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 🙂

I had mine removed at 38, 17 years ago (but kept my ovaries). What they did do pre-op was to give a hormone injection course (app what they can give men for Prostate cancer) which shrunk my uterus / fibroids to make surgery easier.

It also gave me very temporary hot flushes, which funnily enough I have NEVER experienced since, even during peri or post Menopause.

It doesn’t form part of a routine diabetes check up, obviously. The link is she has is checked regularly and happens to mention any other concerns, as would anyone.

@hildaogden99 I am assuming peri as I have only been on hrt for 6 months. I had irregular cycles before hrt, then the hrt regularised them in The first 4 months and then they stopped. I was as asked if I wanted a bleed or not and I said I wasn't bothered. I certainly wasn't told I couldn't have one type or the other. Strange the difference in approach. Mine was with a specialist menopause nurse rather than a dr- maybe that's why?

I'm not sure what you mean by checked. A dr checking her diabetes won't be a gynaecologist.
Periods at 65 is not unheard of but it's the sort of thing that would raise eyebrows and be investigated because it's incredibly rare.

I think this is down to lack of communication by the person you saw, telling you why certain types can be prescribed.
If you're having only 2-3 periods a year, continuous can be tried, but the risk is that some women will carry on having spotting with it and it won't do what it's supposed to do- stop all bleeding.

Just updating this thread......

So I went to the GP. Asked if the gynae gave any explanation for the bleeding. She said they didn't, just reassured nothing sinister found. Asked why they were suggesting cyclical HRT instead of continuous given my age and she didn't really answer, just said it might make the spotting worse so best to try sequential initially with a view to moving to continuous after 6 months. Result is I'm starting sequential HRT (is that the same as cyclical?). Oestrogen gel plus progesterone tablets with review in 3 months. I've not had any spotting for over 2 weeks now - hope it doesn't get worse once I start HRT. Am away next weekend so will start when I get back in case of side effects.

Will have to see what happens I guess....

I had my HRT review with the pharmacist who said cyclical until 55 then no more periods, as "surely that's enough" I didn't realise there was some protocol for that, he made it sound quite personal!

I bled very heavily and regularly well into my sixties, when I had a Mirena fitted (I asked for a hysterectomy but they were reluctant). That helped a lot but nearly ten years later I still get occasional spotting, more noticeable now I’m on anticoagulants for a heart issue. The excellent practice nurse looks after me and has recently referred me for a routine scan - will replace the coil under GA for a second time via a specialist menopause clinic later this year, with a hysteroscopy as well. No one seems that bothered as long as I’m well.

Are you saying you are bleeding still in your 70s? Not on HRT?
You should be referred quickly within 2 weeks for your scan and a biopsy.
And yes, you need a referral to a gynaecologist but not 'routine' - this would be considered urgent.
Do ask for it to be moved along a bit faster.

There have been no changes other than the slightly more noticeable spotting on the anticoagulants. I still get cyclical symptoms such as mood swings, changes in vaginal mucus and occasional ovulation pain - I think my left ovary fires intermittently. But I am on an urgent pathway for the scan because of the standard protocol, and my appointment at the menopause clinic may be brought forward as a result. From conversations there, I don’t think that I’m the only woman they see showing perimenopausal symptoms much later than average, but they do get referrals from all over the country.

Are you in your 70s? You mentioned having a Mirena in your 60s and now it's 10 years later.
You're ovulating in your 70s?

Well I don’t know. I think I might be, sporadically. Human bodies do all sorts of surprising things. Some women have an early menopause in their twenties or thirties. Some people are still running marathons in their eighties. Some people live many decades later than the average.
If the age of menopause is normally distributed, like many physical characteristics, it’s not outwith the bounds of reason that some women have very late ones. I think - though I’m not sure - that the original research that said the average of menopause is 51 was designed to eliminate outliers by using a limited age range in its sample (which is OK but can be misleading). The nurse I see says that she knows of a few other older women who still get e.g. hot flushes, which is why they stay on HRT.

This is the only published article I’ve been able to find that seems to confirm the phenomenon
https://pmc.ncbi.nlm.nih.gov/articles/PMC10557373/

I think - though I’m not sure - that the original research that said the average of menopause is 51 was designed to eliminate outliers by using a limited age range in its sample (which is OK but can be misleading). The nurse I see says that she knows of a few other older women who still get e.g. hot flushes, which is why they stay on HRT.

It's pretty much the same in the western world. The International Menopause Society is a worldwide organisation and they report on stats including hundreds of thousands of women.

Being post menopause and still on HRT is not unusual.
My consultant told me some women never get rid of flushes. I'm post menopause by many years and been on HRT for over 15 years because of symptoms.

OP here! It's been suggested to me elsewhere that I just use the progesterone continuously, so just take 1 x tablet daily continuously instead of 2 x tablets daily for 2 weeks, assuming that's what my prescription is (not collected it yet). Or would that be stupid/dangerous? I feel it very likely I'll bleed on the weeks I stop progesterone and at 58 I've had enough of bloody periods! Surprised GP didn't react when I mentioned the over 55 guidance 🙄

OP I haven't read the full thread, but if you're prone to Fibroids then I would give estrogen a VERY wide berth!
I take continuous progesterone only, as I am prone to polyps. Both of these conditions are estrogen-driven. My GP thinks I use the estrogen as I don't think they'd prescribe otherwise.

I did lots of my own research before reaching this point. I'm 52 but still have periods.

My GP & gynae know I have fibroids which I've been told are shrinking now I'm close to menopause (my fsh is 120!). Both said it's OK 🤷‍♂️

Yes but if you suddenly add a load of estrogen into the mix, they might grow again or bleeding might get heavier.
Just go with a very low dose if you do feel you need it, but plenty of progesterone to keep the estrogen in check. Eg 200mg per day.

My periods finished at 36 so yes there are definitely outliers either side of the average, just important to be checked to ensure there aren't any seperate issues causing the outlier rather than the person 'just' being earlier or later than the norm