Should I just give up HRT

[humblesims]

I've been on HRT now for about 2 years and had stopped periods for about 3 or 4 years before I went on it. Thought I could get through without HRT but symptoms were getting really bad (mostly anxiety and mood).
Now on oestrogel and utrogestan.
For the first 12 months it was great, really helpful and I felt 100% better. But then I had a bleed and the GP put me on the recommended fast track procedure which took about 6 weeks and all was fine so I went back on HRT in July last year. Since then I have been bleeding on and off every three weeks or so for about a week at a time. Heavy bleeding with cramps etc etc. Went back to the GP to ask if the mirena coil might be the answer but I am too old for that and it's not appropriate. His suggestion was to up the oestragel from 2 to 3 pumps a night for a couple of months to see if that helps. I've been doing that for one month and for that month I have been bleeding heavily with cramps for 2 and a half weeks (with a weeks break in the middle). Today I feel like crap and think I will just have to stop altogether and deal with the awful menopause symptoms I was suffering with originally. My GP isnt very helpful, I dont think. He did suggest that I might want to go on the mini pill and have the bleeding more regular but to be honest, the choice of having 'periods' with cramping etc again or the menopause symptoms seems ...I dunno, I'm just so fed up with it all. I cant believe I am 58 yrs old (tomorrow!) and I am still dealing with this shit. 😪

I wouldnt necessarily give up on it, you just need to find a regime that suits you. A lot of people seem to have problems with utrogestan, is there any way you can switch to the patches and see if this helps. I imagine it is the progesterone which is making you bleed so you need to play around with the dosage maybe. 2 pumps of the gel is pretty minimal, I started off on 4 pumps a day and a utrogestan which I took virginally, never orally.

doctors are woefully uneducated in the menopause sadly so if you can afford it if I were you I would get an appointment with a private consultant (I used a lady called Jayne Pangbourne was brilliant) and you can explain everything to them.I had my appt by zoom, went through everything with her, she told me what she thought would be the best regime for me and I went armed to my doctor with all the information needed.

Don't give up just yet.

I'm on the mini pill alongside hrt. I'm on it to flatten my cycle and avoid the hormone surges that were causing migraines. I don't get any periods, they stopped after a couple of months on the mini pill. Good luck

@humblesims I've been on HRT, same regime as you, for two years. I started getting incessant bleeding a few months ago and after checking things out my gynaecologist advised a Mirena.

I had it put in last week and it's stopped the bleeding already. I will be 60 this year - I asked the gynaecologist if I wasn't too old and according to him I am not. If I'm not, neither are you!

If I were you, I'd go back and push for the Mirena.

By the way, I think your GP is wrong about upping the oestrogen to stop the bleeding. If I'm right, it's the Utrogestan that needs increasing. My gynaecologist tried that with me first, but it didn't work - hence the Mirena.

What dose utrogestan are you taking, I believe guidelines have changed recently and upped it to 200mg.
I don’t believe there’s an upper age limit for the mirena coil, I know ladies in their 60’s with it for hrt.

For someone post menopause with persistent bleeding on continuous HRT with no cause found (e.g. polyps or fibroids a Mirena coil would be an entirely appropriate suggestion option to consider (though getting this done can be a difficult depending what services are available where you live) as might doubling the Utrogestan. To clarify, progestogen is taken as part of systemic HRT to for endometrial protection.

I had a Mirena coil installed at nearly 58 as contraception and to help control very heavy periods. This was continued as part of HRT and my consultant would have installed another a few years later to control postmenopausal bleeding. However, the cause was found to be a small fibroid, which was in the way.

I’ve attached the British Menopause Society guidelines on this, which you might want to share with your doctor, and maybe seek another opinion.m
https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

Can you describe how much Utrogestan you are using and how often @humblesims

It's amazing how many posters here describe mis-prescribing by their GPs and then have problems.

As an aside, you are not too old for a Mirena coil- you're only 58.
It may be slightly harder to insert but it's not out of the question.

I'm much older than you(on HRT long term) and was told it would be hard to fit a Mirena now as even on HRT the womb shrinks. But you're not my age.

As posters have said ( your GP sounds a bit clueless) increasing estrogen thickens the lining and makes it more likely to shed.

Are you on a sequential regime or (I assume) continuous combined?

You might find you get into a regular withdrawal bleed on sequential to help settle this down.

Sequential can be used in post-menopause- friend of mine is still using it that way at 70- so don't feel it's not allowed.

I came off HRT 2 months ago, I was on oestrogel and Mirena. They want to do some breast exams and the HRT was making it difficult to get a clear picture of what was going on.

I'm 55 and been on some form or another for 10 years. Mirena only 2 years, and been getting spotting and a bleed.

Coming of the HRT I'm getting less bleeding, hot flushes have come back but intermittent and insomnia and night sweats. But the anxiety, which had been appalling, along with the Anger, hasn't come back or at least not yet.

I'd rather be on HRT but it's been nowhere near as bad as I thought coming off it. Talk to your GP but if they won't do a Mirena (though they probably should) it might be worth a try.

If you want a Mirena, and can afford it, then it's entirely possible to have one fitted privately, by seeing a menopause gynaecologist.

The cost of a Mirena is about £90 and then there's the cost of an appointment with the consultant - but you'd have the coil for 4 years so over that time the cost isn't huge.

@JinglingSpringbells
Can you describe how much Utrogestan you are using and how often?

I am taking one pill a day. Three pumps of Oestrogel. Continous.
Thanks all for such helpful info. Its all so confusing. Especially when the GP is apparently giving me incorrect information. I really need to read through what you've all said and consider what to do.
Thank you all so much. I think the mirena coil is the best way forward by the sound of it.

I should say it's one pill of 100mgs of Utrogestan

Hmm bad advice from GP maybe. I had a similar scenario, still having periods but turned into 2 week affairs. Turns out I have adenomyosis. So we put the coil in for direct effect on the womb to stop the bleeding and moved to 100mg continuous utrogestan for sleep/mood benefit I had had before. Kept oestrogel dose steady. Only 6 weeks into new regime, need to give it 12 weeks, but more oestrogen I would think is definitely the wrong advice.

@humblesims For women on 3 pumps of gel, the BMS suggests 200mgs a day (as continuous hrt) if there is erratic bleeding.

3 or 4 pumps is considered high-ish, and high (compared to 2 pumps.)

I think this is in the link left by @over50andfab . (I've not opened her link.)
It's certainly in the guidance by the BMS.

Ideally, you should have an ultrasound scan (not as an emergency) but sometime soon-ish to check that you don't have fibroids or anything else contributing to the heavy bleeds. You could ask your GP to organise that.

I was like you and bleeding really heavy and switched to continuous and I take the utrogestron vaginally nightly 100 and for the first few months had 2 bleeds a month but all settled down now but I also had abalation of uterus recently. I would ask to speak to another doctor and get a referral to gyne. Don't give up on it yet but if you increase estrogen then the utrogestron has to be increased also. I would try 2 pumps with 1 utrogestron. If you still have menopause symptoms increase to 3 pumps and 2 utrogestron. Hope things improve.

I’m in the same boat OP. I’m 63 and the HRT I was doing well on was discontinued years ago and since then I’ve had constant problems. I’ve just changed from the same combination your on and my oestrogen levels were really low (according to endocrinologist who was checking something else). He recommended GP up dosage to 2 or more pumps of the gel twice a day. Within days of upping it to 2 pumps I started intermittent bleeding and mild period type pain. Now on evorel combi patches. Was fine for around a month and last week started with bad breast tenderness, fatigue and today started a light bleed. I’ve no idea whether to stop either.i hope you get some good advice. It’s hard work

No useful advice I'm afraid as I've just started hrt 10 days ago & my moods are chaotic, having ideation, rage, chronic anxiety & just been told to up my antidepressants which cause insomnia, ideation, SIGH. Just wanted to offer solidarity re the whiteness of all we go through from another mumsnetter sharing your birthday tomorrow & not feeling well enough to go out & celebrate. 🥳

The BMS does not stipulate a specific oestrogen dose where the progesterone should be increased, just states high dose (although 3-4 pumps gel would be considered high dose) and has left it to HCPs to decide. So we currently have some GPs increasing the dose on 3 pumps, some on 4 pumps and some not at all.

A concern can be where some women have been advised to increase their oestrogen beyond the maximum approved dose without increasing the progesterone or vaginal use at half the dose which is not along guidelines.

The guidance on bleeding with no known cause in the attachment above is pretty clear though. Also important to note to anyone reading that any change of HRT, whether starting, increasing or changing it can cause bleeding in the first few months. Bleeding can also happen, as I found, when stopping HRT

I'm in a similar situation with what's now become constant light bleeding. I had everything checked out with a biopsy last October & told everything was fine & that it's due to the HRT. I'm 53 post menopausal on 2 pumps, 100mg utrogestan and also the mini (progesterone only) contraceptive pill. When I first started 3 years ago it was great, the bleeding is now getting me down & I should be speaking to my GP later this week. Not sure what they'll suggest.

Wait times to see a NHS gynaecologist in my area (with routine status, which OP is, because she had the urgent investigations to rule out malignancy) are > 12 months right now.

@Neversaygoodbye The main question is are you really post menopausal?
Many women assume they are, or their GPs put them straight onto combined continuous HRT.

Even after a gap of 12 months, some women still have some ovarian activity with very occasional periods and this can cause bleeding when on continuous combined types.

The guidance for combined continuous HRT is 12 months after a last period OR aged over 54 (because at 54, 80% of women are post-meno or with very irregular periods.)

The option you have is to swap to sequential HRT so you have a timed, regular withdrawal bleed. There is the option of this being 3-monthly (it's in the NICE guidance) for women who are intolerant to progesterone.

The other option is to change to a different progestogen- Utrogestan isn't always absorbed that well (but you can increase the effects by taking it with food- contrary to the instructions on the patient leaflet.)

Or to change to a patch which has Norethisterone in it, or even the Mirena coil.

The BMS guidance is there to allow options. Some women have almost no bleeding on HRT yet others can bleed heavily on the same dose.

For women with heavy bleeding, the option of 300mgs x 12 days is there, or 200mgs every day.
It is also an option for women on 3 or 4 pumps of gel (or higher).

@JinglingSpringbells thank you & yes I don't 100% know if I'm post menopausal. I've been on the mini pill since I had my DS 16 years ago. I've been mostly period free on the pill with occasional break through bleeds maybe 3-4 times a year, minimal bleeding for a couple of days.
I had the usual blood test at 50 before the GP agreed to put me on HRT & that suggested I was post menopause. I asked the consultant what she thought when I had my biopsy & she agreed that I was most likely post menopausal but obviously no one knows for sure.
Thank you for the information you've provided, it gives me some options to discuss with the GP - I definitely don't want a regular period.

@Neversaygoodbye Blood tests are very unreliable especially if you are on a hormonal contraceptive.

I had one blood test when I first saw my consultant (not for menopause but hormones were tested anyway) and it showed me as being post meno.
I wasn't- still having regular periods. I went on to have regular periods for another 18 months until I was almost 53. Consultant agreed that the tests are not accurate.

If you don't want a withdrawal bleed, your only option is the Mirena coil, or a patch with a stronger type of progestogen, or perhaps 200mgs Utrogestan daily. It does sound from what you say that you may not be fully post meno yet.

@JinglingSpringbells thank you I've been thinking I'm not post menopausal all this time but when the "experts" keep telling you that you are what can you do! Having not had a proper period for years & as you say the blood tests being unreliable you wonder why they're so convinced.
I feel more prepared for my talk with the GP now which I'm very grateful for & will let you know what they say. I'm supposed to get my phone consultation tomorrow 🤞

The only way you could find out (and it's not practical if you want HRT) is to stop all hormonal drugs and wait to see if you have a period. If 12 months goes by and no periods then you'd say you were post meno.

Hey ladies
im day 6 on Estalis 50/140 and cramps are so bad!! Should I persevere?
I started as joint pain was unbearable and
this has settled. Does this cramping subside?
thx

@humblesims @JinglingSpringbells
Just to provide an update in case it's of help/interest - Dr has suggested increasing the Utrogestan to 200mg and continuing with the mini pill for the next month and then we'll review. Hopefully if the bleeding has stopped and there are no unwanted side effects then I will drop the mini pill.
Thank you Jingle for your advice and information, it helped in my confidence when discussing the situation with the GP.