Struggling with symptom after coming off HRT due to pm bleeding.

[GeneralUser]

I am pm 2 years. HRT 1 year - Evorel 100 patches plus progesterone.

3 weeks ago I had pm bleeding. Proper period like symptoms. I finally managed to get a GP appointment 10 days ago. In order to be referred for an investigation for the unexpected bleeding I had to come off HRT for 6 weeks.

I feel awful. My anxiety has come back, my body is aching, really aching and I am tired all the time. I also feel dizzy.

What I'm looking for here, I think, is ways of coping. If you had to do the same, how did you cope? Did you get any additional non-hormonal medication or supplements to help?

I am not even thinking about the bleeding and what it could mean all that much.

It's a shame that this new guidance is being made mandatory.
It never used to be a case of stop HRT.

It's actually discretionary advice and GPs can make that choice as far as I know.
From what you say, the issue may well have been too much estrogen and not enough Utrogestan. I don't know what dose you're on but they now suggest 200mgs daily if you're using a high dose patch.

Being really blunt, the chances of continuing with HRT for a few weeks making anything worse, is low. You should have an appt for a scan within 2 weeks, so why stop HRT for 6 weeks?

When I read the guidance a while ago, it seemed more that the 'stop for 6 week's was more a 'reset' to see if the bleeding settled down when restarting HRT.

Have they said how long it will be for the scan?

TBH I'd go back to your GP and explain how awful you feel, and ask if it's absolutely necessary to stop. Many GPs just follow the 'rules' and don't use any judgement on what's best for the individual.

Thank you @JinglingSpringbells

Is Evorel 100 considered high dosage? I am taking Utrogestan 100.

I had not realised it was discretionary guidelines.

I will try to make an appointment asap, that's a battle in itself.

@GeneralUser yes 100 is a high dose

The bleeding is often due to your hormones being out of balance due to the HRT dosage not suiting your body.
Sadly, a lot of GP’s don’t have the skills or knowledge to adjust the dosage to see if that helps.
I had a similar situation and was seen within 2 weeks to have an internal scan. The issue was fibroids and polyps.
The only way I got my HRT right was paying privately to see a consultant who works on the NHS but the waiting list was so long. I upped my Utrogestan as a result.
I found the information on Dr Louise Newson’s website and Insta really helpful if you look her up. She doesn’t give individual advice but her Insta videos have helped me a lot.
Finally - try not to worry. When I did go for my scan I was told so many ladies are given emergency appointments due to temporary bleeding and the causes are not sinister at all. It is usually the wrong dose of HRT, non-cancerous cysts, polyps or fibroids or womb thinning where the lining becomes agitated and irritated.

Yes, 100mcg patch or 4 pumps of gel are the highest licensed doses. Patches start at 25mcg, then 37, 50, 75 and 100.

Have you always been on 100mcg?

The British Menopause Society produced a report not long ago on progesterone and they advise 200mgs daily for women on a high dose. They use words like 'should consider' rather than 'must'.

However, it's discretionary as some women get too many side effects on 200mgs.

I'm on Estradot 100 (same dose as your Evorel) and was told I needed Utrogestan 200 not 100 to prevent bleeding.

I had recurring episodes of period like post menopause bleeding last year and coming off HRT wasn't mentioned at all. Had a scan which was inconclusive and referral for hysteroscopy as follow up which confirmed nothing to worry about. The consultant offered to insert a mirena coil during the hysteroscopy as she suspected fluctuations in progesterone levels might be causing it and the coil provides a very steady dose. Haven't had any bleeding since so worth considering.

I'm on Evorel 75 patches

My GP doesn’t require coming off HRT to investigate post meno bleeding. I think I would go back on it if I were struggling. The gynae didn’t ask either.
(No sinister reason was found for my bleeding btw).

Thanks everyone.

@JinglingSpringbells no, I started with 50 and worked up to 100mcg before I felt better. It was a huge sigh of relief for me when it all clicked into place and I felt normal again. Didn't realise 100mcg was the highest.

@OnGoldenPond I think it's fairly new guidelines.

I didn't manage to get an appointment today, but I will keep trying. I think it took me a week last time.