HRT or not, what to ask for or not?

[Gonnagetgoingreturnsagain]

Sooo.... I've recently been diagnosed with cyst/polyps on left ovary which needs removal and also thickening of womb lining - this is approx a year after starting HRT (Evorel Conti) and having spotting last month and a period last year, I'm 52. I hadn't had periods for about a year before starting HRT. I'm waiting for an op to remove and look into the cyst/polyps and also womb lining result.

My main issue is no more hot flushes but lots of brain fog and sleep disruptiveness. My sleep disruptiveness is partly due to me changing a drug for incontinence which was caused by my metabolism speeding up due to me being on levothyroxine which caused incontinence, I changed this drug about 2-3 weeks ago and GP said it can take 4-6 weeks to take effect. GP would like to decrease my levo from 150mg down.

My brain fog/insomnia is getting me down, I do sleep but it's disrupted. I want to go back on HRT but how long would I have to be off it so I can go through menopause normally? I tried high cost natural menopause remedies inc sage which made no difference for approx 2 years.

My GP when they originally placed me on HRT only gave me that, no other meds and not much further talk about it. Should/could I take something else? I did have anxiety but luckily this has abated.

Can you explain why you have stopped HRT?

I'm not sure what the connection is between your thyroid, the ovarian cysts, the thick lining and stopping HRT.

If you are being treated by a gynaecologist for the ovary and lining, are they advising on your HRT?

You said you didn't have periods for a year before starting hrt, but then also said you had a period last year.

If you're still having even an occasional period (less than 12 months ago) your womb lining would not be as thin usually as someone post menopause (because you may still be ovulating very occasionally.)

Apologies for seeming 'curious'.

Are you using Progesterone alongside the oestrogen ? As a coil or tablet form ?

Female doctor I saw (fairly new) told me to stop the HRT as I was due to have this op. Don't know why and consultant doing the op was confused by this too, e.g. me stopping HRT suddenly.

There's no connection between all you mentioned and me stopping HRT but between all those being stopped means I get some nasty symptoms like thyroid ones. The insomnia could be linked to both my coming off HRT and also getting used to the new drugs for overactive bladder. The consultant lumped in the cysts/polyps and thickening of womb together when I spoke to them on the phone last week and seemed to think (or the new female GP did) that HRT might've caused this, or some other cause, but they didn't think it was serious, just needed to be looked into after the bleeding. The consultant said most cysts/polyps turned out to be benign.

You're right, I didn't have periods for a year before starting HRT, but when I saw GP (think it was male) end of December 2022, I mentioned I'd only had one period earlier in 2022 but I did want to try HRT and GP said, ok then, try HRT, as I hadn't had periods inbetween that time. The GP suggested it too. In fact before the period in June 2022, I hadn't had periods for about six months before that.

I didn't know that about the womb lining not being as thin for me as post menopause, the GP said to me she thought I had been ovulating occasionally.

The main reason I wanted HRT was the brain fog and insomnia and because Menopace Max etc weren't helping with these symptoms at all. Also, I have no idea how long it takes to go through the menopause, if I knew that then I'd be more likely to do it naturally!

Nope, was never suggested to me by GP!

My understanding is that if you still have your uterus you should have progesterone as together with the oestrogen to prevent thickening of the lining. @JinglingSpringbells is far more expert than I am but I do think unopposed oestrogen is not advised.

Thanks for this - wonder why my GP didn't prescribe this?

You are using Evorel Conti.

Conti= combined continuous HRT.
The patches contain estrogen+Norethisterone. (That's the progestogen.)

However, in women who are not fully post menopause, conti HRT doesn't always control the womb lining (because the progestogen is low-dose and for women but no ovarian function at all.)

This is why bleeding can happen on conti HRT if it's started too early.

The best way is to use sequential, to start. That's 12 days per month of progestogen. This will give a withdrawal bleed once a month. (like a fake period.)

If you are not post menopause, your womb lining can be thicker.
I assume you've had a biopsy - or are waiting for one?
And that you have had a scan that showed a thick lining.

It sounds, sadly, as if there is no joined up thinking in all of this. It's all a muddle and the GP doesn't sound very clued-up.

Your gynaecologist ought to be taking control, communicating with you and offering advice.

There is no need to stop HRT while having a biopsy (speaking from personal experience .)

Can't you get an earlier appt with the consultant who's overseeing the investigations?

Also, I have no idea how long it takes to go through the menopause, if I knew that then I'd be more likely to do it naturally!

Nobody goes through the menopause.

Your periods end but the loss of estrogen last forever.
Peri comes to an end (irregular periods) but some women have symptoms for life.
My (private) consultant has women aged 80+ on HRT.

Thanks for the detailed explanation. That makes sense re the bleeding.

I'm waiting for a biopsy yes. And have had a scan that showed a thick lining, yes.

Yep, no joined up thinking here and my male GP wasn't very clued up, the female ones I saw recently (one was a locum) were more clued up.

I do wonder why one GP told me to stop HRT though.

I don't actually have a gynaecologist, all I have is a consultant overseeing the investigations.

I think I might pay to see a private gynae.

Ok, so after my periods stop I just have to deal with the loss of estrogen or not.

I have little to no idea about this, all I know or heard about is 'you go through the menopause and then periods stop'. And this is all really based on my DM and her mum's (my nana's) experiences where my DM had I think an ectopic pregnancy in her fallopian tube, requiring an emergency op, in her mid 40s and after that her periods stopped. My nana had a hysterectomy in her 40s as did my aunt (DM's DSis) also in 40s. My friends talk about this a bit but not in detail.

I think I will get an earlier appointment with the consultant overseeing the investigations, she rang me last week and was helpful.

If you are referred for a hysteroscopy and biopsy it's usually done within 2 weeks of reporting the bleeding.

Is this your timeline now?

With cysts, the rule is they tend to leave cysts under 5cm alone unless they look suspicious. Many small cysts go away.

With bleeding on HRT, they tend to leave it alone if the biopsy is okay, and swap the HRT dose/ regimen for a different type.

I'm not sure from your posts what you have had done on this or if you are still waiting for a biopsy/scan/ etc.

Re the bleeding the hysterectomy and biopsy has been done within 2 weeks of my reporting the bleeding.

I think the cyst/polyps is larger than 5cm or it might look suspicious. Hence the op
to check it out.

I’ve had the scan and awaiting the biopsy which was scheduled for today but has to be done under GA rather than LA as was too painful.