HRT after ablation - is this normal?

[Catsinahat]

Hi, I started on HRT - Oestrogel 2 pumps and then Utrogestan for 2 weeks out of 4. I had an ablation 3 years ago and most months prior to HRT would get a few days of very light bleeding or brown discharge - so I knew roughly where I was in my cycle as this would be my period but due to the ablation there was hardly any bleeding. For the first 6 months on HRT I still had this slight bleeding once I finished the Utrogestan which I assumed was normal (and one month was quite a bit more than normal too) However, for the last 4 months I am not getting any bleeding at all. Just wondered if I need to ring the Dr to discuss or if this is normal given the ablation? I thought even if your periods stopped the withdrawal of progesterone caused bleeding - which I assumed would be a small amount because of the ablation but still present? Please can anyone advise as there is loads of info out there but less so that I’ve found specifically for if you’ve had an ablation! Thanks 😊

I don't think you need to see your dr.

The amount of bleeding on HRT varies a lot. Some women have almost none, around 20% have none at all, and others have a lot.

It really depends on how well/much of each hormone your body is absorbing and how your womb responds. eg some women don't absorb transdermal estrogen very well and with 2 weeks of progesterone there isn't much lining to come away. The dose of Utrogestan is actually 12 days, but most GPs seem to be saying 14 days (all coming from a certain meno GP who wrote a guide). This means the lining may not build up as much as it would on 12 days.

Utrogestan is tricky as it's not as powerful as the older synthetic progesterones. A lot of women find they bleed (all the time) on it, as it doesn't control the lining, but some like you have no bleeding at all.

The other thing is that in the months you have had no bleeding, your own estrogen levels might have dropped as they do the further into meno you go.

This will also affect the thickness of the lining.

Does this make sense?

Women who are post-meno use progestogen every day (small dose) and that thins the lining and they don't have a bleed at all.

Thanks so much for your reply. Yes that does make sense. I have wondered if my own oestrogen levels have dropped as I feel I need to up the gel. I wonder if I can change to taking one tablet every day now then rather than the 2 weeks on 2
weeks off (which I find harder to remember!)