Breakthrough bleeding since April

[Melissa]

I need advice. My case is not straightforward. I am not expecting black and white answers but I would greatly appreciate any educated thoughts and suggestions. I have been trying to figure this out since April 2021. Background: 8 plus years postmenopausal intact female. Started HRT in December 2020 for my bone health but realized quickly after joining the forum how critical the hormones are to our overall well being and brain and heart and bone health etc.

I have my hormone provider appointment coming up in a little over 2 weeks. I am worried they will take my hormones (specifically E) away from me because I have been experiencing breakthrough bleeding since April. When my blood P was low, middle and high still I bleed.

My latest blood work as of September 29th.
All findings are trough findings and the P levels are approximately 12 hours (a little more than 12) after rectal insertion.

Estradiol is 97
Total Testosterone is 299
Free Testosterone is 2.8
Progesterone is 10.7

I inject 0.7 mg E twice a week.
I inject 6 mg T twice a week.
I insert 200 mg generic prometrium gelcaps twice a day.

As I wrote I have been experiencing breakthrough bleeding daily for the most part. My P used to be low (2) and I bled. My P used to be midrange (5) and I bled. Now my P is at 10.7 which is a good number (and at a 10 to 1 E to P ratio) and still I am experiencing bleeding. I have tested my P at 6 hours and it is 19. But that would be the max it reaches I believe at 6 hours. My E would also be higher at 6 hours vs a trough reading so hopefully the ratio is still 1 to 10 P to E.

I have had two ultrasounds (May and end of July) and my lining looks fine and my ovaries look fine and there are no fibroids or anything of note on the ultrasound). I am having my third ultrasound in 2 weeks.

My dilemma is I am not sure if my P is still too low or even too high? If I am bleeding doesn't that mean my P levels are not good? My E is certainly not too high at 97 IMO. I am not experiencing any negative side effects that I know of. I do plan on reducing my T injections just a bit but am waiting to speak with my provider as I respect her opinion but yes I want to reduce to 4 or at max 5 mg T twice a week.

I have OHPC (synthetic progestin but the least risky of all the synthetic progestins) injections on hand and am ready to start those to see if it will stop my bleeding. However, if by some chance my P is too high then OHPC would be a bad idea as it would make it worse I think. So my quandary is this. From my findings are my blood P levels too high or too low? Since I am still bleeding something is wrong and it has to come down to P right?

An additional piece of info. I insert P around 8:30 PM and 8:30 AM and find the bleeding starts around 3-4PM and around 6-7 AM....could the fluctuation in blood P levels be causing my bleeding? Could my uterus be that sensitive to fluctuations? When I look at the rectal P graph it shows P goes up then starts going down at 6 hours...and coincidentally my bleeding starts anywhere from 6-9 hours. Not always but often. Wouldn't this be a sign my lowering P blood levels is causing my bleeding? And if so what can I do about it? I cannot keep P levels stable 24 hours a day. I don't think it is physiologically possible given the way P works in our bodies.

Sorry for asking so many questions. I am so worried my hormone provider will take my E away and I am trying to figure this out before my appointment with them. When I get my 3rd ultrasound done it might give me more clues but it might not so I am trying to be prepared as best I can. If the US shows a too thin lining then I know P is too high and if the lining is too thick I know P is too low. But if the lining is just right what do I do to stop the bleeding?

I do not want to start the OHPC injections unless I am confident my P is not sufficient to protect my uterus. However I am not sure I can afford to wait because if I am still bleeding at my hormone provider follow up appointment I might be in big trouble that is, taking away my E.

I am feeling like I am running out of time and would be devastated if my E was taken away from me. Thanks.

 

[ed031561]

My GF, 57 post menopausal, was on test cream years ago. She stopped seeing the doctor (too expensive) so stopped the test cream. Was told she has osteo and asked me if I could give her weekly test injections, as she also saw a dramatic decrease in sexual desire. I was giving her about 25mg/wk and after a bit she started to experience breakthrough bleeding. I researched for an amount to give a woman for TRT and found 15mg of test cyp was an accepted amount. When I reduced the amount the breakthrough bleeding went away. Since you are taking 12mg total a week, try reducing the amount of test to 6mg/wk to see if the bleeding goes away. I can't comment on taking E as I have never done that with her. I read a report from Europe that they just use test in women as the test aromatizes to estrogen and gives them an acceptable level of estrogen. No need to supplement further. That might not be true for all women, but my GF does not supplement with estrogen. As far as using prometrium, I have read that can cause breakthrough bleeding in itself. I would try lowering the test and see if it helps. If not, try eliminating the prometrium and see what happens. Good luck!

 

[Melissa]

My GF, 57 post menopausal, was on test cream years ago. She stopped seeing the doctor (too expensive) so stopped the test cream. Was told she has osteo and asked me if I could give her weekly test injections, as she also saw a dramatic decrease in sexual desire. I was giving her about 25mg/wk and after a bit she started to experience breakthrough bleeding. I researched for an amount to give a woman for TRT and found 15mg of test cyp was an accepted amount. When I reduced the amount the breakthrough bleeding went away. Since you are taking 12mg total a week, try reducing the amount of test to 6mg/wk to see if the bleeding goes away. I can't comment on taking E as I have never done that with her. I read a report from Europe that they just use test in women as the test aromatizes to estrogen and gives them an acceptable level of estrogen. No need to supplement further. That might not be true for all women, but my GF does not supplement with estrogen. As far as using prometrium, I have read that can cause breakthrough bleeding in itself. I would try lowering the test and see if it helps. If not, try eliminating the prometrium and see what happens. Good luck!

Thanks very much! I actually reduced my T injections from 6 mg twice a week to 5 mg twice a week and am planning on going to 4 mg twice a week. Maybe it will help, thanks! Also I just started OHPC injections which is supposed to help the bleeding. I have done two injections so far 125 mg each injection (0.5ml) but so far it hasn't stopped but it could take time. I appreciate your input, thanks!

Glad your girlfriend is doing well on her current protocol.

 

[Melissa]

ETA: Since I posted I had another pelvic ultrasound and my endometrial lining is now 7mm. So my gyn said I have to do a biopsy. I don't understand why my good levels of P aren't protecting my endometrial lining. Anyway just wanted to update the thread with this info. Hoping the OHPC injections will stop my bleeding. I am doing the biopsy in November as my gyn is away the entire month of October. Sort of nervous about the biopsy as I have read it is very painful. But I will do it because I have no choice and hope for the best.

 

[MarcoFL]

My GF, 57 post menopausal, was on test cream years ago. She stopped seeing the doctor (too expensive) so stopped the test cream. Was told she has osteo and asked me if I could give her weekly test injections, as she also saw a dramatic decrease in sexual desire. I was giving her about 25mg/wk and after a bit she started to experience breakthrough bleeding. I researched for an amount to give a woman for TRT and found 15mg of test cyp was an accepted amount. When I reduced the amount the breakthrough bleeding went away. Since you are taking 12mg total a week, try reducing the amount of test to 6mg/wk to see if the bleeding goes away. I can't comment on taking E as I have never done that with her. I read a report from Europe that they just use test in women as the test aromatizes to estrogen and gives them an acceptable level of estrogen. No need to supplement further. That might not be true for all women, but my GF does not supplement with estrogen. As far as using prometrium, I have read that can cause breakthrough bleeding in itself. I would try lowering the test and see if it helps. If not, try eliminating the prometrium and see what happens. Good luck!

Did I miss it or can you tell what strength T you are injecting? Not sure I can add much but I assume you are taking the one formulated for women.

 

[Melissa]

Did I miss it or can you tell what strength T you are injecting? Not sure I can add much but I assume you are taking the one formulated for women.

I’m injecting 5 mg t cyp twice a week. Intramuscular injections into my deltoid.

 

[Nelson Vergel]

Melissa
You may want to join my Women's Health and HRT group on ********. There are over 7,000 women there on HRT.

https://www.********.com/groups/womenHRT/

 

[Melissa]

Melissa
You may want to join my Women's Health and HRT group on ********. There are over 7,000 women there on HRT.

https://www.********.com/groups/womenHRT/

Thank you Nelson, I am a member and that group rocks. So do you. Thanks for all you do.

 

[ed031561]

Did I miss it or can you tell what strength T you are injecting? Not sure I can add much but I assume you are taking the one formulated for women.

She is getting 15mg/wk of test cyp. Same test as men use.