Post menopausal bleeding on HRT

[JenaWren]

Has anyone had bleeding on continuous Oestogel and micronised Progesterone?

I’ve been on HRT for 7 months and no issues until about 6 weeks ago when I started spotting. Scan has shown normal endometrium.

I’m on a pretty low dose - 1 oestrogel pump on Tues, Thu, Sat and Sun and 2 pumps on the other 3 days. Plus 1 progesterone nightly.

Doctor hasn’t advised yet - just said we would need to review dose if it continues.

I'm guessing option will be to increase progesterone or decrease oestrogen. Is that right? I’m not keen to increase dose if I can help it.

The bleed you had was within the 6 months they allow for combined continuous to settle down.

Why are you varying the dose on different days? That's likely to give you symptoms anyway.

That can sometimes cause spotting as your estrogen levels will be fluctuating. I think it says on the patient leaflet that missed doses may cause a bleed.
I know you're not actually missing a dose but why are you changing it?

If you've been told by your GP to keep to a low dose, it would be better to do 1.5 pumps every day ( just discard half the amount from 1 pump.)

Thanks Jingling.

My GP advised using that dosage to get me to the equivalent of 1.5 pumps. She advised that guessing half a pump wouldn’t be as good. She’s a specialist menopause GP.

I’m trying to keep the dosage as low as possible on the advice of a haematologist. I had a provoked DVT following a serious accident last year.

Maybe I’ll go back to just using 1 pump.

If you have to aim for 1.5 pumps, what's the point of doing some days at 2 pumps? I genuinely don't understand that. Why not 1.5 pumps every day?

Transdermal estrogen doesn't increase the risks for blood clots (this is in all the prescribing and NICE guidance) and has a favourable effect on arteries.

Funnily enough I was coming to post the same thing. Had rare bleeding - about 3 times a year - on sequential HRT and switched to continuous in April or May. All well until sore boobs and nipples then a very light bleed (my periods were always very light) on 3rd Aug and yet another started today 3 weeks later. Constant sore boobs.

I have been on 50mg estrogen patches and utrogestan every evening. I am not especially worried as the sore boobs make me think it's the HRT.

I find it ironic that having never had regular bleeds on sequential HRT I am now having more frequent bleeds on continuous.

Great advice - as ever. I think I’ll try 1 pump and see how I go. If necessary I’ll do the 1.5 pumps - I think I’ve got enough experience to judge the quantity.