Post-meno bleeding. More progesterone?

[Chuffles]

I started Evorel Conti (50) HRT patches a good 18m after my last period and for over a year everything was fine. It really helped with joint pains and brain fog (my main meno issues). Then I started having occasional bleeds that were investigated in May 2023 with OP hysteroscopy (hands down the most painful procedure I’ve ever had). Results of biopsy were clear and endometrial lining was only slightly thicker than what is classed ‘normal’. Consultant said bleeding was likely due to HRT imbalance. GP changed my HRT to Evorel 75 patches plus 100mg of progesterone daily.
That seemed to do the trick until a few months ago when bleeding started again. Latest bleed has been going on for 6 days now. The bleeds are lighter than full-on periods but I do get cramping and some breast soreness and skin changes beforehand. Is is worth upping the progesterone to see if that helps? Do others on Evorel 75 take more than 1 progesterone tablet each night?
I’m really hoping not to have to endure another hysteroscopy

I have no idea, but you know you’ll need to flag it up with your GP at least. It probably is a similar issue, but you can’t assume. I have had a hysteroscopy, and like you wouldn’t want another but you need to get it checked.

Yes, they should prescribe more progesterone. This should have been done after your hysteroscopy. I took 2 with a 75 patch, then 3 with a 100 patch to stop post menopausal bleeding.

If this doesn't work they should prescribe a different progesterone, e.g. Provera.

The Mirena Coil is another option.

I don't know why they put us through these procedures but then don't offer the solution that is clearly set out in the BMS guidelines. It makes me so angry.

If they want to do another hysteroscopy you can ask for a general anaesthetic.

I had post menopausal bleeding for over a year and tried all the progesterones, now I have a Mirena and it's stopped.

Why did you move from 50 to75?

I started Evorel Conti (50) HRT patches a good 18m after my last period and for over a year everything was fine. It really helped with joint pains and brain fog (my main meno issues).

You'd only increase the estrogen dose if it wasn't helping with symptoms.

By giving you more estrogen, bleeding is more likely. But what comes across is that your GP thought more estrogen would be a solution to the bleeding.

I'm not sure if you're using Evorel combined continuous with Norethisterone in every patch, which is a bleed-free HRT.

Or is it Evorel (estrogen only) plus 100mg progesterone a day?
Are you using Utrogestan now and weren't before?

As you're using a 75 patch and bleeding, this BMS advice is to use 200mgs a day of Utrogestan.

Or go back to conti patches and stay with a 50mcgs.

Thanks for the useful replies. Sorry I wasn't particularly clear. I started on Evorel Conti (Evorel combined continuous with Norethisterone in every patch). As it looked like I needed more progesterone to halt the bleeding and the Conti patches aren't available in a higher strength preparation, I was moved to the Evorel 75 (oestrogen only) patches with 100mg Utrogestan daily. Not sure why the oestrogen was effectively upped, but it sounds as though the progesterone wasn't upped enough?

I shall ask to move to 200mg and see if that helps. Tbh, the consultant who did the hysteroscopy did suggest I could get my GP to insert a mirena for the progesterone, but given how painful the hysteroscopy was I don't fancy anything entering my cervix ever again!

If you had bleeding on 50mcg and Norethisterone, then you are pretty likely to get bleeding on 75mcg and Utrogestan.

This is because Utrogestan isn't as powerful as synthetic progestogen.
And, you're on 50% more estrogen.

It's like a backward step.

Why don't you go onto a 50mcg patch and 100 Utrogestan and see how that goes?

And be doubly sure your own periods have stopped. I know you said they had but for younger women (under 50) they can sometimes start again and you can get the odd rogue period now and then.

Thanks @JinglingSpringbells. I'm nearly 57 and started HRT about 18m after my last period so I'm pretty sure this is post-meno bleeding. But I didn't know that about synthetic progesterone being stronger. You're right, the change does seem like a backward step. I can't say I've much confidence in my GP's understanding of HRT (like most GPs unfortunately, I think!). I'll ask to try what you suggest.