Bleeding every three weeks on continuous HRT, considering coil or patch

[StrawberryBlonde70]

I am 56 and on continuous HRT. As yet, I haven't gone a year without periods and am now having bleeds every 3 weeks. An US scan showed my womb lining is 5.1 mm when it should be below 4mm. On Friday, I am due to have a hysteroscopy under GA. The consultant has said that it could be the HRT that is causing the bleeding and so said my choices are to stop it, have a combined HRT patch or a coil fitted. I wasn't keen on the idea of a coil but it could be fitted during the procedure.
I wondered if anyone has had a similar experience and what worked for them as I don't know what to do.

You could take the mini pill instead of the coil. Does the same thing - ie provides extra progesterone. And then have the combined patch as well. Thats what I did for a very long time. You may have a few months of spotting on the pill initially but it does stop eventually - I stopped HRT for various reasons after a while but I still take the mini pill now as I love the fact I never have periods etc on it (I’m 45 and been in menopause since 37 due to autoimmune issues).

@StrawberryBlonde70 no words of advice, but I am in a similar situation. Hysteroscopy booked for next week.

However, doesn't the consultant need to know what is causing the bleeding before they make a suggestion? If you have a polyp won't the solution be different to if you have endometrial hyperplasia? At least that's what my consultant told me. When I have the hysteroscopy she will take a good look to see what is going on, take some biopsies, remove any polyps if they are there and then determine what to do afterwards.

That was me. No tweaks to my regime stopped the bleeding which was getting worse and worse. I had a mirena coil fitted and it was life changing.

Same thing happened to me on combined continuous patches. I wasn’t surprised - the same thing happened years ago when I was on Depo injections. Had the US & hysteroscopy - all normal. The gyno has written to my gp recommending oestrogen-only patches and oral progesterone so that the dose can be adjusted if necessary.

That said he was very keen to shove a coil in while he was down there. I refused. I really don’t want one. Seeing the GP tomorrow to request the new patch/pill combo.

Similar happened to me - had an ultrasound and womb lining was fine but the consultant said if you're still having periods you shouldn't be on continuous HRT. Can you not just go onto sequential?

I'm a bit confused.

The consultant has said that it could be the HRT that is causing the bleeding and so said my choices are to stop it, have a combined HRT patch or a coil fitted

You said one option is to have a combined patch- so what are you using now?
You've said you're on continuous HRT now.

Why are you on continuous? It's for women post menopausal. It can be tried with women over 54 who are still having periods but the outcome is usually what you have- bleeding.

That's why you're bleeding so often. The small dose of daily progesterone won't control your own cycles.

You should try sequential that will give you a regular withdrawal bleed.

Also, if you are not post menopausal, that thickness of lining is not really high.

I'm often surprised at how quick some doctors are to do invasive tests without considering the whole picture.

Not post menopause, on HRT- but think there is an issue with 3-weekly bleeds (which are 99% likely to be your own natural cycle.)

Why didn't your GP just suggest sequential HRT?

If you're still having periods, your womb lining will not be below 4mm, even when using HRT. That doesn't mean you have hyperplasia or cancer.

The 4mm cut-off is for women post menopausal who have no bleeding for a year or more,the suddenly bleed, not women having regular 3-weekly bleeds who are not post menopause.

I went onto sequential patches. Very light bleed in between. As I'm still late peri at 55. Eventually it will stop and then I go on continuous. If I want to.

I went onto continuous HRT 2 years ago and haven't had a problem until the tail end of last year although my periods haven't stopped of course but they were getting less frequent.
I've read that some GPs are prescribing continuous before women are post menopausal. Mine was done because I wasn't sleeping and it was felt the daily dose of progesterone would help with that and it did.

I was on sequential HRT prior to that.

Thanks for your reply. I don't think they advise the mini pill for women of my age.

Continuous hrt is also advised for women who’ve been on sequential for 5 years and over 55.

I agree that he does need to know what's going on. He did say he didn't think it was likely he would find anything but I feel he is just being ultra cautious and wanted to tell me what my options were to stop the bleeding. If I wanted a coil, he could fit it then if it was appropriate to do so and would save having to go through another procedure.

I’m also on continuous and still having periods. My GP recommended the switch from sequential to help stabilise my hormone levels (I also have hypothyroidism). When I said I thought that continuous was only for post menopausal women he said that’s no longer the case.

Same here.

You can take the mini pill at any age as it’s progesterone only. The combined pill - with oestrogen - is the one you have to stop. I take the mini pill for lupus related issues (heavy periods, clotting) as do lots of women with lupus and in our health group we have women aged 60 plus who are still taking it.

Yes, some GPs are but it comes with the downside of what you've experienced.

There is no one size fits all.
You're one of the women who still bleeds on it.

Why does your dr think a patch (with a synthetic progesterone) will be any different to what you're on now?
Is that because it's stronger (Norethisterone)?

@Sparrowsandbudgies There is only one mini pill that can be used as part of HRT- Slynd- and it's off-licence.

The usual mini pills are too weak and have to be prescribed as 3 a day (Noriday.)

This is in the BMS guidelines.

There is no real advantage of the mini pill over other types of progesterone, only that it also offers contraception.

It is the case, simply because it comes with the risk of odd bleeding which then means investigations.

There are obviously exceptions like yourself, but the downside is that a lot of women will have to undergo hysteroscopy.

@MargoLivebetter Scans show polyps and hyperplasia.

It doesn't need a hysteroscopy to find those.

If hyperplasia is there it needs a biopsy which can be done on its own- very simple procedure and easier than a hysteroscopy - although most drs will choose the latter.

@JinglingSpringbells my consultant told me that the ultrasound couldn't determine absolutely if a lesion was: cancer, atypical hyperplasia, polyp, fibroid or hyperplasia without atypia and that was why the hysteroscopy was needed. Or have I misunderstood? I'm really hoping I'm not having an unnecessary procedure.

I took Cezarette - one a day- and had the Evorel conti patches. This was prescribed by a NHS menopause consultant and also supported by Newson health (privately).

Yes, you need the biopsy to be definitive.

But you were on Evorel Conti- that contains progesterone anyway.
The OP can't use estrogen and just the usual dose of a mini pill.

It depends on the skill and experience of who does the scan.

A highly experienced consultant who does scans can absolutely identify a polyp or a fibroid, from thickening. (with some exceptions perhaps.)

Happy to discuss off forum without giving my entire experience here.

They can't tell if a thickened area is normal hyperplasia or atypia etc without a biopsy. So if it's just thickening you need a biopsy.

Thank you @JinglingSpringbells that is really interesting to know. I can't work out if the consultant is trying not to worry me now! If you don't mind I'll send you a PM, so as not to derail the thread for the OP.