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.

But that’s what I’ve suggested - that the op go on the mini pill alongside the combined patch, as suggested in her original post. Unless I’ve completely misunderstood. Lots of women do this.

I had a Mirena fitted for frequent heavy bleeding (done at the same time as the hysteroscopy) and it sorted out the bleeding. Unfortunately, I was one of the unlucky few where it causes weight gain so I had to have it removed again after a couple of years. When it was removed, I went on to sequential progesterone but the frequent bleeds came back until I got to my current regime of 75mg oestrogen patch and two Utrogestan capsules every day continuously.

She doesn't say anything about the mini pill in her first post.

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've never heard of anyone using the mini pill with a combined continuous patch and it's definitely not in the BMS guidance unless it's being used as contraception - in which case Slynd (new mini pill) does both.

I was just sharing my personal experience!

I feel like every time I share my experiences on these threads I get made to feel like I’m making things up. I’m not. Lots of women take the mini pill (instead of using the coil) for part of the progesterone in HRT alongside a continuous combined HRT patch. It’s not unusual. I know this because we talk about it a lot in the various health groups I’m in. And I’ve never actually heard of the pill you mentioned earlier. Most people are taking Cezarette. It’s a good option for women who - for various reasons- do not want to have a coil, like me. I don’t know why I always feel like I have to somehow justify myself to you on these threads. It’s tedious. If you’re saying it’s not licensed or recommended then that’s fair enough but NHS menopause specialists are prescribing that combination and it works for many women.

Hi OP I am also 56 and have never stopped bleeding. I moved from sequential onto continuous at 54 (as was the recommendation at the time) after taking a blood test to show my hormone levels were post menopausal. I began getting periods twice a month, kept thinking it would settle down but for reasons too longwinded to explain I put off going back to my GP until recently when I had a couple of months of slight continuous bleeding every day pretty much. Anyway, went to GP who referred for urgent scan. Scan came back abnormal with ill defined endometrium 8mm thick. Protocol is to automatically refer for urgent 2 week pathway for gynae. Yesterday I had a hysteroscopy where they did a biopsy and removed a polyp, they gave me the option to have a coil inserted - I’ve never wanted one of these before but when speaking to the consultant before the procedure (separate appt) we talked through options, usually the bleeding is because the HRT isn’t balanced and you likely need more progesterone than 100mg tablets once a day to prevent the build up, she recommend the coil as it’s the best thing to stop the build up with a higher dose of progesterone at a set amount, also it can be preventative for endo cancer. I decided to go ahead with it and it was all very straight forward. I’m looking forward to the bleeding finally being done with!! I had this all done with a GA as I’ve read too many horror stories about them being done with no pain control and I’m not interested in being in any more pain! Just waiting now for the biopsy results - hopefully all good.

I will still use the estrogen gel with this.

Thanks everyone for your input. I have my procedure tomorrow so will see what the outcome is. 🙏

Hope all goes well today @StrawberryBlonde70

Good luck today @StrawberryBlonde70 breathe deep and try to relax when they do the hysteroscopy - it doesn’t take long. When I had mine I was given a local anaesthetic which must have helped a lot with the pain.

I’m on sequential had the same issue with bleeding but they upped the progesterone to counter it. I take regular magnesium which helps with sleep in the non progesterone weeks.

Thank you 🙂I had a spinal block so didn't feel a thing. They didn't do a full hysteroscopy in the end because I was on a period so just took the biopsy. The consultant didn't seem concerned so providing the biopsy is clear I will just speak to the GP about adjusting my progesterone.

Hope everything is OK with your biopsy. I was offered a coil but didn't want one. My lining was only very slightly over where it should be (5.1mm) so I am going to ask about the combined patch as this is the next best thing. I have never had a blood test to check my levels so don't know if I am post menopausal or not. My bleeds have been behaving like a period but have in some cases just become more prolonged but not heavier.
I hope you get some relief from the coil. The consultant said I could just be having a late menopause. Apparently that's genetic but I don't know as my Mum had a hysterectomy at 38 and my Nan never discussed it.

I don’t think the blood tests are very accurate at all but it was the only way they would let me switch over.

Hopefully both our biopsies come back clear. 🤞

@StrawberryBlonde70 sorry to drag you back to this thread, but I wondered what you had decided to do?

I ended up having a big polyp removed as well as the biopsies and I thought that would be all my problems solved, but I appear to be starting another bleed again - which is really annoying.

Sorry to hear your procedure didn't solve the issue for you. My biopsy came back clear and the consultant was of the opinion that I may be someone who is having a late menopause. I was offered the coil at the appointment but I said I would rather try to control it externally. My GP has reviewed my HRT and reduced my oestrogen and doubled my progesterone. We are going to try this for 3 months and then review again. She said I might need to change to a synthetic progesterone as this is often more effective. I am currently having a bleed which started yesterday but it's early days into my new regime so I am trying to stay optimistic.

Ok, that’s interesting @StrawberryBlonde70. I was told to double my oestrogen, as I was low dose. It all feels a bit like guesswork!

Well I have been on reduced oestrogen for a week (75mg) and 200 of progesterone every day and am currently on day 11 of a bleed and losing the will to live. The GP said to review the new HRT regime in 3 months so not sure what to do in the meantime.

The coil is almost certainly the right answer / it was for me when nothing else worked and the increasingly frequent bleeding turned into terrible flooding etc. sending thoughts of solidarity

I’m so sorry this sound awful. I haven’t been myself but my friend had a similar issue and after a clear scan then went to a private menopause clinic and paid I think it was £150 for an assessment. It turns out she wasn’t absorbing the gel at all and that was the cause - apparently some women don’t. The person she saw wrote to the GP and she got a different form of Oestrogen and it was sorted within weeks. Prior to that her GP was faffing with different amounts of gel and progesterone and she bleed for a year.

I was bleeding having been put on withdrawal bleed HRT from ages 41 to 50 but then asked to go on continuous at 50 as there is a high risk of uterine cancer in my family and the GP agreed. I’m on HRT as a preventative measure It was a bit of faff but it is not just a case of increasing oestrogen or progesterone and very much a balance. I’m on 3 pumps of oestrogen gel morning and 100 mg of progesterone at night and this for me means no bleed. However I also have vaginal atrophy and take oestrogen pessaries I have to be very careful because too much or too little means a bleed.

Would a visit to a menopause clinic be worth it for you?

Similar happening. I'm 54 was ordered off mini pill, been on since 2020 2 a day, in February because of my age. Bleeding started I felt period like. Then in July horrendous floods occurred over a few days.
GP assumed cancer I was sent to hospital gynae unit they did scans lining too thick for menopause but ok if I still had periods. Most thought I was meno 1 agreed with me still periods cos it felt hormonal. Had smears and cervical checks all ok there. Still up in the air with endo.
They gave me the pill again but I didn't take as I didn't want to mask it and cancer be growing.
Horrendous bleeding for last couple of weeks, had to wear nappies hardly left the house. Also moody etc.
Phoned GP yesterday she said get back on the pill. So took two and two today bleeding stopped hallelujah.
Going to do hormone test as she was a bit snotty with me because I said it was all up in the air.
So back to square one on pill.
Don't know how long this will go on for.
She mentioned 55 (3 months away) being the age but you are 56.

Personally I would go on the pill. Had mirena years ago it was horrible.
GP was more concerned about me getting pregnant!

Sympathy to you @StrawberryBlonde70 it's horrible. But solidarity to you.