Wrongly prescribed continuous HRT do I need a scan?

[DaveBingo]

Just wondered if anyone can advise please. About 18 months ago I was prescribed continuous HRT, 4 pumps oestrogen gel and 100mg utrogestan for 25 days out of 28. But latest GP has just clocked that because my periods had not stopped this was wrong and I should change to sequential.
I have carried on having a monthly period throughout so reading up I think my natural cycle must have been breaking through. The dose of progesterone has obviously been too low for quite a while so should I be having a scan to check the thickness of the womb lining? Or does the fact I have carried on bleeding monthly mean I will have been shedding it? Hope this all makes sense, TIA

Hopeful bump

My understanding is that if your periods haven't stopped yet, any bleeding isn't a concern as you're not yet post-menopausal. But I'm not a doctor so double check with yours if you're worried!

Thank you that's reassuring. TBH all the GPs at my practice seem pretty clueless about HRT

@DaveBingo If the bleeding has been regular and really IS a period, then you're probably fine.

A scan might not show what you expected anyway because in peri, when you're having normal periods, the lining can grow very thick (and be normal) and the scan would need to be timed right after your period stopped (like Day 5 for example.)
This is very hard to arrange within the NHS as appts aren't sent to coincide with the times of women's cycles.

You're right that the progesterone dose was far too low.
For women on 4 pumps of gel, there is some guidance that they may need 200mgs a day.

The dose you were on was probably not doing very much at all.

What your GP should to is monitor how you go from now on sequential. If you bleed at odd times and not once a month, ask for a scan.

Thanks so much for your reply. I've also since realised that I should have been taking the utrogestan on an empty stomach not just after eating like the GP told me! So that's probably messed up how it's been working even more, arghh!

Actually, it works the other way round.

The empty stomach is to minimise side effects (like sedation.)

Taking it with food actually doubles the effectiveness.
(I think this may be on the patient leaflet- it's referred to as 'increases bioavailability'.)

It's definitely online on medical websites if you want to google and check.

Oh my goodness, so that probably explains why I feel so groggy and awful all the time, just thought HRT not working for me.
However, I am glad really because if it doubles the effectiveness I guess that means I was getting the protection I needed after all.
It's really shocking how the doctors (at my practice anyway) don't seem to actually know much about the HRT they are prescribing.

My GP has just changed me from sequential to what you are on.
She's quite knowledgable and said the even though I'm still having periods, the latest research says this method is far safer than other methods.

The progesterone for two weeks stops the womb lining getting too thick and still enables a bleed between cycles.

So I'm guessing you are ok and are actually on the right path and not the wrong one as your GP has suggested.

It's so very hit and miss with GP knowledge. But I'm confident in mine and I do ask a lot of questions.

@protectthesmallones What your GP has said is not entirely correct.

The risk of hyperplasia with Utrogestan isn't there for at least 5 years on it.
This is in the link I left for another poster today.

https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

The risk of endometrial cancer for women on HRT is very small and less risk than other factors (weight and smoking.)

The other thing that GPs don't seem to mention is that the risks of HRT like breast cancer and around 1.5% higher with continuous compared to sequential.

If you're using hrt for many years this is worth considering.