WLIs and HRT / oral progestogen - recent guidance from BMS concerning

[WeAllHaveWings]

Just seen this in facebook which is a bit concerning.

I have asked my provider for feedback. Interested in any feedback from other providers.

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Good to read that link. I don't want a coil and have had problems with patches not staying on in the past, though I know they're great for some people. Don't really want a bigger dose of utrogestan either. So will try the vaginal route starting tonight - my only worry really is if they don't absorb properly, if I stand up or go to the loo too often and they aren't getting into my system.

My GP has booked me in for a coil - I am not keen. However I have taken double prog and it has not get stopped the bleeding - which is not intermitent or spotting but is a heavy 7/8 day period every month. Maybe it will take months to work.

I am also booked in for a hysteroscopy and biopsy which I dont want to have. I have had 2 in the last couple of years and they have been clear despite having thickened endometrium.

Finally had my '2 week urgent referral' with Gynae consultant this morning (after an 8 week wait).

It was really great and he was 100% clued up on WLI - he suggested that the drop in weight impacts the ratio of oestrogen in the body (ie it becomes more) so ovulation starts again (this would fit my bleed patterns which are full on periods which have started every 3 weeks and then stopped after 7 days - I have had 3 since starting MJ on 1st April).

He believes it will settle in time but that the progesterone is necessary to protective to the womb lining against oestrogen - which thickens and then sheds as a bleed as the ostrogen ration has increased. I told him that I had taken double progesterone and that my GP had put me on a waiting list to have a coil fitted (to ensure prog dose is absorbed and by-passing the stomach). My double prog hasnt kicked in yet (only been doing it a few weeks).

However I still had to have the hysteroscopy this morning as the ultra sound showed thicken endo and a polyp - so had the camera and biopsy taken. Will hear back in 2 -3 weeks.

How is everyone getting on with post meno bleeding. I have had my hysteroscopy results back and biopsy is cleat but have thickened womb lining. I am seeing my GP on Fri and on a list for a coil. I have been taking double prog but I am bleeding heavily every other week now and absolutely exhausted with it that I have just started taking iron supps.

That sounds rotten. I hope they find a solution for you.
im not very knowledgable about this but have thought heavy bleeding would not go along with your womb lining being thicker - where is it all coming from?
Im inserting my utrogestan but obviously I can't tell if that's working better

Maybe I should try to insert. But I wonder if it is anything to do with absorption at all as that would then be a concern for my thyroid, BP and cholesterol tab.

Sounds awful @Terrapinn, I don’t know enough about this, the menopause board might be able to help with what usually the options are if bleeding on HRT (without the added complication of Mounjaro), and any changes may take time to settle

Maybe it might settle down if longer on double utrogestan dose
Coil (could perhaps be done quicker privately, if that’s on option, if GP will refer, deal with removal in future)
Utrogestan vaginally (200mg pessaries with applicator, only licenced for ivf but clinics do prescribe)
Lower estrogen dose
Synthetic progesterone through patch

Had bleeding in June saw my GP who said insert vaginally. This cleared it up.
Today Ive had more bleeding and period pains !
Can't see GP for 2 weeks . Help !

I had my HRT review yesterday, and doctor has switched me to combined patches in response to my query about progesterone absorption on MJ. Sounds a good alternative, we will see how it goes ...

Hi @Terrapinn i know you posted a while back but those on thyroid meds may well need their levels checked and prescription altered as weight loss progesses...all oral tablets can face absorption issues due to slow digestive transit (one of the reasons for unplanned mounjaro babies!) and heavy periods are a classic symptom of hypothyroidism www.drugs.com/drug-interactions/levothyroxine-with-mounjaro-1463-0-4363-20051.html

I have had this reply from VOY, I guess I will need to ask the GP about it.

It is really important you know that as the absorption of oral HRT tablets may be affected by the weight loss medication, it may be worth discussing a switch to the transdermal route. It is always advised that you inform your GP that you are on Mounjaro, and report any unexpected bleeding and period-like pains to them as soon as possible (these symptoms would warrant further investigation).

If you have any other questions, please let us know.

Sounds good, hope it goes well!

Can you go on them when you are still having regular periods do you happen to know? thanks

Sorry, no idea, I am firmly menopausal.

OK, thanks, I will ask the GP

If you are still having periods I believe you use combined progesterone/estrogen patches for part of the month and estrogen only patches for the rest, probably similar to your routine for oral progesterone.

The significant difference is the progesterone in patches is synthetic not micronized/body identical so there are different side effects and risk profiles
(you can see differences if you ask for a for comparison in google or ChatGPT, or look for some youtube videos)

Thanks

Is there something about this only applying to high doses of MJ / increasing the dose?

I'm about to reduce to 5mg so unsure if it applies to me now.

That is ludicrous. Presumably he prescribes the progesterone?!? He should be taking into account other medications however and whoever prescribed them, and even if they were purchased over the counter. Can you see another GP at the practice?

from my conversation with my GP’s pharmacist, it was something to be aware of when I increased the dose of MJ, but not while maintaining or reducing it. At the time I had the consultation I was close to my target weight so was planning to start reducing my MJ dose

The bleeding started for me on the lower doses. I has since resolved after taking double progesterone dose - but it has taken about 8 weeks to stop.