Continuous bleeding on utrogestan

[RevolutionaryBiscuitsOfItaly]

Hi everyone, I'm wondering if anyone has experience or could offer insight which might help me understand would could be going on, and what I should do next?

I had a mirena fitted in January 2015 because of heavy periods. I then started HRT in May 2017, at the age of 49, as I had night sweats affecting my sleep so probably perimenopausal. I had Evorel 75 patches (oestrogen only) as the mirena provided progesterone.

This regime worked pretty well, and after some initial bleeds after the mirena was fitted, and had almost no bleeding, which suited me fine.

Fast forward to October 2019 and I had the mirena removed because my GP was concerned this had been in place for more than 4 years and so was off licence for the progesterone component of HRT. I considered having another mirena but decided instead to start utrogestan.

I started a continuous (25 days out of 28) 100mg regime. Because of my age (51) and no bleeding for a couple of years, I thought I might have already gone through menopause.

Since starting utrogestan, however, I have had frequent and heavy bleeds. There seems to be no pattern to them, and they're often continuous for 2 or 3 weeks. I've now been bleeding heavily and continuously for the last 4 weeks, so things are getting no better.

I'm worried that the utrogestan can't be working properly to thin my endometrium.

Is it possible this is just a transition which I need to be patient and go through, or utrogestan is not working, or something else?

I'd be grateful for any thoughts.

It's probably nothing to do with Utrogestan, but is your own heavy periods that have come back now the Mirena is out.

Daily Utrogestan (I tried it but went back to taking it on a cycle) can cause slight spotting for a few weeks but never what you are having.

You didn't have bleeding with a Mirena as it stops bleeds.

Really,the only way you will know for sure is to stop all HRT and see if your own periods still come.

If you can't bear the thought, you need to either take Utrogestan as a cycle ( 12 days out of 28) which may help reset your own periods into a more regular pattern OR go back to the Mirena.

@JinglingHellsBells thanks, I think you're right. I think I'll try moving to utrogestan 12 days out of 28 as a first step and, if no better, see about having another mirena. I can't face returning to no HRT, particularly if I'm not even through the menopause yet, I've never been so tired and down as i was before I started. Thanks for your insight.

I swapped from using it on a cycle to daily and lasted 3 weeks. I got a headache daily and also spotting so went back to cyclical use and am still on that (in my 60s.)

Might be worth getting a blood test for iron to see if you are a bit anaemic now due to blood loss?

Sorry- the point I was making was that it's normal to get some spotting when switching from something that control s bleeding 100%, but not full-on flow. (I'd been using HRT for several years before trying Utrogestan daily.)

I hadn't really considered that I could have cyclical 20mg utrogestan if possibly menopausal, but from your experience and my quick review of the Menopause Matters forum just now, it seems many women prefer it. I do feel tired and listless, and came over quite dizzy earlier today, so I think I'll get some iron tablets just in case. I'll give it a couple of months if possible to see how the cyclical regime works out. I'm reluctant to bother my GP at present

You are clearly not post meneopausal as you are having a lot of bleeding.

The idea of no-bleed HRT is for convenience as most women prefer that way.

It didn't suit me, and with no-bleed there is also a slightly higher risk of breast cancer from using 2 hormones all the time (it's the progesterone that's the culprit.) Not many GPs or women know this but I see a meno specialist. It's not a much higher risk but as I've been on HRT for over 10 years it's worth considering.

The iron tablets you can buy are a tiny fraction of what you'd get on prescription- the daily dose on prescribed iron is around 300mgs, whereas over the counter stuff if 10-20mgs.

If you are talking to your GP anyway then they might prescribe iron without a blood test. Evidently many GPs are sitting around not doing anything at the moment- but they are doing phone appts.

Thanks @JinglingHellsBells, I'll give the GP a call. Prescription iron tablets gave me a bad stomach when I've had them before, but i do think I need them.