Heavy periods on HRT

[Orangesandlemons77]

Since I have started HRT my periods have got quite a bit worse, from a few days to a full week of quite heavy flow which is painful as I have previous pelvic surgery and a lot of internal adhesions in the area.

I'm currently on 2 pumps of gel and 2 progesterone capsules for two weeks of my cycle.

I do have co-codomol on repeat prescription anyway for the pelvic pain but on my period I am taking it back to back along with a hot water bottle and quite limited in activities.

I'm wondering about ways of dealing with it as I think the HRT helps me and not that keen to come off it.

I wondered about the Mirena, but I have a tilted womb (due to the adhesions, had a surgical join in the bowel at the rectum and this is 'pinning back' the womb) and I'm a little concerned about getting one due to this (slightly higher risk of problems with it apparently) or the mini pill- but I also struggle with depression and wonder if that might make it worse.

I did have a Mirena some years back prior to the surgerical complications and it seemed to stop my periods completely which was great.

Anyway I just wondered if anyone had any further ideas. Contraception could be a plan as well. For example the combined pill, but worry about side effects from that too.

My GP recommended the Balance website, and just read the following on there regarding this-

If you are taking HRT, changing your regimen can help manage and reduce heavy bleeding during perimenopause. One common approach is to adjust the balance of oestrogen and progesterone in your HRT. Your clinician may increase your dose of progesterone or suggest changing it from being taken orally to vaginally. This can reduce heavy bleeding. Sometimes switching the type of HRT can make a difference. For example, if you are on a sequential HRT regime (where oestrogen is taken every day and progesterone is taken for part of the month), changing to a continuous regime (where both hormones are taken every day) might help. This extended exposure to progesterone can help to control the womb lining and reduce bleeding.
Non-hormonal treatments include medications such as tranexamic acid, which can reduce bleeding, and prescription-only anti-inflammatory painkillers, such as mefenamic acid or naproxen, which can also be effective in reducing blood loss and alleviating pain.

https://www.balance-menopause.com/menopause-library/heavy-periods-during-the-perimenopause-what-you-need-to-know/#:~:text=Your%20clinician%20may%20increase%20your,HRT%20can%20make%20a%20difference.

Can you do the continuous regime of you are still in peri / getting periods please?

The bleeds on HRT are not real periods, they are a withdrawal bleed created by the HRT cycle.

How do you know you still have periods? Were you having regular periods prior to HRT?

If you were, it's unlikely combined continuous would work because the amount of progesterone isn't high enough to control your own estrogen +HRT estrogen - and you'd bleed anyway.

Ideally you should see a specialist to have an assessment about the Mirena.
The other option which is advice by the British Menopause Society is to increase the 200mgs x 14 days to 300mgs x 14 days. or you can try reducing your estrogen to 1 pump instead if that would control your symptoms.

You can't have the combined Pill and HRT.
You could use the mini pill in a higher dose to give contraception and be part of HRT- but again, you may need a specialist unless your GP is knowledgeable.

Interesting, thanks. Yes I was having periods before starting the HRT (started just over a year ago) but they were much lighter.

There is a GP at our practice who says they specialise in the menopause and women's health so I will start there. Thanks this is really helpful.

It seems to have been worse since I started mounjaro weight loss injections 4 months ago, could losing 15kg cause this to get worse do you think?

Probably not. Being overweight is a high risk factor for all female cancers. It creates more estrogen that can thicken the womb lining.