Advice appreciated on post menopausal bleeding

[Family143]

I wonder if anyone can offer any advice. Apologies in advance as this may be long but I want to give the full picture.

I had my last period in 2019 at the age of 48. I have been on hrt since 2022. Everol 75 (moved up monthly from 25 to 50 to the prescribed dose if that makes sense) and 1 utrogestan daily. I use Newson Health Clinic for hrt prescription and advice.
Every year, whether on hrt or not since I have been considered to be post menopausal I have had a bleed. Very much like a period although my periods were extremely heavy and I had an ablation to help with this resulting in much lighter periods. The post menopausal bleeding lasted for about a fortnight and I needed to use sanitary products. The bleeds happened whether I was on 1 or 2 utrogestan and only once within 8 months to a year but each time as it was over 6 months from the last time, it was investigated

Each time the bleeding was investigated under the 2 week pathway with an internal scan. On the last 2 occasions my womb lining has been above the acceptable limit and I have had further investigations.
I had a mirena coil fitted in November last year to help with the bleeding and had no problems until March when I started bleeding but this time in continued longer than the normal 2 weeks I had had previously. Newson advised I also take 2 utrogestan to try to stop it A scan showed I had a partial bicornuate uterus which had never been picked up before and also no mirena. An x- ray confirmed it hadn't migrated so I have no idea when it fell out - with the bleeding or before it started.

I had a hysteroscopy which revealed some womb lining that hadn't been ablated in one 'horn' of the heart and a polyp. The polyp was removed but I am still bleeding - 4 months now. It has reduced but I need a panty liner or mini tampon daily.

Newson advise that in their experience some women do just bleed without any explanation. Research has told me a mirena coil is more likely to fall out with a uterus shaped like mine and as the bleeding increased from being on it I am reluctant to try it again.
I am still taking 2 utrogestan but am fed up of bleeding.
Is the only answer a hysterectomy?

Again apologies for the very long post.

Have you had a diagnosis of endometrial hyperplasia. I have been in the same position, 2 week pathways, increasing womb lining etc and I was given a diagnosis of endometrial hyperplasia. It is about hormone imbalance, weight, insulin resistance. I am 7 days post surgery for a 10 cm cyst and double ovary and tube removal but the consultant decided to insert the mirena coil and try a medical management and scanning protocol to keep the womb intact. If this doesn’t work the only option is the removal of the womb. I hope this helps. Make sure the womb is scanned often.

Wow that's a lot of stuff going on!

The really obvious answer to me at least is why don't you stop Utrogestan and try Norethisterone? It's one of the synthetic types and in almost all patches and is more powerful in terms of keeping the lining thin.

I'm surprised the Newson clinic hasn't suggested this.

You can take it was a separate tablet alongside an estogen only patch.

I used Norethisterone alongside gel for 6 years before swapping to Utrogestan (I've been on HRT very long term).

Has no one suggested this?

Thank you both so much for your replies.
@wiggo no I haven't been diagnosed with endometrial hyperplasia. It's never been mentioned. The bleeding episodes have never lasted longer than 2 to 3 weeks previously, until this year. My womb lining has never been thicker than 6.3mm. On the hysteroscopy there were lesions from my ablation and lots of almost fluffy like tissue which they didn't seem concerned about.
@JinglingSpringbells no Newson haven't mentioned Norethisterone. To be fair to them when I mentioned the bleeding at my last 2 reviews, it had been investigated and completely stopped on both occasions. I have spoken to them though about this extended bleeding and it wasn't mentioned so I will speak to them.

I don't know what kind of response you will get from Newson.
My instinct from knowing what I've seen and heard of them is that most of their Drs are just GPs and are trained to a fairly low level on HRT. (There used to be handful of them, now their website shows dozens and dozens.)

I don't know if they'd consider Norethisterone as they seem to offer women one thing only- gel/ patch and Utrogestan.

TBH in your shoes I'd be looking for a consultant gynaecologist with meno expertise (many apologies if the dr at Newson is this!) .

Thank you @JinglingSpringbells
I think you're probably right. All my consultations have been with GPs.
When I had my hysteroscopy and the consultant saw that I had one part of the heart that hadn't been ablated he said it could be that I wasn't post menopausal and the episodes of bleeding were periods. I did tell him that I had still had regular periods post ablation until they stopped. He said I needed a blood test to check! I questioned the validity of a blood test whilst on hrt and accuracy at the age of 53 and he brushed my concerns aside. It just makes me question the knowledge of some professionals around women's health and have a perpetual feeling of banging my head against a brick wall! I have had gynae issues since my periods started and wa hoping that no bleeding should be one benefit of the aging process.
I have followed your advice and booked to see a gynaecologist who lists menopause as one of her specialities so I am hoping that she will be able to help.
Thanks again.

I used to take Norethisterone to delay my period when I was younger and it worked great for me. I am using 200mg Utrogestan every night no breaks now but am still getting very light spotting every 4-5 weeks (month 5 now, was on 100mg but still the same as now even double the dose). Did you swap to Utrgestan for a reason?

Sorry no advice, but as someone who is bleeding again with the coil in, I just want to after solidarity. I honestly don’t know why the doctors persist on trying to sort the bleeding, having costly investigations time and time again, when it could just be whipped out and end it.

I agree, wish I could have mine out!

I completely agree @DustyLee123 and @Ladybird3355
I know it's an operation but I think that's what I would prefer!