Does hrt cause breakthrough bleeding? Is this common?

[Pancakeparlour]

I have been struggling with peri symptoms for the last 6 years but I have some gynae issues which are holding me back from trying HRT.

I have spent years struggling with very heavy periods and recurring thickened uterine lining and multiple uterine polyps. Over the years I have had these removed endless times via hysteroscopies but they always grew back. I refused synthetic hormones such as the mirena which is a big regret in hindsight.

In 2022 I opted for a uterine ablation. Within 6 months this 'cured' the heavy periods and I was left with very minimal bleeding each month. However, it has not been a success because the lack of bleeding has been replaced with excessive pain each month. I requested a pelvic MRI and have discovered I have deep endometriosis and diffuse adenomyosis. The endo has always been there but the ablation has caused the endo to push into the walls of my uterus causing the adenomyosis. I am still waiting for excision surgery (2 year wait where I am). My endo gynae is not keen to perform a hysterectomy, no idea why but I imagine it's NHS costs.

Anyhow, I am struggling with peri issues and would like to try hrt but I am very hesitant because the (private) specialist I saw said the hrt would most probably cause breakthrough bleeding. Obviously, my uterus can't bleed well because most of it is scarred from the ablation, any bleeding causes my uterus to go into spasm which is causing the horrendous pain.

Did anyone find their HRT caused any bleeding? I have been offered Utrogestan (one a night for 14 days) and Estradiol (0.06% 2 pumps a day).

I am very nervous as I don't want to exacerbate the pain or activate any endo.

A menopause specialist is really the best person to ask- are you seeing one on the NHS?

Can you ask why they don't want to do a hysterectomy?

The HRT you've been offered doesn't sound right.
For a no-bleed type it's 100mgs Utrogestan every day. The cyclical version is 12 or 14 days x 200mgs per month.

Assuming you don't want a period you take Utrogestan every day. Otherwsie what you've been told will activate endo.

Is the Mirena out of the question? Would it not be better to use it along with estogen?

Thanks

The info I was given was during a recent consultation with a private gynae who specialises in menopause and hrt. My GP didn't want to advise due to my issues and although my NHS gynae is an endometriosis specialist he said he had no experience (or interest!) in hrt so couldn't advise me.

In all honesty I have no idea why he was trying to put me off a hysterectomy. I have no risk factors that I know of. He just reeled off all the risks from the surgery and left it at that. It's really difficult to get an appointment with him but I've left a message with his secretary.

This is why I'm confused about the utrogestan. Although I don't bleed I do still have a 28 day cycle. I still show signs of ovulation around day 14, suffer from pms and my 'period' pain comes on the day my period tracker says I'm due and lasts all week. Obviously the only reason there is no bleeding is because of the scar tissue from the ablation. So I assume the private gynae based the instructions on the fact I'm not in full menopause just yet?

Deciding on the ablation over mirena is a huge regret. Sadly due to the scar tissue covering my cervix I can not have the coil unless I opt for surgery to open it up which no gynae seems keen to do and with laparoscopic excision surgery expected this or next year tbh I'm not too keen either.