Bleeding 5/6 months after starting Evorel Conti patches

[Greencarpettiles]

Hoping for some advice from anyone with HRT knowledge or similar experience.

I’m 52, started on Evorel Conti patches in July and have just started bleeding. Also had v sore boobs for the past couple of weeks.

I will be contacting my GP on Monday but posting for advice in the meantime. Can anyone advise what I should ask my GP for?

I did have an episode of post menopausal bleeding just over a year ago (before starting HRT) was referred on the 2 week pathway, scanned & told all OK. Should I now ask for another scan?

I’m feeling quite anxious so any advice would be v much appreciated.

The patches artificially create a monthly cycle as if you ovulate.

I had exactly the same. I needed extra progesterone. I've ended up.on 20mg of Provera which has stopped the bleeding, having tried extra ( up to 300 mg daily )of Utrogestan.

In your shoes I would ask for a scan just to reassure myself but then ask to change or up the progesterone dose.

For sore boobs try a very high dose of Starflower Oil.

You should speak to your GP asap.

I’m the same age and also 6 months into using the same patches. I had a bleed 2 weeks ago (the same time that I went for a check up / review before the GP would issue a repeat prescription).

There is a small risk of endometrial cancer - and bleeding can be a sign of this. I was advised I shouldn’t worry - within 2 days I had a hospital appointment, was given a scan, had a consultation by a gynaecologist and had a swab taken. I was given the all clear a few days later.

Its probably nothing to worry about but do go and get it checked out.

Thanks all.

@RandomMess is that definitely the case with the Evorel Conti patch (I thought this was the Sequi patch but could be wrong).

@NorthernSpirit yes endometrial cancer is my main concern.

@Movinghouseatlast can I ask if you had a scan?

Ah yes conti is the one that contains progesterone and mimics the 2nd half of your cycle including PMT.

Yes go to your GP,

Were you peri or post- menopause? My infrequent cycles still interrupt taking patches.

Thanks @RandomMess. My GP classed my as menopausal at the time of prescribing Evorel Conti as I hadn’t had a period for over 12 months, however I delayed stating the prescription for approx 6 months due other unrelated (non health) stuff I was dealing with, and in that time period before starting HRT I had the ‘post menopausal’ bleed I mentioned I my opening post, so perhaps I wasn’t menopausal after all.

Honestly I’m a bit confused about it all. Could I have done myself harm by having the wrong type of HRT (for menopausal instead of perimenopausal women)?

If you have been through the menopause then you don't need progesterone anymore.

It seems sensible that you were prescribed conti which contains progesterone as that is what protects you from cancer.

Def go to the GP just to be super safe.

@RandomMess did you mean to say if you've had hysterectomy then you don't need progesterone anymore? As if you have a uterus/womb then you can't have unopposed oestrogen HRT without progesterone - this is to prevent endometrial hyperplasia/cancer.

Sequi is the cyclical one but conti/continuous you take daily progesterone.

If you hadn't had a period for a year then seems reasonable to have started on continuous but sometimes can need higher progesterone to prevent any breakthrough bleeding, especially if on higher doses of oestrogen.

In your case you really should make a GP appointment to assess for causes of the bleeding and they will discuss next steps, depending on any relevant examination findings and pertinent factors from your history. They will also have access to your letter from gynae after your previous review that may contain follow up advice.

Yes, I had a scan and it was normal. My menopause specialist said that some women have wombs that want to bleed.

Thanks everyone.

@Movinghouseatlast can I ask how you found your menopause specialist?

A quick update, I spoke to my GP on the phone yesterday and she has referred me for a scan on the two week pathway, so waiting for that now.

she is also arranging for me to have blood tests to look at hormone levels, although apparently there is a month+ wait for these.

I was referred by my GP. My GP disapproves of HRT but the upside of that is she offloads onto someone who knows what they're talking about!

@Movinghouseatlast yes that does sound like a big upside, I wish I had seen a specialist / had a better understanding of HRT before I started using it. In fact right now I wish I hadn’t started it at all!

I am seriously thinking about stopping HRT as one of my most debilitating menopause symptoms is anxiety, and I am now feeling really anxious!

Also, don't be anxious! I know it's hard but of the women who have a thickened womb lining shown from the scan and go on to have a hysteroscopy 90% have nothing wrong. So a thickened lining isn't even a definite indication that there is something wrong.

There apparently isn't enough research as to why HRT causes some women to bleed. It can stimulate fibroid and polyps.

If you join the Facebook group The Menopause Support Network you will see SO many posts from women who have had post menopausal bleeding.

however I delayed stating the prescription for approx 6 months due other unrelated (non health) stuff I was dealing with, and in that time period before starting HRT I had the ‘post menopausal’ bleed I mentioned I my opening post, so perhaps I wasn’t menopausal after all.

It sometimes looks as if GPs don't have a clue.

If you were not at least 12 months post without a period, you were not post meno.

Your GP ought to know this and the bleed you have had is 99% certainly a period that conti HRT won't stop (because the daily progestogen is too low to prevent a bleed.)

I know it's best to have things checked out BUT the lack of education by some GPs is meaning so many women are being tracked for investigations when it's the type of hrt they are on.

Thanks for the reasssurance @Movinghouseatlast, really needed.

@JinglingSpringbells I’m massively confused about whether I’m on the right treatment or not, & really cross with myself that I didn’t make sure I understood better before I started HRT. It’s really not like me.

If goes well with the scan I think I will try and find a specialist menopause clinic and start from scratch.

@Greencarpettiles Please don't worry.
The likelihood is that nothing is wrong.

Just to reassure you there is no right or wrong' way of using HRT.
There is the option of cyclical or continuous for women of any age.
So you've not done yourself harm.

I see a menopause specialist privately (one of the best around) and I still use sequential HRT after 15 years on it, because I don't like combined continuous.

It's a choice over which way to use it. Most women prefer the no-bleed sort, but there are pros and cons for using it that way or on a cycle.

Most bleeding when on HRT is because of the hormones and nothing else.

You said your Gp wanted to take blood- that is likely to be inaccurate because when you are on HRT it won't show much at all in terms of hormones.

If you want to find a specialist, the BMS has a link on their website where specialists are listed geographically.

Thanks @JinglingSpringbells I will look at the BMS website

Still waiting for a scan appointment. Put my phone down for a minute this morning and missed a call from the hospital 😱. Tried to call back and just got recorded messages on every number I tried.

Also got a letter from my GP today telling me to call ‘urgent suspected cancer’ gynaecology phone number if hadn’t heard anything by 20.12.23. Letter sent 2nd class so arrived today two days late while I was at work, no answer on the number as out of hours by the time I called.

I know some kind posters have reassured me on this thread already, but my anxiety is really spiralling tonight. It just feels like I am stuck in limbo and now have to deal with the Christmas weekend with no so more waiting and more anxiety.

Also still wearing patch as GP said to leave it on until I’d had my scan. Shall I just take the sodding thing off and see if the bleeding stops?

Really, don't be anxious. It the vast majority of cases there is nothing wrong. It's just caused by not enough progesterone.

I'm on a menopause Facebook page and honestly every other post is about people bleeding on HRT.

They really shouldn't mention cancer for this, they should maybe call it investigation, so as not to worry people.

Thanks @Movinghouseatlast I know I’m not being rational, but I suppose that’s the thing about anxiety.

I had a cancer diagnosis a couple of years ago, totally unrelated and treated, but that’s obviously not helping.

i don’t want to spoil Christmas for everyone, so need to have a really firm word with myself!