Quick help needed, if at all possible please

[PhoebeBuffay1234]

I need some quick advice, if that’s at all possible, please. I have an appt later this morning. I was changed to continuous progesterone in April, even though I was still having my own periods. I have continued having ‘periods’ since then. I believe I wad changed too quickly.

I had a scan last week and it was all fine and no further action. I have just spoken to the nurse to see if I need to change my HRT and now she’s asked to see me and potentially might refer me to gynae. I’m not against this as such but from everything I have read online, this sounds like a hormone imbalance more than anything and it suggests trying to go back to cyclical etc.

I have a ‘fear’ of medical professionals due to previous awful treatment by a GP (not related to peri) and so I feel reluctant to push back on what she says. What would you do if you were me? Would you question it all? Obviously I’ll go to gynae etc but I just feel it’s all a bit much.

Thanks in advance!!

@jinglingspringbells in case you’re around. I know you’re very knowledgeable and have advised me before.

How old are you?

50!

And why were you changed to continuous? Iirc, its 1 year since last period, or 54. And neither applies to you!

Over 2 years I have tried the combined patch, so transdermal prog., the 14 day in a month progesterone dose (oral pills) alongside estrogen, and the 1 oral pill continuously- and then back to the 14 day in a month version. I have always been quite intolerant to progesterone which has been the reason for the changes, but nothing has changed this very much. Of them all, the continuous prog. caused the worst side effects. Currently waiting to try a coil (but am quite fearful of this and have resisted a few times).

From scans in the winter, there were effects that had probably arisen due to hormonal imbalances (cysts etc). Thankfully not sinister, but at that point you do weigh up what you fear (medical investigations or something unknown - or something that isn't really connected to peri at all) and would probably need the best expertise you have at your disposal. So if the scan has good results, that's good. Can you ask more about what the gynae referral would be looking to exclude?

I was started on cyclical on 26th Jan this year. I think I messed up the timing of when I started the progesterone bit of the cycle and subsequently had longer and erratic bleeds (but not unlike the bleeds I’d had prior to starting HRT as part of the fun that is peri). The HRT nurse then suggested to make it ‘easier’ that I should go on continuous. That was April 27th. I’ve been having what feels like normal for me periods since, though a couple of longer (but light) ones. I never have heavy bleeding.

Thank you for sharing. I’m happy to be checked out of course but I just feel like it’s all been done incorrectly. I also have ME so it’s a massive upheaval having lots of appts (though also I appreciate how lucky I am to have access to such things)!

Yes, it's not easy to shake something from your mind that there is a big inner resistance to (the road that's narrowing into a corner for a coil, in my case!) I hope that the nurse will be able to give some info that is useful for you and that the appointment goes well.

Had my appt, she examined my cervix which was normal this time (previously had erosion) so that is reassuring. I’m upping my progesterone to 200mg daily and review in a month, but I still wonder if going back to cyclical might be better. Will give this a go though.

Hi there @PhoebeBuffay1234

I think it's fairly obvious that you ought not to be on continuous HRT.
I despair at times at the number of times this happens and women are then subjected to the stress of scans etc.

The nurse suggested you try continuous after 3 months on sequential?
That's a bit mad TBH! You were still having periods. Some nurses seem to have very little knowledge.

The guidance (om Menopause Matters, written by an NHS consultant gynae) and the BMS is to use continuous women should be 54, or no periods for 1 year at any age.

There are some drs who will suggest that after a year on sequential you try swapping to continuous but it is an experiment. Rather than subject women to scans they ought to revert to sequential and see if it settles.

The other thing is you are supposed to give it 6 months for any bleeding to settle.End of April to today is only just 5 months.

TBH I'd carry on with sequential . Pick a date and start the 14 days per month from that date and carry on with the same date each month.

If you are still unsure, go back and have a scan but the BMS medical advice is to change the HRT first.

Aw, thank you so much for picking this up. You helpfully answered my post last month. I was going to go back to cyclical and then I had what seemed like two periods back to back so I thought I’d best get it checked. Cue the scan referral. Luckily that was all fine and no hysteroscopy or biopsy needed.

I’ve just started very light bleeding again today, 22 days after my last period which was normal for me prior to all of this. It’s as if my own hormones and cycle are just overriding the HRT still.

I feel like I sort of daren’t go back to cyclical after she’s told me to up to 200mg daily from tonight (this is where my fear of challenging medical people raises its head).

You're welcome and I'm sorry you are having ti deal with this @PhoebeBuffay1234

But the issue is a) she's a nurse and seems a bit muddled and b) she's mis-prescribed anyway as she's not following guidance.

she's got bogged down with trying to help you not to have a heavy withdrawal bleed. That's sort-of okay but the downside is you're bleeding anyway so it's not working!

https://www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age.

The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved.

When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin.

Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control.

And, in fact, the 200mcgs a day is really for women who fulfill the criteria for continuous and still having bleeding issues. It doesn't apply, or work, for women in peri with regular periods.

The guidance is try continuous at 54 even if having periods or wait for 12 months with no period at any age.

You're going to have to challenge her or do what the guidance actually says which is revert to sequential.

Can you not try a coil for progesterone? Then you can take the oestrogen every day. There's no age limit linked to that.

I’m reluctant to try the coil…not because of the coil itself as I always had the ‘copper coil’ as contraception…it’s the synthetic hormones that concern me as I have a history of anxiety, OCD and depression. I’m really good on the combination I’m on in terms of mood and symptoms so don’t want to upset the apple cart so to speak.

Thanks again. I think I’ll do that then. And should I expect a withdrawal bleed on sequential when I revert back. And assume that it may still take a few months to settle into a pattern?

Yes, you should but bear in mind it may not happen for the first month. Hope it all goes well!