Bleeding - HRT was great for 6 months

[carkerpartridge]

I have been on Evorel patches and Utrogestan for just over 6 months. It has been going pretty well, dose was tweeked from 50 to 75 a couple of months ago. I had been having a regular bleed every month.

This month, 2 weeks after the expected bleed I am bleeding again (has been 5 days so far). Obviously I am going to see GP about it but I wondered if anyone has had similar. I'm trying to work out what's going on. I have felt like I have had more of the peri symptoms that I had before HRT and have had quite a few gastric issues - maybe IBS. I've been a hormonal wreck this week and just hoping it can be resolved!

It takes three months for a change to settle. Are you also taking utrogesten?

Yes I am taking Utrogestan for the second part of my cycle as I am perimenopausal, I was still having periods before I started HRT (although they were getting a bit more spaced apart. All the info I read says that it takes about 3 months to get used to HRT, which I thought was the case, but this extra bleeding has started at just past 6 months.

Has the bleeding only started since you increased patch?, also how are you taking the utrogestan. Maybe breakthrough bleeding and need to increase utrogestan x

I would guess at you needing more utrogestan too.

Christine0708 Yes the new bleeding has just started in the past week, so about 3 months after increasing patch dose. I am taking the Utrogestan as micronised capsules on last 12 days of each cycle. I have managed to get a phone appointment with my GP this morning so hopefully will make some progress.

@carkerpartridge with utrogestan you really need to let it create its own cycle by taking it say the first of every month for 12days so first Nov then start on first Dec otherwise you are following your own cycle which is going to be erratic in peri. Or you can take it as 2 weeks on (or 12days) and 2 weeks off.

I am taking the Utrogestan as micronised capsules on last 12 days of each cycle.

Do you mean your own cycle, (which can vary a lot) or are you using Utrogestan on the same date each month? eg 1st October, 1st November, etc.

As you are still in peri, it's not unusual for your own cycle to break through and give you an extra period. It's nothing to worry about, but a nuisance.

A patch of 75mcg is considered higher (50 is 'medium') and you might need to take Utrogestan for 14 days or even increase it to 300mgs (3 capsules) for 12 days.

The BMS advised that women on higher doses of estrogen might need to do this ^^

Christine0708 I was told to take Utrogestan from day 15 for 12 days. I have taken this to mean that each cycle is 27 days. I have never had a face-to-face appointment for HRT and find the instructions I was given quite unclear!
Jinglingspringbells Yes I am still in peri. My periods were becoming a bit less frequent but since taking HRT I have been getting a bleed every month. I agree that maybe this unexpected bleed could be my own period as I have been having lots of PMT symptoms over the past week.

Anyway I spoke to GP, over the phone again! She didn't mention any of the things that have been brought up here. She has told me to stop my HRT altogether for a week to see if the bleeding calms down and then have a face-to -face appointment with GP. Her reasoning was that if the bleeding stops it will mean it's down to HRT rather than a medical issue. To be honest she seemed quite severe in her approach and has freaked me out. It is good that she is taking it seriously but I got the impression that she was just dealing with my symptoms rather than treating it as an HRT and peri issue if that makes sense Goodness knows how I'm going to feel with this sudden withdrawal from HRT...

I also mentioned that I have been getting lower backache and IBS type issues but she seem to disregard them. She actually told me not go mention gastric problems if I see anyone else for this issue as it will complicate matters!! I am seeing a different GP next week so hopefully she will have a different approach.

The advice from your GP is very odd @carkerpartridge
There's no logic to it!
If this is your own period it might stop (and probably will) within a week, so how would stopping HRT 'prove' it was the HRT? !

There is no way my consultant would do what she has said.

Odd bleeding on HRT in women who are in peri is common and rarely 'dangerous'. It's not the same as women who bleed post-menopause (either on HRT or not.)

TBH (and it's your call) I'd be tempted to push the experience to one side and see if it happens again. If it carries on, you then might want to think about upping the Utrogestan or even changing to a Mirena coil that can control bleeding really well in younger women.

JinglingSpringbells Thanks so much for your comments which do help to reassure me. I feel like the doctor's first response to this has been to prove that it is or isn't something sinister which I am finding very unsettling. She said that I must not forget about my appointment next week as it is very important. It all just feels a bit patronising and scaremongering. She was presumably a locum (as not on the practice staff list) so I don't know if that makes a difference...maybe trying to prove that she is doing a thorough job...

My original GP practice (which was great) has shut down, so I am now getting to grips with a new one.

Same thing happened to me op. I had gone from 75 to 100 evorel patch and was still having monthly bleeds. Then I randomly had a bleed mid cycle.. the Dr told me to go back to 75 patch again and sent me to get a ultrasound of my uterus. Turns out my uterine lining was too thick so I has to have a biopsy.

Anyway, turns out I'm fine. Had the mirena put in whilst having the biopsy so I don't have to bother with utrogestan anymore and the Dr said I could up my evorel dose to 100 again. Honestly your Dr doesn't sound like she has a clue.

I was really impressed with my gp, odd bleeding and I had an ultrasound booked within a week.

Thanks WitchyFingers2. I wish I had been sent for a scan. Instead I have to go to GP next week so that they can "examine me". I think a quick scan would show up much more than a GP rummaging around!!

@carkerpartridge A scan won't necessarily be useful (I've had loads- all privately- for odd bleeding and sometimes just as an MOT.)

It's tricky doing a scan on someone in peri AND on HRT.
The lining will be thicker mid cycle anyway, until you bleed again, so the only accurate reading would be the very last day of your withdrawal bleed.

There are also very different cut-off points for the thickness for women who are post-menopause, or in peri. In peri, especially if you are ovulating and producing your own estrogen, the lining can be 15mm thick, whereas post menopause (and not on HRT) it should be less than 5mm.

The likelihood is this is either a one-off extra period, caused by your own ovulation (and that's not controlled by HRT anyway) or it's spontaneous shedding of a thicker lining (which would be rare/unusual as it's only 2 weeks since you had a bleed.)

The first step is usually to increase the progesterone or to change to another type. IF you are referred for a scan, then it has to be done straight after a bleed when the lining is at its thinnest, otherwise it's a bit meaningless.

Nothing can be found by ''examining' you.
Complete waste of time.
All that means would be looking at your cervix.

That's interesting JinglingSpringbells. There are so many variables aren't there. I had hoped that my HRT would have been tweaked today but now that I've been taken off it (for a week at least) I don't know where this leaves me. Fortunately the doctor I am seeing next week is a different one, so I'm hoping she's a bit more clued up.

@carkerpartridge If it's okay I'll Pm you as I can tell you some personal experiences without putting it out on the WWW!

JinglingSpringbells yes great thank you!

I’m in a similar situation OP, but I have a Mirena and Oestrogel. I started last summer, and was having regular light periods - more just like spotting. This month I started a “period” three weeks ago and it’s still going. I have made a GP appointment but the first one available is 15 December! In desperation I have a consult with a private GP next week but it’s just on the phone. I’m hoping she might advise an increase in gel or something.

I had a clear smear in July, and an ultrasound in March. I do have fibroids - not sure if that is playing a part.

Judy That's a long wait for an appointment, hopefully the private appointment can give you some sense of what's going on. I had thought that I might have fibroids based on other symptoms that I have have. I think I'll bring it up when I have my next appointment. It's at times like this I wish I lived in a country where it's standard practice to have a gynae!

@carkerpartridge i was told the fibroids were small and that a huge percentage of women have them - I don’t know if they cause bleeding? I am so sick of it all and just want to wake up and be post-menopause!

I'm not sure why @JinglingSpringbells is saying to dismiss your symptoms, this poster isn't a gp or a gynaecologist as far as I'm aware (but does seem to stalk this board with "advice")

Any abnormal bleeding is worth getting checked out. Definitely try and see a different gp and maybe get a scan, you never know what is going on.

Perimenopausal.women who still have periods are not immune to.uterine cancer so best to get it checked out.

WitchyFingers2 It's good to get different perspectives on here but I won't be basing any of my own decisions just on MN advice! I think I was surprised at the GP's advice because it seemed very focused, very soon, on sinister causes for the bleeding. I will definitely be open to any investigations, blood tests, scans etc that can put my mind at rest.

@WitchyFingers2 I am not dismissing her concerns and as for 'stalking'?

You said "A scan won't necessarily be useful " that's not really something you have the expertise to comment on now is it?

I don't see why you say "It's nothing to worry about, but a nuisance." Regarding the breakthrough bleeding? How do you know? I don't, which is why I recommended seeing another gp and maybe getting a scan. You're "advice" is at best useless and at worse actively dangerous. Ignoring unusual.bleeding is never good regardless of age.

@WitchyFingers2 If you must know, I've also had a long private conversation off the forum with the OP. I gave information there about my own health and experience (having had scans almost annually for 15 years, by some of the most experienced gynaes in cancer) and sharing that info which you are not able to read in the posts.

I will reiterate one very small part of that which is that a scan, unless timed for immediately after a bleed, is not accurate especially in peri. Unfortunately, the NHS is rarely able to time scans in that way.

I am also a health writer, who talks to medics and reads a lot of medical information.

I hope you won't come back with more personal attacks which go beyond discussing the point.