Continual Utrogestan and periods

[RagingWoman]

I'm now 55.
Had peri symptoms for 3-4 years.

At 53 my periods suddenly became heavy and painful. I asked for HRT and was sent for a hysteroscopy to check all ok. Gynae consultant (female) did it and gave me all clear for HRT. Started on Oestrogel and cyclical Utrogestan

The oestrogen did everything it's meant to and more! My life changed for the better overnight. But the progesterone withdrawal bleeds were still heavy, long, erratic, and crampy. GP said it will settle down. It didn't.

The GP I saw is a new-qualified and young female who is keen to learn but won't do anything that's not "in the manual". I have medical experience and am very in tune with my body and have done masses of reading up both in here and the Newsom website and all the other sites.

After I persevered for a year, I changed to taking the Utrogestan continually, as per the NICE guidelines (after one year or at over 55). All the problems disappeared but I'm still having a "period" every 2-3 months which is very light, not painful, not intrusive, is all dark blood and lasts about 3 days total (I change mooncup every 12hrs and there's never more than a tsp full of dark clotty blood). I had a phone appt with GP and told her what I was doing and that I would come back if I was concerned. Heard no more about it

Had a med review with clinical pharmacist this week, discussed the HRT with her, reassured her that I feel fine, no symptoms, and I understood the danger signs etc. I don't consider myself to be post menopausal because I've had a period in the last year. There's no documented harm in taking continual progesterone during peri.

But now the GP has messaged to say "pharmacist recorded that you're still bleeding. Please make an appt to discuss this" I don't really want to as it's a waste of our time. But if she blocks my meds I'm fucked!

Any advice please on what to say to her or something I can signpost her to that says it's all perfectly normal? Thank you!

If you're using combined continuous HRT there should be no bleeding after 6 months.

This is from Menopause Matters written by a consultant gynaecologist (NHS.)

https://www.menopausematters.co.uk/postmeno.php
POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved.

When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control.

• Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).
• If sequential therapy started while still having periods, wait till age 54 years.

Patients should be advised to expect some bleeding in the first few months of treatment, but should have settled by six months.

Any bleeding persisting beyond 6 months of continuous combined therapy, or bleeding occurring at a later date, should be investigated.

In situations when a higher than medium estrogen dose is needed and progesterone is taken separately, great care must be taken to ensure that the progesterone is adequate for protection of the womb lining. It should be noted that no data is available for the effect on the womb lining of varying doses of transdermal estrogen and Utrogestan.

It may be absolutely nothing, but your dr would be doing her job to refer you for a scan to make sure you don't have hyperplasia.

The main reason for not using continuous during peri is that it doesn't always control the womb lining, there's irregular bleeding, and then there is a dilemma over 'is this hyperplasia and does it need a scan?' and that's the only way to find out. Because once on any HRT you never know when your own periods have stopped.

How much gel do you use? If it's more than 2 pumps, you may need 200mgs Utrogestan daily.

Can I jump in this thread please?

I'm 51 yrs old. Was on HRT for a year and told on to go onto continuous utrogesten aged 50, just one tablet a day with 75 patches

Moved to gel about 5 months ago, up to 4 pumps now and getting more menopause symptoms, worst of which is waking 3 or 4 times in the night and being flippin exhausted.

Saw GP last week and discussed crappy sleep and I'm still having periods between 40 and 70 days gap.

I asked if I can go up to 2 tablets of utrogesten and she said let's do a blood test for oestrogen levels in 4 weeks time (only moved to 4 pumps from 3 pumps 3 weeks ago). If I'm not absorbing the gel I may be able to have oestrogen tablets.

GP referred me for an urgent internal scan (oh joy) tomorrow.

I think the gel isn't working and I shouldn't have been put on continuous utrogesten just because I turned 50.

Not sure what my options are or what the best treatment should be. I guess it's reassuring to get a scan so quickly but it all feels very hit and miss (last GP appointment before last week suggested prozac for the night waking 🤬 I declined)

@JinglingSpringbells

Thank you
I hadnt considered the possibility of hyperplasia for her concern and of course you're right that she is doing her job in taking this seriously.
It just feels so normal to me!
If higher dose Utrogestan is what I need, can that be advised by the gynae consultant? Ie is it within guidelines?

Yes.

It's in the BMS guidance.https://thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

If you w ant something off-label, tailored to your needs, (different to the above) it's probably best to see a private menopause specialist who can tailor the number of days on Utrogestan to your situation.

It's something that needs sorting though because any odd bleeding on combined continuous is always investigated especially at your age .
If you carry on with what you're doing and you keep bleeding, it will just flag up the need for investigations each time.