Changed HRT regime - frustrated!

[theonlyoneiknow74]

Just moving this from Womens' Health!

About three months ago, after a conversation with the specialist pharmacist (menopause) at my GP surgery, I switched from a cyclical HRT regime to a continuous one. I'd been on cyclical for about 2.5 years at this point and it had all been fine really - I'd have a withdrawal bleed a few days after coming off the progesterone and then that was it until the next 'cycle'. I was taking 1 pump Oestrogel a day and two Utrogestan daily for two weeks, then off for two weeks.
I'm 51 and I'm still having periods although it's obviously been hard to tell in recent years as my body had adjusted to follow the HRT cycle.
I asked about switching to continuous after reading that it was recommended after being on cyclical for a long while. I was alos interested to maybe try the patches instead of the gel/tablet.

Anyway, the pharmacist agreed and was happy to support the changeover. She said it makes sense to stick with the gel/tablets initially to see how I respond to the continous regime and then if okay, I can try the patches in a few months.
So, I started on the continuous regime of 1 pump gel and one tablet each night. I was warned that I might get some bleeding whilst it all settles down.

In a nutshell, I've had bleeding on and off pretty much since changing to this regime. Sometimes it's more just spotting, other times blood when I wipe but not a lot, a couple of weeks ago I had what I think must have been a period as I had terrible cramps, sore boobs and then proper bleeding for a few days.
I seem to go for a week or two where it seems like things are settling and then I'll get spotting or bleeding again.

I've got a review with the specialist pharmacist in a couple of weeks but I want to know what I should be asking for in terms of moving forward.

As I said, I think the current regime isn't quite right as the progesterone doesn't seem to be enough to supress the bleeding and I'm still having periods as well to further complicate things!

Does anyone have any experience of this?
I'm okay to keep going with this as I'm sort of used to the intermittent bleeding now and it's not too bothersome on the whole, but just wondering if there's a better option.

I don't want the Mirena coil btw!

Same has happened to me! I was using hrt sequential patches, then gel and tablets - had a regular period with both, sometimes very little period. I’ve been changed to continual patches and have now bled almost continually for over 3 months! I went back to the GP, who kind of looked at a a loss, and said give it 3 more months and go back if no better 😡😞
However, for the first time in months using the continual patches, I’m currently day 7 period free 🎉🙄🙄

Frustrating isn't it?!

I suspect it's the progesterone that's insufficient and I'm wondering if the answer is to go back to sequential - at least with that I knew what was what! The continuous has definitely not been an improvement so far.

I’m not sure you can go back to sequential once you’ve changed over 😞

I’m sure you can change back as long as your not post menopausal and still have your womb .

I think so too @Bossyboo

How can they check you’re post menopausal? They don’t do blood tests as hormone levels fluctuate constantly. It’s not good to keep chopping and changing apparently. I didn’t even want to change, the GP indicated it was the best way 🤷‍♀️

As I said, I think the current regime isn't quite right as the progesterone doesn't seem to be enough to supress the bleeding and I'm still having periods as well to further complicate things!

Yes, that's it ,exactly.

Might be worth going back to cyclical.

Can I add some info here for you @theonlyoneiknow74 ?

I've been on cyclical for many years since being post meno (started HRT in my early 50s.) There is no absolute rule about swapping to continuous. This has been monitored by my gynaecologist, with their full support.

It's promoted as being safer for the womb but the downside (which is rarely mentioned) is that continuous has some other slightly higher risks.

It's actually a choice.

I have a friend in her 70s who is still on cyclical.
Some women don't get on with continuous at all.

Try going back to sequential and see how that goes.
GPs tend to see this as very black and white and just 'follow guidance' whereas as individuals, it's a choice and depends on how you feel, what you prefer, etc.

@JinglingSpringbells thank you, that’s good to know. I think this is what I’ll do.

I’m watching with interest as haven’t started hrt yet other than being on Mirena which has also failed to suppress periods (despite the promises made for it, although it has made them lighter.

i am only in my mid forties but have a lot of symptoms eg fatigue, brain fog, irritability and temperature fluctuations,’tendonitis and muscle loss. My night sweats reduced after the coil was fitted.

The reason I haven’t started it is my fear about side effects and not being able to find the right dose - I struggle with almost all meds. I’m not sure I can face this kind of upset.

For those who are older and still on cyclical - does that mean you bleed still even in sixties etc?

For those who are older and still on cyclical - does that mean you bleed still even in sixties etc?

Yes but that is sometimes less of an issue to the other side effects of daily progesterone.

But if you have a Mirena coil it would usually control the lining so it didn't shed.
HRT is a much lower dose than your own estrogen.

My GP said that no matter what HRT you use, your periods will eventually stop! She said other symptoms may still be there hence why you can take HRT into your 60’s, 70’s, but she said periods definitely stop when their own ‘life cycle’ is done 🤷‍♀️

Maybe she didn't explain it properly? Or maybe she's confused.

There are two types. Bleed-free and sequential ( withdrawal bleed.)

The bleed on sequential HRT is a withdrawal bleed (the same happens with the Pill.)

As long as you use sequential HRT you will get a withdrawal bleed - in your 70s and 80s if you continue with that type.

It's not a 'period' in the sense you're fertile.

Oh I know you’re not fertile 😆
She said the body will naturally stop building and shedding the womb lining, no matter what HRT you’re on. She did say you can continually suffer with other symptoms (hot flushes, memory, night sweats etc) for the rest of your life! I was shocked at that part - I naively obviously, assumed once you’d gone through menopause, all those symptoms would stop and you’d be back to normal! How stupid am I?!

Sorry but that's nonsense. It's shocking she is so lacking in knowledge.

I've used HRT for over 15 years on a cycle through an excellent consultant gynaecologist, a friend has been on it over 20 years and is in her 70s, and yes we have withdrawal bleed. The womb lining is still stimulated by estrogen, 12 days of progesterone controls it stops it growing too much, and it sheds a few days after the last progesterone tablet (or patch is someone uses those.)

I hope you won't be going to her for HRT!

@JinglingSpringbells thank you so much, your advice is really reassuring and easy to understand. It’s shocking how little some GPs know and the impact on us is not insignificant.

I'm similar age and time on cyclical and been on continuous almost 7 months now and it did take about 6 months for spotting to stop. Hopefully it has stopped now.

Update!

I’ve decided to go back to cyclical for now. I’ve had some proper bleeding over the last couple of days and this seems to be the general pattern. I have a week or two if I’m lucky where it seems to be settling then I start with spotting then it gets a bit heavier. Then I get an actual period too now and again. I think I’m definitely still perimenopausal and my own oestrogen plus the daily pump of Oestrogel is too much for the single Utrogestan tablet and therefore I feel that the bleeding will be an ongoing issue at this stage. I’ve given it three months on the continuous and it seems that things are not improving. I’ve got a follow up with the meno specialist in a couple of weeks and I’ll explain my decision then.

I changed to continuous 6 months ago and have just seen the gp this morning who advised to change back to sequential. I’m 54 and have been on hrt for 4 years but obviously I would still be having periods as I’m getting a bleed every 2 weeks. I use 3 pumps of oestrogel. She said I can try it a bit longer but otherwise go back for a year or 2.