Would you stop HRT if you were me?

[HeatAndEat]

I have more days bleeding than not these days.
I've been on HRT about 3 years. Patches and Utrogestan. It has helped.
But my periods are getting worse and I have been bleeding on and off since September.
I'm 52. I had regular periods before HRT.
I had a scan in the summer. A small fibroid was found. Gynaecologist said the bleeding was because I'm overweight and the fibroid was too small 1 cm.
I am 18 stones so he is not wrong!
GP is requesting a biopsy under the 2 week wait
Provera isn't working to turn of the blood.
Its red and watery when it's not clotty.
I'm tempted to take my chances and see if removing the Patches will help
Maybe I will have stopped naturally.

No, to answer you question, but I'd want to know what was going on and have the biopsy result.

Confused- are you using Provera or Utrogestan?

Are you using (whichever) daily or on a cycle (12 days a month)?

If your periods had not stopped at 49 then you should have been on sequential HRT - 12 days a month of progesterone. This gives a withdrawal bleed every month.

If you are not on that, it's possibly why you are bleeding. If you are on continuous, daily progesterone, you can bleed if your own periods have not stopped.

Daily progesterone is for women who have not had a natural period for 12 months.

But did the dr not discuss this?

Also - and sorry to mention this - being overweight is the biggest risk factor for endometrial cancer (and other female cancers.) This is because fat cells produce more estrogen which stimulates the womb lining making it thicker and producing more blood loss. In post menopausal women the lining isn't shed and just carries on getting thicker until it does bleed eventually. A thick lining which grows and grows can develop cancerous cells.

I expect that is what the dr meant.

However you had a scan recently and that should put your mind at rest as everything looked okay.

I think your HRT needs adjusting but weight loss will also help long term.

Hi
Thanks @JinglingXmasbells

I was/ am on sequential HRT.

But the periods, eventually didn't stop.

GP suggested provera instead of Utrogestan but to take it immediately instead of waiting to when I would normally take it ( 12 days per month)

I know now I'm in the risk group. Never have weigh and periods any thought before the keto remark.

I can't think of any good ( ie not cancer) reasons why I'm bleeding all the time. I feel fine.

I'm at a bit of a loss what to take to make the bleeding stop.

I am on a diet ( not keto though as vegetarian) as of yesterday

I don't want to tell you stuff you know, but I assume you know that the 'periods' you have are withdrawal bleeds and not real periods?

So no one knows when their own periods have stopped when using hrt (without stopping the hrt to see what happens.)

So anyone on sequential will bleed (forever) as long as they use that regime.

It's bleeding outside the usual monthly bleed that isn't right and needs investigating.

Yes, thanks, I get it. Obviously I'm frustrated by having to wait for tests.

Why would a withdrawal bleed not stop?
Tiny fibroid? It was 1cm in the summer. Maybe it grew?
I have had provera before and it worked in a day but this time no sign of any changes.

My thinking is if I take off the HRT patch then no extra oestrogen then I won't need progesterone and then no withdraw bleed?

Then maybe my real periods will not return or at least be manageable?

I don't know. I can't really leave the house for any long period.
Tranexamic acid, ibuprofen, provera. Still bleeding.

So you are bleeding all of the time - or most of the time?

Did the gynae not offer any real advice?

It's not good enough just to say it's your weight. That doesn't sort out your problem.

Usually the treatment is Norethisterone. For treating hyperplasia, the treatment is Norethisterone for up to 6 months (daily and with no estrogen.)
Or the Mirena coil.

Did you know what the thickness of your lining was at the scan? That would be helpful for you to know. For women on hrt, sequential, they allow up to 10mm during the 'growing phase' of the cycle and it should drop to around 5mm after a regular bleed.

I think you have to wait for the biopsy and another scan (?) but yes you could stop the estrogen. However, you might still lose blood until it's all cleared.

Thanks @JinglingXmasbells once again

The gynaecologist said I should have the Mirena which I did but it came out with the next bleed! I had it a week!

No idea on the measurements but I seem to recall I was due a bleed around the time of the scan and the sonographer said it was thick but to be expected at that time. Although I may be misremembering this from a scan years ago.

HRT is linked to 'worse' fibroids in some people.

How is HRT helping you?

It's helped bladder pain. anxiety, aches and pains, brain fog, night sweats,
Testosterone was the biggest improvement

It's grand!

But now I'm always bleeding all the things above look more appealing

A 1cm fibroid is tiny. It's not that which is causing the issue. It's only when fibroids are huge or loads of them that they increase the surface area and more bleeding. Obviously after 3 years your HRT isn't making it worse.

Obviously I do not want it to be cancer but I'm cross a biopsy hasn't been on the table before.
I don't think it's the fibroid either

Let's hope it IS because of flab!
Dr Google hasn't got much for me to go on, other than cancer, I feel very under informed.

If you're not worried about iron anemia then it sounds like HRT still massive net benefit for you. You haven't mentioned Cervical Ectropion which is "normal" for our age & was apparent cause of my prolonged bleeding (else tiny fibroids, technically I'll never know which it was). CE sorts itself out over medium time usually, but are treatments if it doesn't. Nurse who does smears described my CE, GP didn't know what it was.

@YeOldeTrout I've never heard of that being 'normal' for women in menopause.

I had one in my 20s - they called them cervical erosions then- and I had it cauterised under a GA ( they don't do that now much.)

It caused spotting, not full-on bleeds.

They are the lining of the cervical canal growing out onto the cervix. The cells are very fragile and bleed, often after sex.

They are easily diagnosed by looking.

@YeOldeTrout thanks. I haven't heard of CE.
As my bleeding can be very clotty then I suspect its more traditional periods/ withdrawal bleeding.
Smear last year fine
All previous smears good
I'm taking multi vitamins during iron.
Probably need extra iron now though.

This is my ignorance... by "withdrawal" bleed is that something to do with having days without taking/being exposed to HRT medication and the womb lining starts to shed in response to no HRT drugs?

@YeOldeTrout as I understand it.
If you still have periods when you have HRT then you have sequential. Oestrogen all the time and progesterone on days 1 - 12 followed by a bleed.

Continuous HRT is oestrogen every day and a half dose of progesterone all the time. No bleeding.