58, still peri (?), they want to prescribe cyclical HRT?!

[hildaogden99]

Will try to keep this brief as possible!

I'm 58 and have still not reached menopause. Periods have become much lighter and further apart the last year or so and earlier this year I thought they might be stopping as I had a couple of 10 week gaps with no bleeding at all. But since July I have been having random light spotting on average every couple of weeks, sometimes less, with the longest gap being 3 weeks. I don't seem to have perods anymore, just light spotting lasting a couple of days at a time. Been fully investigated (ultrasound, hysteroscopy, biopsy) but all fine. No real explanation given but suggested verbally it could be the fibroids I've had for years, which have caused a lot of bleeding issues for years, including spotting. Although they seem to have shrunk somewhat over the last year or so. FSH is very high suggesting menopause.

As well as the spotting being a nuisance, I've got other menopause symptoms so have been considering HRT (previously avoided due to the fibroids). GP spoke to Gynae who suggested cyclical rather than continuous HRT which surprised me given my age, as I thought those over 55 could still have continuous even if not fully menopausal? My concern is that cyclical will give me "periods" which I don't want, I don't want any bleeding at all at my age!

I'm going to my GP in the new year to discuss further but trying to arm myself with as much info as possible so I can make an informed decision. NB. I do have private insurance (with a big excess) so will use that if I don't feel I'm getting anywhere with NHS.

Any advice? Thanks 🙂

In a similar boat - nearly 57, still got a coil that was fitted 8 years ago (and on the list for it to come out) which made my periods much more normal after being exceedingly heavy for years. Periods v light recently with spotting like you describe and thought they had stopped but last month got a bright red period - still not heavy enough for a pad and coped with panty liners but still......!!
I'm following your post with interest as I'm just riding it out at the moment, no peri symptoms that are causing an issue, so I really don't want to get into taking HRT !

Sorry your suffering too. My menopausal symptoms are not terrible either but it's making my health anxiety so much worse and I just want an end to it all. Aside from the recent investigations, I've had 3 ultrasounds in the last 3 years, due to my dysfunctional bleeding as well as 3 operations on the fibroids over the last decade. I just want to be able to leave the house without a pad as the spotting can strike at any time. Like you, it's not heavy (mostly doesn't make it to the pad, just wiping) but such an nuisance as well as a worry!

@hildaogden99 You should be able to use combined continuous at 58 and also because you have only spotting (and fibroids.)

It's odd that a gynae doesn't know this but on the other hand not all gynaecologists are up to speed on HRT (they all have their own specialisms.)

Have you considered a Mirena coil which should deal with the spotting anyway as well as being part of your HRT?

Why have you had 3 ultrasounds in a year? The guidance is if nothing is found it doesn't need doing again for a year or more if you don't have new symptoms.

There is no hard and fast rule on this TBH and it's also personal preference. I have used cyclical for years well into my late 60s because I didn't like the side effects of daily progesterone.

If you see a private gynaecologist your insurance won't cover you for menopause unless you have an appt for the spotting and want another opinion on that. They won't cover routine and long term HRT.

I've had private insurance for 40 years but apart from some gynae investigations associated with menopause, which it covered, I've paid for all my private consultations and HRT for years. It was worth it because my consultant (who I chose after a lot of research) is one of the best and has trained other drs on menopause.

You're looking at around £300 for an initial appt (which your insurance is likely to cover if it's for the spotting.)

You should consider talking to your GP and having a scan.
Heavier bleeding when you have a Mirena needs looking at.
BUT your coil is now out of date other than for contraception.

I went on the list to have it removed at the start of August when I was 172th in the queue! By December I was 68th inthe queue so Hope it will be out soon. 😎

Have you considered a Mirena coil which should deal with the spotting anyway as well as being part of your HRT?
Had one a few years ago, caused constant spotting & acne. Couldn't wait to get rid of it so not keen to try another one.

Why have you had 3 ultrasounds in a year? The guidance is if nothing is found it doesn't need doing again for a year or more if you don't have new symptoms.
Ultrasound #1 2023 for spotting between periods. Nothing found except fibroids.
Ultrasound #2 2024 for period that lasted 4 weeks & needed tablets to stop . Nothing found except fibroids.
Ultrasound #3 2025 - spotting every couple of weeks as described above. Nothing found except fibroids. However, GP worried it could be post meno bleeding due to high FSH so put me on 2 week cancer pathway hence hysteroscopy & biopsy.

Different GP each time.

So it's great I don't have cancer but I would still like to know the cause & get it treated!

If I had a crystal ball I would have had a hysterectomy years ago but kept being told I must be near menopause when fibroids shrink, yet here I am....

Good point re private insurance not covering menopause/hrt so will do it from the spotting angle......

I’m a bit younger and have been on HRT for a few years now (on continuous now).

When first prescribed I was on cyclical and whilst it solved the peri-meno symptoms I really struggled with the bleeding. Very irregular through the month and heavy clotting (apologies for TMI). I had no idea when it would start/finish.

My periods had always been regular so this was so hard to cope with - I was bleeding more often and much heavier than I ever had. Changing to continuous has genuinely been amazing!

Sorry- need to go to Specsavers- read 3 ultrasounds in a year. Once a year is understandable.

You can have periods that are no more than spotting. (not sure if that's been mentioned?)

Also, if you have scan done by a consultant gynae they can usually tell a lot from your ovaries because post meno they shrink and nothing is going on with them. Was that mentioned at all?

Lol.

I really don't think these are periods as the bleeds are between 1&3 weeks apart and only usually last a day or two. I had a small amount of spotting last night which has now disappeared, last episode was just over a week ago, when similar thing happened. It's so annoying as it's been going on for 6 nearly months with no explanation as to why! All they said at the ultrasound is that my ovaries looked normal.

Irregular bleeds, even spotting is classic peri.
The point is you're only getting bleeding because your womb lining is building up. Then it's coming a way.

Sorry to ask but are you overweight? Endometrial cancer is linked to being overweight - it's one of the biggest risk factors- and it's because fat produces estrogen (which builds the womb lining.)

I hope you get some answers to all of this.

Nope not at all, I'm a healthy bmi, always have been, very fit, work out regularly. My womb lining has never been thickened, has been within normal parameters at every ultrasound I've ever had (quite a few due to my fibroids). It is bumpy though apparently due to the fibroids. The likely explanation is a combination of the fibroids and hormonal disruption of menopause but it's so frustrating as it seems never-ending. I don't know anyone my age who still has periods, even the doctors have suggested I'm a rare thing!

Is there a reason they don't want you on continuous? I am 47 and on continuous. I hav daily lenzetto and have a mirena in for progesterone. Bleeding regularised and has now stopped after 6 months lenzetto.

No idea, I'm going to see GP after Xmas and will ask why. Are you post meno or still peri?

Still peri.

I had a hysterectomy for fibroid, best thing I ever did. Been on HRT (oestrogen) since peri started & very glad both to resolve all my symptoms and for all the protective health benefits.

Really wish I had when my fibroids first started giving problems age 46. I kept being told I must be close to menopause so probably not worth it and here I am age 58 😵 Will still consider it if I can have keyhole but was originally told I needed full abdominal as my uterus is so bulky from the fibroids bit wondering if that could have changed as they do seem to be shrinking.

Thank you for all the input. I will see the GP in new year with the following questions (the recommendation for cyclical came via text message saying to make appointment if I wished to discuss further)

1. Did the gynae offer an explanation for the ongoing spotting now that anything sinister has been excluded?
2. Do you know why they suggested cyclical rather than continuous as I understand women over 55 are suitable for continuous even if they have not reached menopause? (Does anyone have a reputable link I can show her saying this?). I will also say I'm concerned about withdrawal bleeds causing more bleeding than I have currently and that I want bleeding to end!
3. Would it be possible to be referred privately back to the consultant who did my last two surgeries for further advice? (I've searched her profile and it does also say she has a special interest in HRT and menopause).

Anything else.

Thank you so much & merry Christmas 🙂

Edited to say I was diagnosed with fibroids 12 years ago and have had 3 lots of surgery to remove them (last time 4 years ago). Unfortunately, they grew back everytime time and bleeding issues resumed. However, periods were much lighter after the last surgery but I still had to endure erratic bleeding & spotting. Hysterectomy had been mentioned previously but advised due to my age menopause should come soon so probably worth waiting it out. The fibroids appear to have shrunk a bit this last year but still there so will mention Hysterectomy again to consultant if I manage to see her!

Did you start on continuous HRT or do the 2 yrs cyclical then go to continuous?

Sorry if this is a stupid question but how do you know you're still peri as presumably you don't bleed on continuous?

You don't.

You stop HRT for at least 3 - 6 months if you're over the average age of menopause and see what happens.

Combined continuous HRT is for women aged 54 or over because at that age 80% are post menopause. OR it's for women under 50 without a period for 12 months. Or it can be for women over 50 who have very infrequent periods like 3 a year.

This is online on medical sites (it's not my opinion!)

You asked for a link.

https://www.menopausematters.co.uk/postmeno.php

This is written by Dr Heather Currie, consultant NHS gynae who was awarded an MBE around 3 years ago for her work on menopause.

My sister is 63 and still has regular periods, every month. She has had tests but everything is perfectly fine. I’m 58, about 2 yrs ago I was regular and then suddenly stopped within a couple of months. Our mum had a hysterectomy at 42, so we had no point of reference leading up.

I obviously think you’re doing the right thing getting checked and exploring your options, but don’t think you should worry at this point.

That is almost unheard of. Is your sister having a regular scan (annually or more) to check her uterus and also see if there is any ovarian activity which would explain periods?

She is type 1 diabetic so is checked regularly. She started her periods late because of her diabetes and they say this is linked. She’s a biochemist so she finds the science of it fascinating and is happy with her own research into it. Because of this she is often selected for medical research and trials. She is very fit and healthy other than the diabetes. We’re happy she had it covered.

Can you explain the connection between the diabetes and having her womb scanned? It sounds interesting.