Does this warrant a GP appointment?

[Holdinguphalfthesky]

I was on the POP for a few years and had no periods while taking it. About 12-13 months ago I started HRT- gel and utrogestan. GP told me to take both every day and I could stay on the POP. I did that for a month or so and then stopped the POP and we used condoms instead. I’ve had no bleeding on the HRT either so it’s several years since I had a natural or a withdrawal bleed (I did get bleeding while using the implant but that came out in about 2021).

I do sometimes forget the utrogestan and last month my prescription was late so I missed a week or more of them. Then last week I had a very light bleed for 2-3 days and today I have some spotting. Do I need to go to the GP? Or is it just one of those things? I’m 48 and there is little risk of pregnancy as we haven’t had a lot of sex recently and we do use condoms.

If I forget to change my patch i will get a light bleed for a few days but im having monthly periods still as well. I’d probably go to doctors to make sure the pop wasn’t part of your hrt, if it was you may need to increase. And you could mention bleed too.

Yes - any post menopausal bleeding should be checked out

I suppose you don’t know if you are post menopause as the pop artificially stopped your periods. I was on the same combo as you, and would have spotting if I missed a utrogestan dose or two. I was also inserting them.

i switched to taking them orally again, and now take 2 daily as my estrogen was increased. Also stopped the pop. Haven’t had any spotting since then. But if in doubt talk to GP (I did)

Thanks. It seems a bit odd because I’ve been off the POP for almost a year and had no breakthrough bleeding before last week, and I did have a longer (c10 days) off the utrogestan but that was about a month ago. Louise Newsome website suggests maybe my own hormones have changed underneath the ones I’ve added?
no pain with these bleeds but I did have sensitive boobs (as in premenstrual phase) for a week or so before last week’s bleed.

You don't know if you are post menopausal.
Likely you are not at 48 - it's possible but the average is 51-52.

There's a lot going on here.
The POP means you won't usually have periods.
Using progesterone every day means you won't usually have bleeding.

BUT if you aren't post menopausal AND skip the progesterone when you were taking it daily then yes, you will spot.

The most important of all of those is you were put onto continuous HRT, you've missed taking progesterone for a few days, so it's likely you will spot.

OR it's your own cycle and you're not post menopausal.

Your GP is likely to be flummoxed because there is no easy answer to this. You either have a scan, which seems a bit OTT considering you've been on continuous HRT for a while, or you regard it as a one-off and carry on but don't skip the progesterone.

Thank you. So in the absence of other symptoms, like fatigue or pain, can I safely wait and see on this, would you say? Put it down to missing 10 days of progesterone last month?

I can only say what usually happens, which is stopping progesterone leads to progesterone withdrawal = bleeding on a sequential cycle.
It's also likely to have the same effect on continuous combined.

Do what gives you peace of mind.

Thank you 🙏