Still having periods (proper periods, not withdrawal bleeds) on Evorel

[AnnoyingPopUp]

Hi all

I’m nearly 52 and have been using Evorel patches (2 weeks Evorel 50, oestrogen only, followed by 2 weeks Evorel Conti, combined oestrogen and progesterone) for nearly 2 years. I am still having periods!! Not withdrawal bleeds - proper periods, including horrible PMT, premenstrual headaches, period pain, etc etc. All the stuff I was experiencing before I started HRT (which I’m taking to help with sleeplessness and migraines, and it does seem to be helping with those).

But why I am I still having proper periods rather than just a withdrawal bleed? The periods aren’t regular either, and they don’t always correspond with when I’m taking the progesterone. I have a vaguely 28-day-ish cycle but some months it’s 5 weeks between periods and other months it’s 3. I’ve seen 3 different GPs, all female, and they all just say that my periods will stop eventually. BUT WHEN?? And is there any point in my being on HRT at all if, as seems likely, my body isnt absorbing it? I had blood tests about a year ago which showed a lower-than-expected level of oestrogen, but 1 GP said that this showed that I wasn’t absorbing the HRT and the other 2 were noncommittal and said that, if they were me, they’d keep taking it anyway….

What to do? I want my periods and my pre-menstrual symptoms to stop. They’re awful. I’d be fine with a painless withdrawal bleed. I can’t take HRT tablets due to migraines. I started my periods at 11 and I feel that, after over 40 years of this shit, I deserve a break!

Most women transition onto a continuous HRT like Evorel sequi to conti after they have reached around 52/53 ish. Once on conti you don't have a withdrawal bleed anymore although I still have the very occasional spotting.

This isn't always the case.
The guidance is to move to combined conti after 12 months of no periods at all.
But it's a choice, not a rule.
I know someone else doing this, who is 70 and prefers a withdrawal bleed to the side effects of daily Utrogestan.

If women start combined conti too soon they usually get breakthrough bleeds because the amount of progestogen is too low to control their own hormones.

@AnnoyingPopUp One very simple reason for your bleeds might be you are using a higher dose of estrogen (you're topping up the amount in the patch.)

Your GP should be aware that the usual reason for bleeding is because there is insufficient progestogen to control the amount of estrogen (which builds up the lining.)

The doses in patches are designed to work together, so in theory if you increase the estrogen, you MIGHT need to add more progestogen.

If you're not happy with what's going on, could you see a private specialist?

One way forward would be to use an estrogen only patch or gel, and Norethisterone (as a tablet rather than the patch) and at a higher dose.

Or you could use Utrogestan and use enough to control the bleeding.

I am already taking extra oestrogen - I wear an additional Sequi patch as well as the Sequi/Conti patch. I had a blood test a year or so ago which showed that I have lower-than-expected levels of oestrogen, despite the double patches, which is why I think I’m not absorbing the HRT. The GP at the time said that this would mean that I wouldnt absorb it via gel either. However, 2 other GPs since then (I’ve moved house, and had to move to a different surgery) have differing opions.

This ^^ is what I meant @AnnoyingPopUp

I've been told recently when I asked my consultant about blood tests for estrogen levels that they are meaningless.
To get an accurate level blood has to be taken many times in day.

If I were you, I'd stick to the usual patch and see how you feel, without topping it up with more.

If you look at this table, the amounts of estrogen and progesterone are supposed to balance each other out.https://www.menopausematters.co.uk/perimeno.php

Adding more can often mean more bleeding.