yr post meno and it's likely you aren't! hence the bleeding.
The Vagifem won't make any difference, it's not absorbed into the blood stream or the uterus which is why is can be used long term quite safely by women who are not on any kind of HRT.

Hello
Just changed to FemSeven Conti Patches and week two now have what appears to be a full bleed! Wasn't expecting that. Previously on Tridestra tablets which worked to a certain level. Bleed every three months although the last couple of courses I had a really bad headache for around 3 days before my period broke. There was no let up so I ended up off work which isn't good. Mentioned to doctor that the Tridestra didn't seem to be working as well and that some of my symptoms were coming back. He suggested I try these patches. Dr didnt say anything about having problem bleeding for the next few months. Is that pretty normal? Will it stop and do you think they are worth sticking with? If I am bleeding so quickly perhaps I am not yet ready for 'continous' and need to go back to sequel tablets again. None of this is proving very easy. Seem to have every symptom going when others are flying though. Also have vaginal atrophy which was something else he thought might improve if I was on the patches. Any advice or words of wisdom appreciated :-)

Whereabouts are you now in relation to the 3 month cycle of Tridestra? Have you just had a bleed or what ie when did you start the Femseven? Yes a certain amount of bleeding/spotting initially is normal on conti HRT. Also are you post-menopausal or don't you know yet? If you still have a cycle then this could break through maybe?

I wanted hrt coil and patch. Had old coil out but they coukdnt get replacement in. I was initally put on 2mg combined tablet and tabletsfto stop bleeding. It was decided I was at risk because of my weight. So I was put on conti patches. Since then I've bled heavily. Back ache etc. A shock after 6 yrs of no bleeds