Bleeding more frequently when HRT has been tweaked

[Bellini12]

I was on a regime of 2 pumps of oestrogel and 2 weeks of utrogestan progesterone tablet. After a couple years of this I felt like my symptoms were getting worse; terrible insomnia, anxiety and frequent heart palpitations (all checked out and heart is good).

Dr moved me up to 3 pumps of oestrogel and 1 progesterone tablet nightly. Since this, I have gone from monthly periods to a period every 20 days and now every 14 days! I’ve had 5 periods since beginning Sept!

Obviously am a bit fed up with this (they are normal periods with pain - not just spotting). I’m 53 and over having periods now.

Has anyone else had this? I do feel like my symptoms have improved - sleep is better and palpitations have almost stopped so don’t want to change but am fed up with bleeding every 2 weeks.

Whenever I’ve gone up or done in my HRT doses I’ve bled more frequently although it’s never been a full on period as I have the mirena coil, I’ve been told this is normal but if you’re worried I’d give your gp a ring

I am having more or less a proper period every 2 weeks now. It was as a direct result of going up with my HRT.

I will go back to the Dr but wondered if it may settle down or if anyone else had this experience?

@Bellini12 This is a bit confusing.

If your GP has out you on combined continuous HRT ( that's 100mgs progesterone every day) you should not bleed monthly at all because that type of HRT is for women post menopause with no natural periods (or very nearly like 2 - 3 a year.) It's normal to get some spotting for 6 months.

See this medical guide https://www.menopausematters.co.uk/postmeno.php

The other sort of HRT- sequential - is designed to mimic a natural cycle and you'd have a withdrawal bleed once a
month.

Had your periods stopped for 12 months before HRT? If not, you shouldn't be using combined continuous as the low dose of progesterone won't control your own cycle.

Sometimes when you increase the estrogen dose you have to also increase the amount of progesterone. The British Menopause Society had a guide on this (it's online) and they recommend 200mgs a day of Utrogestan with 3 pumps of gel IF you're getting breakthrough bleeding.

Or you'd go back to sequential which is 200mgs x 14 days in a month.

Talk to your GP and maybe question why you're on continuous combined if you're not post menopause.

Thank you. That’s really interesting @JinglingSpringbells
I started HRT 2 years ago when I was 51 and I was still having monthly periods. I went on it as was starting to get menopausal symptoms and the HRT helped with these.

However I’m baffled as the private menopause specialist that I first saw said I could move over to continuous progesterone after a year! I didn’t and waited over 2 years but as my symptoms got worse again it was the GP who recommended I go up an oestrogen pump to 3 and also go onto continuous. I had just turned 53 and she said NHS guidelines said that was the age to move up.
But it does sound like my body isn’t really for it yet. I could cope with spotting but this is fortnightly periods.

I do find it all a little confusing on how to get the balance right.

Hi, were you getting a fortnightly bleed on continous hrt?

@Menapause2026 yes. Was bleeding every 17-20 days. Got fed up with it in the end so dr moved me back to cyclical (2 prog tablets for a fortnight) and went straight back to monthly bleeds. Not great but better than before.

If you’re having more frequent bleeds then it means the progesterone isn’t stabilising the uterus lining adequately. Do you take your progesterone every night? I find that if I even miss one tablet then it triggers a bleed. I don’t know how much three pumps equates to but I’m on 75 mg oestrogen patches and I was on 200 mg Utrogestan every night. Utrogestan is one of the poorer forms of progesterone for stabilising the uterus lining. If you’re having frequent bleeds then the usual treatment would be to double your dose of Utrogestan or switch you to a synthetic form of progesterone. The gold standard for preventing bleeding is the Mirena coil which should stop it more or less entirely.

It’s definitely worth going back to the GP as they may want you to have a transvaginal ultrasound to make sure you don’t have a thickened uterine lining or any other obvious issues such as polyps. The other possible scan would be a hysteroscopy where they can have a good look at the cervix and uterus.

Note that I’m not a health professional; I only know about this from my own experience. I strongly recommend you go back to the GP.

Yes took the prog every night. I did go back to the gp and was moved back to the original routine of 2 pumps oestrogen and cyclical HRT. Everything settled quickly and went back to a regular monthly bleed. She did mention getting a scan to be sure so I can chase this up. But the bleeding went back to ‘normal’ She said some women aren’t ready to move over to continuous. She didn’t suggest 2 x prog throughout the month though.
I don’t want the Merina for a variety of reasons.

Thank you for replying, so is yours not continous?

@Menapause2026 I started off on cyclical, moved to continuous (1x prog tablet every night) but the frequent bleeding made me frustrated so went back to the Dr and she put me back to cyclical (2 x prog tablets fortnightly) and the bleeding settled down to normal monthly straight away.
I would love to stop having periods now tho at 54 but won’t go on the Merina. I just don’t think I was far enough along the journey when I swapped.

How long were you on continous please? I have been on just over a year and getting spotting every fortnight with a but pmt like symptoms. I have had a scan and my lining was 5.5 so had to have a biopsy

I was on continuous for 7 months (1 tablet a night) and kept on hoping it would settle down but it didn’t. The bleeding wasn’t heavy but just annoying. The fact it moved back to monthly bleed when I swapped back to cyclical shows it was the progesterone tablet making me bleed. I am going to be booked in for a scan though to be sure.
I’m confused about when you get moved to 2 x progesterone tablets a night though? Is that when you are out the other side?

Thank you for replying. Was it mostly just there when you wipe? I don't know anything about hrt other than evorel conti, it is all so confusing

You mean the bleeding? It wasn’t like a proper period. Just a little bit every day. As soon as I swapped back I had a monthly proper period then 3 weeks with nothing. But I believe it’s the progesterone that makes you bleed.
I really can’t wait to stop periods for good now.

I thought starting hrt would be the answer but getting a light bleed fortnightly now and the 3 days up to it are horrendous like.pmt and intrusive thoughts, its awful

@StuntNun so you were right. I went for a scan and womb lining is slightly thickened and I have a polyp. Now being booked in for hysteroscopy in 2 weeks. Obviously concerned but have heard this is very common and obviously due to changing the progesterone which obviously wasn’t the right balance for me at the time.

It’s good you’re getting throughly checked out @Bellini12 hopefully they can remove the polyp during the hysteroscopy. My gynae used a local anaesthetic for mine which made it easier.

Thanks @StuntNun for your advice. Glad the scan was chased. I got a cancellation and it’s all happened so quickly. I must admit I am bricking it because of the wording ‘cancer referral pathway’ but from what I can gather it is very common to have this procedure and HRT can cause a thickening of the lining if progesterone isn’t balanced. Also good a polyp was spotted and can be removed.
I’ve researched enough to know I will want a General anaesthetic. I don’t think I could cope otherwise.

Please don’t worry about it, it’s almost certainly due to the progesterone not balancing the oestrogen. Mine was thickened and it came back down to normal within four weeks of changing my progesterone from cyclical to daily and reducing my oestrogen dose slightly.

That’s really encouraging to hear @StuntNun. The Dr did say that many ladies on HRT have this procedure and it ends up being ok. I am happy to go to daily progesterone but last time I did that I bled more frequently so am not sure how I will avoid that (unless I am further along now in my journey). It’s all about the balance and I will discuss that in detail afterwards. But that’s great you were sorted by 4 weeks afterwards!

I've just been referred for my 2nd 2ww hysteroscopy in a year!

I'm 59 and prior to starting HRT 9 months ago still hadn't gone 12 months without a period (had never gone more than 3 months actually). However, I also have a long history of fibroids which has caused me 13 years of abnormal bleeding despite 3 lots of surgery to attempt to reduce them. Blood tests (which I know can be very unreliable) suggested I was post menopausal so due to this and my age (apparently it's not possible to still be in peri after 55), GP put me on the 2ww for post menopausal bleeding. I had hysteroscopy & biopsies which were all clear. As I also had menopausal symptoms, I started cyclical hrt in January. After 3 months of this, I moved to combined hrt as I didn't want periods anymore at nearly 60! Unfortunately, the combined hrt didn't stop me bleeding and actually made it more frequent. In August I bled for 5 weeks straight so was sent for an ultrasound which not only showed the fibroids had grown but also my womb lining was thickened - this is the first time in many ultrasounds the lining has been thickened so I'm sure the HRT is to blame so trying not to panic, but obviously they need to check. I will have another hysteroscopy and biopsy in the next 2 weeks. I will be gutted if I have to come off HRT as it really helps me but I can't take the bleeding & fibroid growth. Meanwhile, I've reverted to cyclical HRT and the bleeding has stopped so I suspect the progesterone balance of continuous was off. The fibroids had started to shrink prior to starting HRT so regardless of the outcome of the forthcoming investigations I think I'm looking at hysterectomy unfortunately.

That sounds really tough @Instacrap I’ve heard hysterectomy is a big op to deal with. Do you feel it would be worth it though, if it stops the bleeding? I assume you would then stay on oestrogen-only HRT for any menopause symptoms.

Yes, that would be the plan. I'm at the end of my tether with all the bleeding but can't take the menopause symptoms either but HRT affects the fibroids so I don't think there is much choice sadly.

I was told I had a fibroid but they didn’t seem too concerned about it. I’m 54 and fed up with bleeding too (moved back to cyclical so having monthly bleeds). Dr said as I have no intermittent bleeding then this is a good sign but they need to investigate the thickened womb lining. Im still waiting for the apt, I could have had it earlier without sedation but I didn’t want that. To still be bleeding at nearly 60 is tough @Instacrap

I do think that the HRT offered by nhs is a very much one size fits all. I am thinking of going private after this to get a tailored prescription (eg they can specifically balance your progesterone to suit you and deal with fluctuations too).