Continuous ultrogestan... 100 or 200mgs? occasional bleeds

[omega4ever]

Hi, Im 57, been on HRT since 50 and changed to continuous from cyclical about 2 years ago. No idea when my last real period was as I was still menstruating at 50 when started HRT.

I take oestrogel 2 pumps daily and 100mgs ultogeston orally every night. I have also started vagifem vaginally in the last few months ( following a smear test that was really painful but normal) .

My problem is intermittent light spotting ... I sometimes feel achey like a period is coming... then have either dark old blood staining or fresh light spotting for a day or two.

When I was on cyclical HRT I felt very periody before bleeds and this was my reason for changing to continuous progesterone.

Would increasing the ultrogeston to 200mgs at night be an option to try and counteract this? Anyone take 200mgs at night with any experience?

I dont really understand how the oestrogen/ progesterone balance affects bleeding... would less oestrogen also be an option? I suppose I could try to reduce.

My GP is useless... has no idea and impossible to get hold of to have a sensible discussion.

I would value any options. Thanks in advance.

https://www.menopausematters.co.uk/postmeno.php

Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months. Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.

You need to see your GP.

It's likely to be an imbalance but you are on a low-medium dose of gel and the right amount of Utrogestan.

The other thing to consider is that sometimes, when women start vaginal estrogen it can result in slight spotting, either from the physical 'trauma' of inserting it (using plastic applicators) OR the vaginal walls can bleed anyway, when they are very dry and atrophic.

So it could be any of these but you should be sent for a scan to check the womb lining.

@JinglingSpringbells thank you for answering.

Please may I Pm you later today with more info..

I put on my "big girl pants" and spoke to a male locum GP at my surgery this morning. I really didnt want to speak to a male... but there was no female available .... he was actually very nice and pleasant. He did ask if I wanted to come in and be examined with a chaperone, but I decided against as following our discussions he is doing an urgent possible cancer referral to Gynae team anyway.

He has also given me a script for Tranexamic acid and is arranging bloods and a scan. Bloods form I have is for U and ES, LFT, FBC, TFT, Feritin and CA125.

Im pretty scared now. I had a smear earlier this year and it traumatised me... so painful and Im so tense .... cant imagine how I'll cope with proper pelvic examination or tests.... Shit.

He thought it might be good to stop (!!!!!) my current HRT untill Ive been seen and this is freaking me out too.... Ive been on HRT 7 years and dont feel I can cope with abruptly stopping... he wasnt too sure about this so just wondered if anyone had any ideas.....

I was happy for you to PM me- no issue there @omega4ever

I will come back to your questions here shortly tonight. In the middle of things ATM!

Please don't worry. Statistically, anything serious like cancer is rare in women using HRT and especially combined continuous. I did look at the numbers a while back and it was very low.

Sometimes vaginal estrogen can cause spotting. here is info on Vagifem [[https://www.vagifem.com/

Not sure why you have been prescribed Tranexamic acid. This is usually given for heavy periods, to reduce the flow (and it can be bought over the counter for heavy periods with pain.)

Did he explain why? And are you supposed to use it all the time?

The investigations will probably be an ultrasound scan first. This is not nearly as 'bad' as a smear. They don't insert the probe very far and the whole process takes about 5 minutes. Keep using the Vagifem to make sure you don't get too dry.

It's not a good idea to stop HRT abruptly. There is a risk of blood clotting as a 'rebound' action when you've used it for a long time. The advice for women who stop is to reduce it gradually over 3 months or longer. (I'm happy to expand on this by PM with my own experiences if you'd rather do that.)

Yes I was prescribed 200mg Utrogestan daily for bleeding and this was upped to 300mg. It is common to increase or change progesterone for bleeding issues. I'm now on Provera as Utrogestan didn't work for me.

@Movinghouseatlast Thanks for info. May I ask if your bleeding problems started after a while of being stable on continuous Utrogeston ? Im glad that Provera is helping you now.

Just an update,
Ive spoken to GP re bleeding and had bloods ( normal ) and a vaginal USS... I have a thickened endometrium aprox 7mms ) and a possible polyp and fibroids) and am on a 2w wait for a hysteroscopy. Terrified now. I managed to get an OPA cancellation last week to see Gyneacologist and she wanted to do it there and then. As i dont have children and finds smears/ vaginal exams very painful I've opted for a GA... Hopefully in the next 2ws too. She was a bit pissed off I didnt even try and have it then , but I just know it would be a disaster... Im such a coward and Ive heard how painful a hysteroscopy can be for some women. She also taken at me about the mirena... which Im not keen on, as if it goes in it has to come out again in 4 years... she wants me to think about this instead of utrogeston... I want to stay on utrogeston and dont really know what rationale to give... is there any evidence that one is better than another???

Ive never even had a GA for very scared about the whole thing tbh.

Any helpful experiences ladies?

I swapped from Utro to the Mirena, but I had bad side effects from the Utro.

The mirena is fine. I don't have to think about my HRT except when I change my patches. The idea of gel or tablets every day would be way too much commitment for me.

I don't have issues with pelvic exams though and usually have my pants off and legs akimbo before they turn their backs! But if you're having a GA anyway, I'd have one put in.

Dont worry about them coming out, you don't even feel it. It's literally painless.