HRT and spotting

[Trixie2012]

Hi , I’m on Everol and 200mg Utrogestan, however I’ve never in 4 years found the right balance of HRT with spotting and scans for thickened Endometrium
Im going for yet another scan as my endometrium was 5.3 so I think a Hysteroscopy is needed
Im just wondering if anyone else is currently going through this and what progesterone your using

I’ve been reading up on Provera and apparently someone mentioned cancer and weight gain on the nice guideline
I’ve thought about the Mirena coil but some women don’t feel comfortable with it and some coils have been lost .

I posted about spotting a few weeks ago.

I have a mirena. I do still get periods but other than than and the odd bit of slightly pink discharge, it works brilliantly.

I also have uterine prolpase and it's still OK.

I had the strings cut very short so I don't pull them by accident when I put my estriol cream in. I can feel my cervix it's pretty low!

No mood swings, no more endless crying and never ending exhaustion like with utrogestan too.

I should have said, I'm on 100mcg.

I had a hysteroscopy D&C last year when endometrium was 6/7mm but all fine. Apparently in peri meno it can be thicker than post meno.

Thankyou for your reply I’m post meno , did you have a GA for the Hystereoscopy and mirena fitting , I don’t know why but I don’t fancy a mirena it must be strange having strings hanging 🙈

The strings soften really quickly, just ask them to cut it short.

I had a GA for the hysteroscopy d&c - and given that I needed codeine for several days afterwards I was on the ceiling with the pain, it's a good job I did! It was like the worst period cramps of my life for nearly a week.

No GA for mirena. I've had 4 over the years so I knew what to expect. Not pleasant and very fainty for a few days but nothing paracetemol and some time on the sofa couldn't fix.

The things us ladies have to endure 🙈 I’m dreading my scan as I know they will advise a Hystereoscopy and tbh Im so nervous

Are you using the no-bleed HRT- combined continuous- or sequential?

If you are using sequential, which is the 200mgs dose, your lining will not be below 5mm. If you're post meno then you must have been advised to increase your progesterone from 100mgs a day?

A lining measurement itself is not an issue (I've been told this, having numerous scans) it's what the scan shows and abnormalities can be seen on a scan if it's done by a specialist.

5.3mm is only just over the threshold which is either 4mm or 5mm (it seems to vary.)

As for the hysteroscopy everyone is different. I had one and with no pain relief or anything and it was fine. A lot depends on the skill of the doctor doing it. Mine took 30 mins compared to about 5 as I had to be dilated, but it was painless.

Hi , thankyou for your informative reply which is reassuring my appointment is tomorrow and I’m not just nervous about the scan and possible Hystereoscopy but where I go from here with my HRT , currently cutting a patch to 62.5 and 200mg Utrogestan , I don’t fancy a mirena coil .

I had spotting regularly on continuous HRT for a long time, hysteroscopy etc done whilst awake (not too bad), no problems found, and a mirena coil fitted at the same time. I've never been able to feel it or the strings but spotting eventually stopped about 6 months later. My consultant told me the mirena is the gold standard for progesterone, much lower dose than taking tablets. Personally I would recommend it.

Was it painful having the mirena coil fitted ? Do you have regular check ups ?

Can I ask @Trixie2012 if you're on continuous combined or sequential?

If it's continuous combined were you advised to use 200mgs a day Utrogestan to try to control the spotting?

The Mirena used to be the gold standard, but newer guidance is that micronised progesterone is better because it's not a synthetic progestogen.

With the Mirena you absorb about the same into your system as a low dose patch (25mcg) which contains a synthetic progestogen. If anyone intends to be on HRT for years (more than 5) it's better to think about a more body-identical sort.

When I went up to 100mg evorel patches I was continuously spotting even with 200mg progesterone (continuous). GP added in Cerezette (progesterone only pill) and been fine ever since.

I’m so confused with so many options I’m on continuous Utrogestan 200mg but I’m still suffering with Endometrial thickening

I need to be prepared tomorrow with questions for the consultant and have some idea of what I’d like to do next

I’m feeling so disheartened at the moment and would like to take something that is as body identical as possible
I read that Provera can cause weight gain due to more appetite not sure how true this is , but it’s synthetic

On continuous and 200mg

There are a couple things to consider - first is taking utrogestan orally with food doubles its efficacy. Worth a go?

Or using it vaginally can help to get it to the womb more easily.

There is also Cyclogest which is the same as micronised progesterone - might be worth discussing?

Any drs suggested those options?

Also a lining of 5.3mm is not a disaster. It's just above the max on conti.
The more important thing is whether the lining look regular with no thick areas and other issues which can be seen on a scan by an experienced consultant.

I had a lot of bleeding. I was put on Provera to try to manage it. The dose was 10mg, then put up to 20mg. My menopause specialist said 10mg usually controls bleeding so that is worth a try for you.

I really resisted a coil,couldn't bear the thought of it but when Provera didn't work I was told it was my last option. I had it fitted during a hysteroscopy under GA. They will give you a GA but you have to ask. I'm so glad I had it, for me it has worked brilliantly.

If you don't have the coil make sure you ask them after the hysteroscopy to write to your GP clearly stating what progesterone you should be prescribed. Some GP's won't prescribe something 'different' without clear written instructions.

Thankyou so much you’ve been very reassuring it’s greatly appreciated , I’m really not keen on the mirena but if I don’t want to stop HRT it might be the last option
My last pelvic scan was in May at 5.3 it might have increased by now as I’m bloated with dull cramps .

Is Cyclogest taken vaginally ?The Dr hasn’t offered any advice as yet

300mg utrogestan daily sorted out bleeding for me, is that on option? Some women just need more than others

I could tell it had made a difference within a week or two

Is there a maximum dose on Utrogestan ?I think I’d be asleep since being on 200 I’m really sleeping well

Is Cyclogest taken vaginally ?The Dr hasn’t offered any advice as yet

Yes, it's pretty much the same as Utrogestan but it's primary use is for fertility/ early pregnancy so it's a vaginal pessary.

Have you (or will you) see a consultant gynae about HRT where their interest/specialism is HRT? It makes a huge difference to the advice/ knowledge they have.

GP unlikely to know this.

You may have to consider dropping the estrogen dose.

Are you 100% sure you are post meno? Had your periods stopped to 12 months before using conti HRT?

If not, the lining will build as well with your own estrogen.

My periods stopped about 4 years ago I’m 59 but yes I might have to drop the dosage to 50, I have been cutting the patch from 75 to 62.5 with advice from meno Dr .

I’m having an abdominal & pelvic scan tomorrow at a Gyne clinic , I’ve had these scans previously so know what to expect but I was told they might want to do a Hysteroscopy 🙈
I will be seeing a consultant afterwards , Im going to put some questions together , your advice is very appreciated Thankyou