Risks of Provera

[Bluebell66]

I take Provera for 10 days every three months as part of my HRT. I take Elleste solo every day. The Provera I was told is supposed to induce a bleed, which it doesn't. I have spoken to my GP who doesn't seem concerned, apparently it's not unusual. I am having very, very sparse periods, not really proper periods, just finished one but prior to this, the last one was May. I am worried about the lining of my womb not being shed, could this cause cancer of the womb lining, I am also worried about the breast cancer risk of Provera. Would I be better on a natural progesterone, and if so, what would that be?

I lost my husband to cancer three years ago, so this is a very real worry to me. I am 50 years old by the way.

Thank you in advance for any advice xx

ps- you don't have to stick to 3- month cycles- you can make them shorter, like every 6 or 8 weeks. THis is what I'm doing now as the bleed after 3 months was too much.

Hi Polly, sorry to have confused you. I'm still debating whether to try Utrogestan again and have an appointment with the GP after Christmas to discuss this and request a prescription.

He is referring me for a scan on the advice of a consultant he queried my situation with. The consultant said my lining probably isn't building up, hence the lack of a bleed but a scan was required to check this.

I'm torn between the disadvantages of taking Provera anymore than necessary and not taking it often enough and letting my womb lining build up.

I would really like an appointment with the consultant as my GP is not very knowledgeable on HRT to say the least. The GP who prescribed the Provera in the first place nearly two years ago said it was to induce a bleed, which it doesn't, hence my concern. I did tell her this and she didn't seem concerned.

Hi Bluebell
The queries you have are on-going for many of us. I've used long cycle for 8 years and I discuss this with my consultant and ask for advice on how long the cycle should be in order to do just what you want to do! (Balance risks of progestogens against the lining building up.)

I think you need to separate this into 2 queries- is Provera going to be better anyway or not for you than micronised progesterone, and how long a cycle can you 'get away with'.

I doubt any consultant will be able to be definitive on this because as well as picking my own consultant's brains, I've asked other women who see other drs. There is no consensus on it.

Those of us who are using long cycle are having scans maybe every 12-18 months, paid for by ourselves outside of the NHS (unless there are symptoms that warrant it on the NHS) to check all is ok.

I was on a 3 month cycle for 5 years but have become less happy about that length so have reduced it to 6-8 weeks. (That means taking progesterone at a maximum of alternate months ie 1 Jan then 1 March, but usually more often.)

The only way to really decide is to have scans and see what's going on, then you can adjust accordingly.

You might like to know that 15-20% of women on HRT don't have bleeds. If you are doing a 3 month cycle with no bleed it suggests that the oestrogen you are on is a very low dose. My bleeds on a 3 month cycle were too heavy which is partly why I changed.

Hi Polly, thank you so much for your detailed reply, it is really helpful. It seems we have to work this all out for ourselves doesn't it.

I was on the minimum dose of Elleste Solo, 1mg. However, having just swapped to two pumps of Oestrogel, this may make a difference, I suppose time will tell.

I think with regards to the intervals between Provera, or Utrogestan (if I decide to try that again), I will wait for my scan and see what that shows.

If there is cause for concern I'm not sure how that will affect me staying on HRT or having to come off it. I assume if my womb lining is thickened, they will tell me to stop the Oestrogen, would you agree?

Many thanks, Bluebell.

Hi
I'd try not to look ahead too much and worry though I know it's not easy as I'm the same!

If your lining was thick- hyperplasia- it's most likely you'd have some spotting and a heavy bleed each cycle. So it's very unlikely anything is wrong.

Even if the lining was thick, the treatment is usually progestogens, more often.

A thick lining in itself is not a big issue- hyperplasia has many stages and can be simple or complex, with cancer or pre cancerous changes being quite rare.

It's worth knowing that the tolerance levels for the lining thickness for women on HRT are higher than women not on HRT. I have heard they can allow a lining of 10mm for women on sequential (with a bleed) HRT compared to a maximum of 5mm for women not on HRT and post meno. (I only know this because of my own scans etc.)

Try not to worry and see what the scan shows. If you stay on it long term though you might want to think about having a shorter cycle because long cycles are more a bit more risky re. hyperplasia.

Thank you so much Polly, I know I am very anxious, but losing my husband within six months to lunch cancer has made me acutely aware of this horrible disease.

I will try and keep things in perspective and await my scan.

I really can't thank you enough for all your support Polly, it's been so helpful to me and I really appreciate it.

Best wishes, Bluebell.

Hello Bluebell,
I started HRT in April. I had hot flushes, terrible moods, no sleep (still not great). I was concerned about the links of HRT with cancer.Went private. Specialist found out that I had Osteopenia. Basically my risk of me breaking a hip within 5 years outweighed my risk of cancer. I started with three pumps and 7 days Ustrogestan . Specialist wanted me to swap to Provera for a bleed but I changed myself back to Ustrogestan (worried about Provera -cancer). I have not had one single bleed. Not sure whether I should be worried?

Hi Lico, when I told my GP I wasn't having a bleed, she wasn't concerned by it, and as Polly says above, 15-20% of women on HRT don't have bleeds. May I ask how old you are and were you still having regular periods before starting on HRT? If you are concerned, I would speak to your doctor and get their opinion.

Have you noticed any improvement in your mood and sleep since starting on the Oestrogel?

Hello Bluebell,
Thanks for this.
I am 57. I started HRT this year.
I was dubious about HRT hence not being on it sooner.. until my moods, tiredness etc were starting to affect my life . This is when it was discovered that my bone density had become very low.. My moods are now much better and hot flushes gone. I sleep better but not greatly. Started to take magnesium. I can understand very much your concerns about cancer (this is why I did not want HRT in the first place-I was ill-informed) but the risks for fractures are greater. A specialist was telling me that he sees more older women dying of complications after fractures than cancer. I was also told that women on HRT get more checks which can diagnose cancer at an earlier stage.

Hi lico I just want to endorse what you have said. I was found to have osteopenia at 47-ish and started on lifestyle measures to improve it. I did which was great- my next bone scan showed an improvement.

Fast forward a few years and I wasn't sleeping with menopause, flushing every hour daytime, so asked to try HRT. It wasn't for my bones, but is an added bonus. My consultant has said the same as you've been told and I know this from my own research (my work involves talking to meno consultants, and researching the stats, aside from my own personal circs.)
I've been told that the latest thinking is that HRT may cause some existing breast cancer cells to grow, but doesn't cause normal cells to turn into cancer.

It's always a bit of a worry, but yes, the number of women who die from complications of broken hips, far exceeds the number of women with breast cancer (not on HRT) or who are disabled for many years with osteo.

Unfortunately, not many women know that 1:2 women will have osteoporosis after 50 and it's one of the biggest killers.

Hi Lico, thanks for that. I'm interested in you saying "women on HRT get more checks". I haven't found this to be the case, even though I've been on long cycle HRT for nearly two years, my GP had no idea I should have a pelvic scan until I requested one. Do you mean we should have mammograms more frequently than normal as well, and if so, how would we go about getting them? Also what about the risks of frequent mammograms (radiation)? The more I look into this, the more worried I seem to be getting.

My anxiety is so high and I'm getting up for the day at 3.00 am every morning after a few hours of very broken sleep. It's been going on for months and I hoped the HRT would help but it hasn't. I'm really struggling to cope as I'm so exhausted. I've tried everything, I'm currently taking magnesium and melatonin but without success. My GP prescribed Temazepam on Monday but even that didn't touch me.

Bluebell I do understand your fears, but you also need to think about the stats and that the risks of HRT are very small. My consultant told me I have more chance of dying in a car accident.
Being overweight, drinking 2 units a day and not taking exercise are all bigger risks for cancer than HRT.

I don't know what Lico means about more checks. Maybe she means they are more vigilant, and see a dr if they have symptoms, or go for screening when it's offered rather than ignoring.

Your GP wasn't in the wrong not offering you a scan. Most scans are only offered if someone has symptoms, such as bleeding and spotting when not expected. They are not offered routinely on the NHS. As we've said, 15-20% of women don't bleed.

Mammograms are not given more often for women on HRT either, within the NHS. There is practically no risk from radiation as it's very low levels.
If you are anxious over all of this, you can request any scan or mammogram privately, by paying for it. I have a private mammogram roughly once every 2 years rather than the NHS's every 3 years. Obviously all of this costs money but it's the 'price I pay' for choosing to use HRT!
In between the scans etc I try to put the risks to one side.

Do you think you perhaps need some other kind of support- maybe CBT or counselling- to help you cope with your own anxiety levels?

Good evening,
I agree with Pollyperky , perhaps you should seek some help with the anxiety levels; it might also be linked to your sad loss. My neighbour who lost her mother to Alzheimer early this year suffers from severe depression following her ordeal.
Apologies, I should have said that I am private; the Consultant insists on bloods twice a year, a pelvic scan and a smear every year or so. He mentioned yearly mammogram but told him that I would prefer every two years (find it too stressful!).

As for the sleep, try not to take these tranquillisers . Have you tried Phernagan as a short term sedative (3 nights only to get a good sleep)? You get them over the counter.

Apologies; meant Phenergan.

Polly and Lico, thank you so, so much for taking the time to respond, your support means so much. Thank you for the Phenergan recommendation Lico, I will get some today. I've been up since 3.00 am and had about two hours broken sleep. I wake up with my heart pounding and a tight, aching band around my head. Since losing my husband, I have struggled with crippling anxiety - about everything - and over the last few months since my sleep has disintegrated, I've become even worse.

I did have CBT but wasn't getting anywhere. I'm currently having bereavement Counselling with CRUSE. My CBT therapist advised this and said we could pick the CBT up again after the Counselling has finished.

I really hoped the HRT would help with my anxiety and stress and improve my sleep, but over the last few months it's deteriorated rapidly.

Your reassurance about the risks of HRT are gratefully received Polly. My GP has given me absolutely no information about it, I am just desperately trying to inform myself of the risks, benefits and the best combination to take for me.

Polly - since I swapped from 1mg of Elleste to 2 pumps of Oestrogel, I have developed considerable breast tenderness, I can barely tolerate my clothing touching me. Is this to be expected and do you think it will settle down? I know in the grand scheme of things it's not serious, but it is quite uncomfortable.

Thank you again for all your support, it is a huge help to me when I am struggling so much.

Bluebell x

I did notice the time of your post Bluebell! (If it's any consolation I woke at 5,30 this morning and didn't go back to sleep.)

If you want to take this off the forum and ask more via PMs please feel free.

I am sorry you are finding the anxiety hard. Do you know what's behind it? I'm sure your CBT delved into this. Is it lack of confidence overall?

Re the sore breasts- 2 pumps of gel is possibly giving you twice what you had with a 1mg pill. I'd suggest you drop down to 1 pump for 2-3 weeks and see how you go. Then try upping to 1.5 pumps for a while and if all's ok you might not need a higher dose.

My dr advised me to start on half a pump and then work upwards to control symptoms.

Re risks, you are only 50. The average age of meno is 52 so until you get to that age your risks don't kick in anyway. HRT is just putting back what you should have anyway at 50. Only you can decide what is right for you. If the worry about cancer risks are crippling you and making you unhappy then you may want to stop HRT. But you have to look at the stats- there is a very small increase in risk and there is newer research that shows Utrogestan doesn't add to the risk. Many drs speak favourably of Utrogestan. More women die of heart disease and osteoporosis than breast cancer. HRT protects against both.

You have to weigh up if the benefits of HRT outweigh what may be a tiny risk- or no risk.

You can't live your life worrying over 'what if' every day as this in itself will make you ill.

Phenergan comes in 10 mg or 25mg (I think). Take the 25mg.

Pollyperky, I was told the same regarding heart disease and osteoporosis.

Lico, I've bought the Phenergan, do you just take one 25mg tablet before bed?

Thank you so much for all your support Polly, it really is helping me, I will PM if that's ok.

Bluebell x

Yes of course Bluebell- it's easier sometimes to go into a bit more detail off a public forum.

Bluebell, look at the instructions regarding dosage.
Could be one or two tablets but do check how many tabkets for sedative effect. Yes you take them before going to bed. Not more than three days.