Haemorrhagic Cyst and HRT

[MaeJae]

Hi, I am 53 years old. I started HRT at 51 for symptoms of hot flushes and mood problems. I switched from sequi tablets to Oestrogel and Utrogestan 100 at age 52, so 1 year ago approximately.
Last week I had crippling abdominal pains and was diagnosed with a haemorrhagic cyst on my right ovary. I had a laparoscopic right ovary removal and part of the tube also.
The gynae who saw me said it might have been caused by an oestrogen/progesterone imbalance. He suggested that I go onto the Mirena coil for progesterone. He said it would give a more targeted supply. I’m really not that sure what to do.
I am also very worried that I caused this problem myself. I used put the gel on in the morning after my shower and take the progesterone before bed but because I am often so tired by bedtime I sometime forgot the table. Maybe once a week or so. I feel terrible that maybe I have damaged my health with my carelessness. Do anyone have any knowledge or experience they capfuls share with me?

I'm not too sure what you are asking :)

There seems to be two very different things going on in your mind.

1 Are you to 'blame' for causing an ovarian cyst by being careless with the Utrogestan

2 Are you going to swap to the Mirena

I do not know for sure of course but if you have only missed the occasional Utrogestan, then I can't see any connection with a cyst.
I'd ask for another opinion on this if you want one. Ovarian cysts can occur for all kinds of reasons. If there was such a strong link with 'missing' Utrogestan I feel it would be something that women were told about (I've used it for 8 years and my consultant has never said anything like that.)

How long ago was your last period? Are you post meno and using HRT continuously or on a cycle ( 12 days per month?

Are you asking if you should have a mirena?

If you want to carry on with the Utrogestan, can you put it next to your toothbrush or face cream or whatever you do last thing at night?

Thanks Jing for your reply. You are right in that I am asking 2 different things. I do feel it is at least partially my fault, possibly I have a low take up of oral progesterone which compounded by missing doses caused the imbalance which caused the cyst.
And also if I am to continue with HRT then I may need to get the progesterone element through a mirena.
I just hoped someone had some knowledge around this. I am confused which is clear I guess and a bit upset by it all too.

I'm not sure what you are confused about. Can you explain?

Is it you think the dr was wrong to blame the lack of Utrogestan for the cyst?

I could help a little more if you could answer the questions I asked :) like how long you have been post meno.

Cysts are caused by ovulation or left-over from ovulation. I don't think there is any evidence they are caused by HRT or lack of progesterone.

The usual thing that happens with missing a tablet (or any type of progesterone) is spotting.

There are also women who, under specialists, use less Utrogestan than is normally used, for various reasons. (I am one of those.)

I have never heard of ovarian cysts being caused by lack of Utrogestan.

I think you should forget about what the gynae said as it sounds as if he was trying to make you feel guilty, and may not even be right.

If it's a choice between the Mirena and Utrogestan, maybe see another dr and get a 2nd opinion?

That is upsetting and I would guess that you are in a bit of shock. Don't blame yourself and keep your Utrogestan somewhere you'll see it as PP said. Mine is next to my bed.

The gynaecologist only said "might" and I'd say if you looked into it they don't know what causes cysts. If you're overpowered by oestrogen then you could reduce your oestrogen dose - seems simpler. What is your oestrogen dose?

Do find out if there's a possibility you aren't absorbing it orally. You can also use Utrogestan vaginally, and you can also take 200mg everyday.

I see a lot of suggestions by GPs and consultants to get the Mirena coil, whereas body identical progesterone taken orally has many benefits and the coil only protects the womb as far as I've ever seen, nothing about ovarian cysts. Also provides contraception and lightens/stops periods if that's an issue.

I wouldn't blame yourself and I wouldn't rush to get the coil either. I'm on 14 days 200mg Utrogestan as I still have periods but I know some people are prescribed 12 days. I'm sure they are not all getting cysts!

I'm sorry you had this experience.

Thank you both for your very kind replies.

I last had a period over a year ago. I had been having periods regularly until age 52 when my GP moved me from sequi to continuous HRT. So I didn’t feel like I came to a natural end of periods rather it was managed by the HRT, if you see what I mean.

I am on continuous HRT now. So 2 or 3 squirts of gel and 100 Utrogestan daily.

I now take the gel and tablet together at bedtime on the principle that it’ll be balanced even if too high or low if I miss a dose.

I’m not that keen on getting a coil at this stage of my life just for the sake of HRT but if I am not absorbing it properly then the alternative may be to stop HRT.

When I spoke to the gynae, I knew that I had missed progesterone doses and I guess I went into intense self recrimination mode and I just wanted to gauge from other people if this problem was created by myself.

I’m due back to see my GP next week and I guess I’ll see what she says.

If you are possibly only just post menopause, (and weren't post meno when you went onto HRT) you and the gynae will never know how long the cyst was there.

It may be nothing to do with HRT! That cyst could have been there for years and it was only seen when it burst.

I really don't know how that dr linked it to HRT. I had a cyst that was there for 2 years, before I started HRT and stayed while I was on HRT and it went away (I was aged around 54). But I was warned it might twist or burst.

The Mirena at your age is not unusual. I was offered it as part of HRT at age 53/54. It's a very common way of prescribing HRT especially for women who have heavy periods.

If you are not spotting when you have missed Utrogestan I really don't think you are not absorbing it as spotting is the first sign.

I've heard of oral progesterone not agreeing with people but not of it not absorbing. Most people seem to do gel in am and Utrogestan pm, but I'm only basing that on a FB group I'm in. Some people split the dose. I'm on patches so it doesn't apply to me. I see what you mean about taking them together meaning it'll be balanced.

I think you had a shock and a distressing painful experience and the comment kind of got to you when you were vulnerable. Many, many women who have has hysterectomies but still have ovaries take oestrogen only, as many doctors think the only function of progesterone is to protect the womb and dont prescribe it if there is no womb. There would be cysts left right and centre if lack of progesterone caused them! Well I suppose not centre... but my point is those women are not getting any dose of progesterone at all.

Definitely stop blaming yourself and be kind to yourself!

You don't need to take them together to balance them. Estorgen stays in your system as long as you apply it regularly.

Yes @Apileofballyhoo some women do not absorb it as well as others as a lot is lost during digestion. My consultant prefers women to use it vaginally for that reason although it's not always practical to do this 365 days of the year at night (you can then use it daytime, or after sex, if that's the issue.)

I really don't think your cyst was caused by this.

And your gynae had no idea how long it had been there. Maybe long before any HRT.

They aren't ALL experts on HRT and menopause just because they are gynaes- they all have their own specialisms.

I meant that If I take them together if I miss a dose I miss a dose of both so the oestrogen/progesterone balance is maintained.

However apiles comment re: women with hysterectomies only being prescribed oestrogen would make my focus on the balance of hormones meaningless.

I did mention to the gynae that my GP had suggested using the progesterone vaginally and I asked if that would work. He said the mirena was more targeted and he felt in my case it would be a better option.

However, thank you all for your help. I’m in a much calmer frame of mind now. And I think I’ll be in a much better place to have a rational discussion with my GP next week. I’d have wasted half the appointment on recrimination and you have all helped settle my mind and I can focus on what to do next.

It was phenomenally painful and I was left without any pain relief in the emergency room for most of the night.

I meant that If I take them together if I miss a dose I miss a dose of both so the oestrogen/progesterone balance is maintained.

It doesn't work like that.

It can take up to 3 months for the effects of estrogen to wear off when stopping hrt. It's there in your system whether you miss one dose or not.

Missing 1 capsule of Utrogestan is not going to do anything.

Utrogestan is there to protect the womb lining from over-growing. It takes weeks/ months for that to happen if someone doesn't use any at all. Some women are on much longer estrogen-only cycles where they use Utrogestan only every 6-8 weeks (with specialist approval.)

I hope this puts your mind at rest.

Your other option is a combined patch. You don't need to stick with gel and another product. There are many other options including tablets (Femoston is supposed to be good) and all the combined patches.

Don't get hung up on either utrogestan or the Mirena.

I didn’t have any spotting in the 2 years I was taking HRT so that’s useful information.
The combined patch seems like a really good option for me.

I just want to say thank you, I really appreciate the time you took to help a complete stranger.

OP, I think you're traumatised and it really does sound horrific so it's quite natural that you would be.

With HRT when you make changes it can lead to menopause symptoms returning for a while so just be aware of that possibility if you do change to something else, it might take a little while to settle.

I hope you feel better. Take care of yourself and be kind to yourself.