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Bleeding After Menopause | Spotting Breakthrough Bleeding | Progesterone
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- Опубликовано: 26 июн 2022
- Just started hormone replacement to help with menopause and . . . you get some spotting or breakthrough post-menopausal bleeding? The solution is (usually) pretty simple.
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Thank you! As a pharmacist, what can you tell us about using the micronized progesterone pills vaginally? I heard that women in other countries are told they can use it that way. (My gynecologist was not knowledgeable when I asked her.) I wonder if we’d need less via the vaginal route and have perhaps fewer of the side effects, like drowsiness?
I have the issue that 100 mg orally is not enough to prevent spotting, and 200 mg make me drowsy until 2 pm the next day! Which brings me to the topic of why aren’t they offering us any dosages between 100 and 200 mg? We are clearly underserved in so many ways…
Thanks for watching. Great questions! You CAN use oral micronized progesterone capsules vaginally . . . but there are some drawbacks. First, the commercially available capsules are filled with peanut oil. That makes them pretty messy to use vaginally, as you can probably imagine ;-) The progesterone will at least be partially absorbed when they're inserted vaginally, but there will certainly be some oily leakage for most women. Depending on the individual woman, sometimes those capsules will dissolve completely and sometimes they won't. There's not a lot of clear data, comparing the vaginal route with the oral route, so it's a bit hard to choose exact dosage. There are studies that show vaginal progesterone creams or suppositories are as effective as oral progesterone capsules, especially for preventing endometrial hyperplasia. Drowsiness is definitely an issue at higher doses and it's much more common in oral capsules because of something called the "liver first-pass effect." That effect is exactly what makes oral capsules much more effective for insomnia and anxiety. To combat daytime drowsiness, you might try inching the evening/bedtime dose earlier and earlier, so you don't get sleepy too early, but it also wears off earlier in the morning. Commercially manufactured progesterone only comes in 100MG and 200MG dosages. You can get doses in between, but only from a compounding pharmacy.
@@SimpleHormones Thank you very much for your prompt and informative reply, Steve! Your channel is such a valuable source of information for us menopausal women.
Yes, the vaginal route is not my preferred one, due to the reasons you mentioned. I actually went up on the estradiol after a few days on the higher progesterone, and the next day drowsiness was pretty much gone immediately! Could this be due to the higher estradiol? But … it seems like the higher progesterone is now not enough for the higher estradiol, since I now have intermittent spotting again! I’m giving it a few months to see if the spotting stops. I don’t plan on upping the progesterone yet again, so I may have to move down to the lower estradiol again. Definitely a lot of trial and error involved in this process!
Your suggestion to inch forward in taking the progesterone is great.
Thank you again, Steve. Your work is much appreciated.
It's very gratifying to read your comment. I appreciate the encouragement.
What about breaking open 200 mg Prometrium capsules and rubbing the contents on vascular areas, such as lesser strength over the counter, progesterone cream?
@@MsKati30 watch Menopause Taylor on RUclips. She says patients can use prometrium pills vaginally.
Thank you for the information. I started on HRT and I started spotting and ofcourse I went to panic mode, but now I understand. I will go see my doctor, but be more calm about it. Information is magic.😊
37 and 5 months into menopause. Started estradiol .050 for 6 weeks. Then, 2 weeks ago added micro 100mg progesterone and have had the most intense bleeding ever
Me too. What have you done/been advised. My gyn doesn’t seem on the ball. From my “research” it seems one should take continuous rather than intermittent progesterone. What have you found out. Please share with me.
If you took estrogen initially without any progesterone, and then added that later, it sounds to me that because of that the estrogen was unopposed and caused a build up of your lining and when you added the progesterone, it will cause the shedding of that lining so it makes sense that you are having heavy bleeding right now. I hope I'm understanding what you said correctly.. if so, we definitely never want to take estrogen without progesterone as it will cause a buildup of the lining. I hope that helps.
You are only 37, periods are ok
I’m 37 too…do you have primary ovarian failure because I do.
Thank you so much! I just felt in my gut that this must be the problem...not enough progesterone.
Thank YOU - Watching all your videos now. I have been looking for over 7 years for someone here in the USA who can give us this type of information. So THANKFUL I came across your RUclips channel. Thank you for providing these informative videos for us.
I have learned that the Mirena or Kylena IUD is more effective than oral micronized progesterone at keeping the uterus from bleeding. You can also try a uterine ablation; a simple in office procedure that permantely thins the uterine lining.
Bless you for your trying to help
You are so great. I am really struggling and your videos and the information is so so so helpful. Thank you.
You're very welcome! Thanks for watching.
Thank you. This answered alot of questions and explained my symptoms.
@luvurself4eva Thanks for watching.
I have been bleeding very heavily for about 3 weeks and I'm on low dose birth control. I do have a fibroid tumor. I cannot afford a hysterectomy so I was told by the ER doctor to check out low dose BC online. But I am at my wit's end with this bleeding.
If you are on HRT for menopause, solution is to just go for it. I developed endometreosis with perimenopause, so I'm fine after menopause. Just go off the hormones and let your periods stop.
67 & 9 yrs after menopause, on Combipatch for 5 months. Just started bleeding (like regular period) 11 days ago & am still bleeding. Of course I'm out of town so have to wait a couple more weeks to even see my doctor. Hopefully it's just the patches.
Hi did your spotting cause discomfort? I started with estradiol cream and am now on the patch and progesterone and feel discomfort in my ovaries and tubes that I haven't felt for years. When I sit down it feels tender in there, did you notice that at all? Thanks I'm 61 and just started so feel anxious.
I have a silly question. When you are on HRT ( Estradiol patch 0.05 mg/day and progesterone micro 100mg capsules) all symptoms of menopause should go away?
I’m on HRT for 2 weeks now but still have a couple symptoms like; itchy skin, bloating and my Energy level never the same. These symptoms I never had before post menopause. Btw, you seem very passion about this topic and we as women really appreciate you and thank you so mmuch for what you do.😊
You answered several questions I had with this video.
Can you please make a video on how to cycle Prometrium and estradiol oatch for perimenopause?
Love your videos.So informative. Thank you
I'm not having serious symptoms after over a year, and I got endometreosis with perimenopause and DON'T want that back! But concerned about post menopausal conditions. I AM weakening quickly and decent increase in overall pain.
can you make a video about continuous vs cyclic hrt?
Yes, please. I’m looking for this too
I've been on HRT for 13 weeks and now just started bleeding suddenly. I'm post menopausal for 2 years now
You'll want to talk with your provider about that. It's not unusual and often relates to progesterone levels that still need to be bumped up.
@@SimpleHormones I have and even got a second opinion, they they it happens, just to wait and if it continues they will look at it again. UK NHS!
Sending me for a ultrasound scan before they will increase my hormones... its a waiting game.
On evorol Conti patches for about to years now I had a small break through bleeding post menopause have a skin tag on down there ♥️
I’m 5 years post menopausal, I started HRT with 2 pumps Oestrogel and continuous Utrogestan 100 with no bleeding, I upped to 3 pumps after 10 months as I felt my symptoms were returning but 3 pumps didn’t really help. I had to swap to patches due to a shortage of Oestrogel here in the UK and was put on Evorel Conti combined patch. I felt so much better with these patches but had a bleed after 5 weeks and had a bleed every other week after that. I had ultrasound scans which came back all clear. I went back to using the gel after 5 months and the bleeding stopped but symptoms returned and I’m back to feeling anxious, the night sweats have returned and many other symptoms. I’m considering asking my gp to put me on Evorel 50 patch with Utrogestan in the hope that I don’t get any bleeding with the Utrogestan but knowing I can increase the Utrogestan gives me hope. Thank you for your informative video. If only it was one size fits all.
You seem to have a more complex case where you need higher dosages . . . but they come with side effects. One size doesn't fit all, unfortunately. In general, I recommend Oestrogel + Ultrogestan (which is bioidentical estradiol + bioidentical progesterone) over combinations like Evorel Conti (ethinyl estradiol + norethistrone). Your GP may not be willing to give you BOTH Evorel AND Ultrogestan. It may be worthwhile to talk with a hormone optimization specialist. I do know a few in the UK, mostly in Central London.
U can take malkangni seed from one to 2 3 in increasing day you have to increase seed malkangni or joytishmati with in ,20 or 30 days u will get ur periods.
I went through it. Feel TONS better now that my periods are long gone.
I'm in the UK, northwest and about to start BHRT (waiting for the blood work results consultation and cream prescription) Let me know if you would like me to recommend the specialist I consulted with.
A couple of weeks on a higher dose of progesterone or a couple of months?
you have the best info!! love your videos! I've been on HRT for over 6 months .075 patch and 100 mg micronized progesterone..I have had the breakthrough a couple of times. (actually woke up out of the blue with it again this morning).. going to have a uterine ultrasound. My question is, I'm also trying localized vaginal estradiol could this be part of the problem with the breakthrough bleeding? and I've tried so many times to get this question answered.. Can the progesterone cause weight gain?
thank you for making all of these videos.. they are a wealth of information!
Carla
Thanks for watching. I would suspect the local vaginal estradiol doesn't have that much impact on breakthrough bleeding. As the video emphasizes, a progesterone dose of 100MG is often too low and that's why you get breakthrough bleeding. Progesterone can cause weight gain, but it's usually temporary and not that much, especially compared to the weight gain from low estradiol.
Hello thank you for this. I’m on the estrogen and progesterone lowest dose and having a bit of spotting. I take it at night and it relaxes me. My other issue is that it’s irritating my digestive system where I’ve never had issues. It’s troubling.
I like how I feel otherwise as I used to have hot flashes too often during the day and every 15 minutes at night. After trying every herb known to mani suffered 10 years and decided to do HRT.
I’m afraid if I go higher with progesterone it will make my gut health worse.
@@dandersohn take vaginal progesterone
I’m wanting to continue with the estrogen patch at 1.50 because I’m getting the health benefit. Taking 100 g of progesterone pill and the last two weeks I’ve have lots of bleeding like a light period. Cramping and severe bloating too. I’m not sure what to do. OBGYN I’m seeing isn’t really helping me figure it out
Thanks for your advice
I want to try and stick it out but need to tweak it maybe
Are you on continuous progesterone everyday of the month? Or only 2 weeks out of the month?
Can you get very light spotting with just the estradiol Vaginal cream?
I would like to try cyclical HRT. In menopause, no periods for 5 years now. starting HRT soon i hope. But i wold like a monthly bleed. Any suggestions how this would be acheived using progesterone, when during hte month?
What causes skin tags down there please thank s
What causes neausa vertigo how long are you in menopause on evorol Conti patches please thanks ♥️
I am 51.5, began HRT 3 months ago, with .50 mg Estradiol patch and 100 mg micronized Progesterone. Gyno then increased Estradiol to .75 mg I didn't feel as energized, so she recently increased Progesterone to 200 mg I didn't feel well at that dosage of Progesterone so went back to 100 mg, wondering if the Estradiol needs to be increased again? Also, with both new doses of Estradiol I had 1 week of a "period" both times and no other bleeding/spotting, etc. and although I am feeling better, still need a lot more energy than I have 🤔 Your thoughts, PLEASE 🙏
Dhea
I am post menopause I am on evorol Conti patches had a break through bleed not much please thank you ♥️
I just started on bhrt 2 months ago. I was using half a sachet of sandrena and 100mg of micronised progesterone. I felt the effects of the estrogen right away and a lot improved. But had some side effects from the progesterone (or estrogen was too low?). Woke up with body aches and noticed by basal temp was high and resting heart rate was up and affecting sleep. I upped by estrogen (ok'd by doc) to one full sachet. I felt great! Body aches gone, rhr back down and body temp back to normal. I was sleeping great! After 4 days of the full sachet, I started a period (haven't had one for nearly 10 years). Not sure if I should up my progesterone or not. I'd hate to go back to those side effects. Any thoughts? I have an appointment with my meno doc in a week.
It’s so frustrating that no one answers these questions
@@serizer9 true! I’d love to figure out what’s going on. Getting the right balance is so hard!
I started HRTs about six months ago. Two months ago I started spotting then had what looked like a full period. I had ultrasound done and the lining of my uterus looks thin however the Doc said I had fibroids and cysts which are small in size. Since then I have been spotting odorless bright red blood to clear drainage. She was hesitant to give me more than 100 of progesterone so I have recently started using Emerita pro-gest cream twice a day to see what happens.
So sorry you've been experiencing fibroids and cysts, along with bleeding issues. I'm not giving medical advice but only acting as an educator. But you might want to take a look at these 2 videos to get a bit more background about progesterone. Here's the first one ruclips.net/video/_f9xXhO2YIk/видео.html
And her's another. ruclips.net/video/w2hHFAgeKys/видео.html
I suspect your doctor's hesitation to give more than 100MG of progesterone is based on the sadly mistaken idea that progesterone causes breast cancer. That myth is addressed in my video "Prometrium® | Progesterone Pills | 6 Things Women in Menopause Need to Know About Progesterone"
PLEASE someone help me! My doctor is not knowledgeable about this stuff, we are both basically winging it. One month ago, we increased estradiol from 50mg to 75mg. About 4 weeks after that, I had breakthrough spotting. A few days ago, we increased the oral micronized progesterone from 100mg to 200mg. I now am bleeding with a full period, and it's stressing me out!!! I have been post-menopausal for 1.5 years, so this bleeding has me very stressed. Should I wait it out, as the increase to 200mg has only been a few days, and my body needs to adjust? I presume the lining had built up for a bleed, before I started the progesterone increase? Either way, some words of advice or encouragement would be greatly appreciated!!!
I started HRT when I was 53 last year I'm perimenopausal, I was on the combined pill because of a heavy periods I had a uterus biopsy everything was clear , they inserted a mireena coil and estradot patches I've increased along the way , but for 12 mths I've been bleeding and spotting and having periods every month, then I stop for 2wks then I restart spotting and having periods, there sending g me for an ultrasound scan this month to check if the coil in place and my uterus ect and if that fine the dr said they going to add utedestran 200mg at night to help for bleeding and my sleep anxiety.
Sometimes I wonder if it's best just to avoid HRT altogether. I don't know what to do🤔
What you need to remember is this: Whether you choose to use hormone replacement therapy to treat menopause symptoms or not . . . there are RISKS EITHER WAY.
I've created a brand new course called The Menopause Solution, specifically designed to help women in menopause answer that exact question, "Should I take hormones (HRT) for menopause . . . or not?" If you'd like to learn more about the course, visit my website here: www.simplehormones.com/hormone-replacement-menopause/
I have been enjoying your videos so much! Thank you!! 😊 My dr got my estrogen dose to high the last time I got my HRT pellets and have very bad breast pain. Can you please let me know that if there’s a way to lower this before they wear of?
Unfortunately, waiting is the best option. There's not really a practical way to reduce estradiol, short of taking an anti-estrogen drug called an aromatase inhibitor. That would definitely not be a good idea, especially for short-term.
@@SimpleHormones Thank you very much!
I started bleeding a short while after the breast pain started so I upped my progesterone and also took Vitex supplement. The pain and bleeding stopped in about a week.
Another question; Can I use the progesterone vaginally to keep the uterus thin and stop the bleeding?
I'm on Utrogestron and estrodial been on it 9 months it didn't make me bleed so far. I had bleeding once but not from HRT and had checks so far nothing but I don't seem to be feeling any better on it..and I have high Anixety do you think it's more This then Menopause with me been post for 5 years now don't know what to think
what about acne? I am still trying to wean off the overdose of testosterone I received in august. I read that progesterone can cause acne as well.
Can you get this on evorol Conti patches please thank you ♥️
Hello, is there a LH blood level of progesterone to indicate as to whether one's progesterone levels are good? Does this LH level change to coincide with ones estrogen FSH level?
I’m in Massachusetts I go to the Brigham in women’s fish center but would prefer a different Specialist . I don’t really think there’s any left in Massachusetts Heather hirsh left and now she does the midi app but they don’t accept my poor people insurance. Do you have any suggestions? Thank you.
I understand topical P cream isn’t good enough.. but what about Crinone/ Vaginal creams I have read they can directly protect the uterus too
Vaginal progesterone cream has been shown to be effective in protecting the uterus.
@@SimpleHormones music to my ear!!!! Thank you so much for yr reply 😘
is it possible for high progesterone to cause bleeding?
Anything is possible with progesterone. I always counsel women taking progesterone that it's very likely to have unusual bleeding (or periods) for the first few months. Periods can be longer, shorter, more spotting, heavier, lighter, all over the place. If you're in menopause and start taking progesterone, bleeding can suddenly happen, even though you haven't had any for years - however this is more common with estradiol in menopause than with progesterone. It often takes some time for bleeding/periods/spotting to settle out after starting progesterone.
I need help!
I don’t know what to do!
I started HRT in September after being 6 years post menopausal and began bleeding. At first it was spotting then escalated to two periods a month.
My ob said it’s not from the HRT?????
Fast forward
I’ve had a biopsy an ultrasound, and a hysteroscopy and they found nothing.
Now I don’t know what to do I have no idea where to turn or how to adjust or maybe go off HRT
If I do will I still bleed?
Has my body gone backwards with my hormones like when I was young?
Please help direct me.
Thank you
Have you figured it out
Thank you for your videos I right now take 400 mg of progesterone I was taking it vaginally/rectally just depends and it seems like it’s been working. I lowered it like an idiot to 300 and then I started spot bleeding. Three days later well damn seem to of broken and I haven’t been able to stop it so I tried to go up to 400 and 500 even 600 and on Nothing yet it’s going on like 9 to 10 days. Yes I left a message with my doctor and I’ve had an ultrasound a couple of weeks ago which my lining was three I did have two baby fibroids, but I wasn’t bleeding at all. This is like the first time is oral the better way ?
@nerolicompletecreme Oh no! Oral is usually better. Keep bugging your doctor and expect that it will take time to stop. Obviously, major bleeding is VERY serious so make sure you get help as soon as possible.
@@SimpleHormones thank you for your knowledge was curious, since you are a pharmacist and no a lot about hormones have you ever thought about creating a progesterone that was slow released that possibly would be covered by insurance that would be amazing ? ❤️
Also what if it's a prescription strength transdermal cream? Would that be something you would suggest?
Progesterone in a transdermal cream usually doesn't help with vaginal bleeding.
@@SimpleHormones thank you
I upped my estradiol 3 weeks ago. Started spotting yesterday. (Post menopausal for 5 years.) How soon do you suggest I up my progesterone? Now, or do I see if the spotting goes away? I'm only on 100mg of progesterone currently.
@MichelleWatkins2 That’s a good question to run by your doctor. Most will not be too concerned about spotting and might have you see if that settles out. More significant bleeding is a bigger concern that would warrant increasing the progesterone. In any case, you should definitely work with your physician in adjusting those doses.
Is being prescribed 200 mg to be taken ALL month long typical?
Yes. Most providers start at 100MG but often need to increase the dose. All month long is most typical if you're in menopause and not having any menstrual periods.
@@SimpleHormones Thank you so much! I am just beginning and my provider prescribe 200 mg of Progesterone. She said it is Bioidentical . I was reading about Progestins versus Progesterone. It’a all a bit confusing, I just don’t want take anything that is harmful for my body but I still have all my parts so it is necessary to balance the estrogen. .. I just found your videos and they are very helpful!
Hi is 300mg progesterone too much? I’m on 200 and had some bleeding. I’ve only recently had hysteroscopy and no issues at all.
300MG is a medium-high dose. My wife takes 400MG and has for over 10 years. Some women simply need more progesterone. The starting dose is most commonly 100MG, which is almost always too low. Progesterone is also a very safe hormone. Don't believe anyone who says it increases the risk for breast cancer.
@@SimpleHormones thanks so much for letting me know
@@SimpleHormones I just found your channel. I have been on 400MG of progesterone for a long time. I still spot monthly. I have had several ultrasounds and biopsies. My lining is at 5mm now. I would love a video of side effects on high doses of progesterone. I really feel it has some and would like to decrease.
@@SimpleHormones Does your wife take 400mg of progesterone every day or just 14 days per month? Thank you
I started bio-identical hormones after a month I started bleeding and i bled for 2 and a half weeks. My dr said I should 'decrease' progesterone and he didnt even check on my progesterone levels. I'm going to see a gyno and get an internal done to see what's happening. This is all so scary and new ground for me. Is it true that oral progesterone makes us put on weight. I have definitely put on weight since starting HRT.
Hello you recommend vaginal progesterone but my OB says she won’t give it because there’s not enough research and they won’t let her! I need help! My gut health is shot and it was fine before I started progesterone 100 mg pills.
I don’t have insurance right now.
I just need to know what to do asI have finally found relief and my hot flashes are 100% gone and I just don’t want to go backwards. It’s just the progesterone that’s messing me up and I’m even having pain in my liver so because I don’t have insurance I can’t go get a blood test to see if it’s missing my liver up but instinctively I know something is terribly wrong. Please let me know how I can get the vaginal progesterone if there is any way at all possible. If I need to somehow make an appointment with you to get canceled please let me know I just need help as soon as possible I’m going down quickly :-(
I’m adding here that I’m having a light period now too
Prometrium (micronized progesterone) pills can be put in the vagina. It’s the same pill that’s used orally.
Can you ovulate with hrt ??
Yes. Birth control is also a form of HRT, but has to be given in higher doses to suppress ovulation. Most women on HRT (meaning both estradiol and progesterone) have officially been diagnosed in menopause and don't ovulate anymore. If a woman is still in perimenopause, she may still ovulate, although less frequently, even if she's taking HRT. I would say HRT can discourage, but not eliminate ovulation.
@@SimpleHormones can diabetes stop ovulation? If diabetes stops ovulation, does it mean a woman loses eggs or do they stay the same? Can damage egg count??
That's a great question. Diabetes or, more specifically, insulin resistance, causes an increased level of insulin in the bloodstream. That's called hyperinsulinemia. Hyperinsulinemia increases testosterone, which often causes ovulation to stop. The "egg" isn't lost, exactly. The FOLLICLE (that's supposed to become an egg) stays in the ovary to create a cyst. Months of not ovulating - often followed by not having a period - leads to polycystic ovaries. That means "many cysts" inside the ovary. So the "egg" (which is actually a follicle) is no longer an "egg" but a cyst.
My doctor won't give me a higher dose of evorol Conti patches please thanks 😂