Different doctors, different advice

[Birdist]

Can anyone help with this?

Saw my GP for HRT some years ago and was given a prescription for oestrogel (3 pumps) and sequential utrogestan (1 pill). I was also told to continue taking the mini pill.

I had some unexplained bleeding a few weeks ago (I don't have periods on the mini pill) and a different GP has referred me to a gynaecologist, who I saw today. She did an endometrial biopsy (😬) , estradiol blood test and has referred me for an ultrasound. But she also said that she did not think there was likely any underlying problem and it's more likely down to what I'm taking. Her advice-

• I shouldn't be taking the mini pill along with HRT- it's one or the other (very much not what my GP said)
• Oestrogel dose is likely too high and utrogestan too low. I should be on one pump Oestrogel and 2 x utrogestan (continuing sequential)

So instead of mini pill + 3 pumps + 1 utrogestan, I'll be on 1 pump + 2 utrogestan + condoms.

I like the approach of generally reducing things- my GP was very much "if it's not right we'll increase the dose" and I hate just adding more and more hormones. But it's so confusing getting such different advice from different doctors.

Has anyone experienced similar?

Normal starting dose for oestrogen is 2 pumps
cyclical progesterone is 2 tablets of 100mg for 2 weeks then 2 weeks off (this changes to continuous at age 55).

the progesterone is to protect your womb lining but doesn’t offer contraception- If you still need contraception, either continue the pop or consider Mirena coil (would need replacing every 4 years but covers contraception and the progesterone part of HRT).

This is just my experience:

Am on mini pill, no periods so given continuous utrogestan. Am under 55.

Once over a certain amount of oestrogen I had to increase to 2 utrogestan.

GP offered combined patches which I didn't want but still continuous and still with the mini pill.

On sequential HRT you take 200mgs Utrogestan for 12 or 14 days a month.

You can use the mini pill as part of HRT- but you need 3 tablets a day, not one. This is covered in the British Menopause Society report on the use of progesterone with HRT. It's an option.

Disappointing your doctors aren't aware as the info is easily available- if I can find it they can! Although it was my consultant who offered me that option many years ago (like 10 years ago!)

I don't understand why you need to reduce to 1 pump of gel.

Why? It's the balance with estrogen + Utrogestan that's important.
Some women do need 300mgs x 12 days on sequential if they are on 3 pumps of gel but it's a case of how you are and if 200mgs doesn't control the lining.

The gynae you saw doesn't sound very clued up because these dosing options are out there for anyone to read- even Joe Public.