What will they give me if they stop my estradiol?

[AlleyRose]

Post meno for 18 months and been on HRT since last August. Started Gina in February due to bladder/urethra discomfort and had a period in March.

Since then, lots of pink/brown discharge. Been to see GP today and been referred for urgent scan to see how thick linking of uterus is.

I think she’s going to stop the pessaries - but they’ve been a God send. I can’t sleep without a hot water bottle between my legs with them but it’s even worse without. The pain and urgency is awful.

Is there anything else that they could prescribe for bladder issues?

There's no reason why you should have to stop HRT or vaginal estrogen yet.
Vaginal estrogen is not absorbed into the womb.

If you're on HRT, the bleeding is most likely related to that - it usually is- either poor absorption or maybe even the wrong sort or you're not actually post meno.

You've not given much info, but if you started HRT in August that means you've been on it for around 9 months.

Had you had no natural period for at least 12 months before last August?
If not, you'd not be classed as post menopausal.

To reassure you, 'urgent scans' for women on HRT are now within 6 weeks (not 2 weeks for women post meno and not on HRT.) This is because the risk of cancer is very rare when on HRT and usually down to dose/ type.

You also don't need to stop HRT while waiting for a scan. The guidance is 'try stopping' to see if the bleeding stops, but it's not mandatory- it's to try to avoid unnecessary scans.

You can keep taking the vaginal oestrogen even if you can’t have the systemic stuff. I’ve had lots of issues with HRT and had to come on and off of it for various tests and been able to continue with Ovestin as it’s so low dose it doesn’t affect blood tests.

Also want to add- I have interstitial cystitis, had it for 30 years, I’m now 44, amitriptyline is the only thing that’s really made a big difference to my bladder pain etc.

@JinglingSpringbells
Thank you, I was hoping you’d reply- you’re very knowledgeable! That’s so reassuring. TBH, I’d rather stop the HRT than the vaginal oestrogen. The pessaries are actually helping with my bladder symptoms. I was put on HRT 8 months ago because of a continuous pressure in my head and low moods. It hasn’t helped that much. I’m certain now, that the pressure is anxiety so I try to ignore it as much as I can (had cameras, MRI, bloods, nasal swabs so don’t think it’s anything serious).
i had my last period in August 2023 but if I’m completely honest, I don’t think this recent one coincided with the pessaries at all. I had breast pain for weeks before I started using them and then got my period. Which is exactly what I was like in peri. I went 3 month, 6 months, 9 months then 11 months so I’m wondering if, like you say, I’m not post meno and that was just another period.
GP said my cervix was healthy and walls of vagina felt fine so not too worried about the scan. More worried about being told to come off pessaries as GP seems to think the two things are related.

@Pigeonqueen - I feel your pain. Literally. Suffered with sex related UTIs since having DC and had IC for years. It’s bloody awful and I was also on amitriptyline for it.

The Estradiol does seem to be helping although every three days is better for me than twice a week. So hopefully you’re right and they won’t make me stop it.

Id forgotten what it was like to have to sleep with a hot water bottle between my legs :(

From what you have said I don't think you're post meno!
you went a whole year from August 23 to August 24 without a period? Or you're not sure?

If you were put on bleed free HRT in August 24, it's still possible to have occasional ovulation after a 12 month gap. The 12 months is an average but there are women who have another period 15 months or longer after the 'last one'.

To me, and obviously I'm just guessing- everything you've said points to being put on a bleed-free type of HRT too soon with the obvious outcome- bleeds. This is because the dose of progesterone in it isn't enough to control your own cycle (which is still coming and going, albeit with long gaps.)

This is why it's often better to start HRT as sequential or at least to age 54 (which is the guidance anyway.)

Vaginal estrogen doesn't build up the womb lining to the point of a period- or really at all. If it did, all women would have to use a course of progesterone now and then- which they don't because it's been shown to be unnecessary.

If your GP suggests stopping vaginal estrogen I'd just ignore that, have your scan and it's likely all will be fine. Don't worry!

I don’t think I am either! I just think I’m going a really long time in between. The only thing that doesn’t make sense is the slight amount of blood in discharge. Sometimes it’s pink sometimes it’s brown and sometimes it’s normal. But I’ve read that this is very usual 2 months after starting pessaries so hoping it will settle down.

I feel better knowing that I won’t have to stop them. Thanks @JinglingSpringbells ☺️

And yes, actually went 18 months between what I thought was my last period and this last one. But I just knew I was going to come on. All the signs were there for weeks - and definitely before I started the vaginal oestrogen.

Bear in mind that the discharge may have nothing to do with the topical estrogen. If you had a period in March it's quite possible that the spotting is part of peri and another light period. OR it can be an HRT blip- what are you and what dose? It can happen with poor absorption from patches or gel.

@JinglingSpringbells
sorry, only seen your last reply. I’m on 75mg patches and nightly progesterone. I’m going to ask to swap to gel anyway as patches have started to cause skin irritation.
The pink/brown discharge only happened after the period but has been pretty continuous now for a month. Never red blood, just very very pale pink or brown mixed in with discharge.

I wonder if I need to reduce the oestrogen in. Y HRT. I’ve just done what you’re not supposed to do and had a quick google. Panicking a bit now. Think I’ll carry on as normal until I get my scan results. This is what gp told me to do.

Some women need 200mcg Utrogestan with a higher dose patch- that's 75 or 100mcg. This was in the latest guidance by the BMS.
That may be all you need.
TBH your GP ought to know this and have suggested it first.

I did google that as I wondered if that might be the case. I’ve only been on 75 since before Christmas and it was after that that my breasts started to get swollen and sore (they’ve been ok since period ended - just like in peri). I’ll ask next time I have an appointment. She’s usually pretty ‘on it’ to be honest and she did ask how much Utrogestan I was taking. I think in her mind it was “let’s get the scan results and make a decision from there”.
Thanks so much for all your help and advice x