No Withdrawal bleed/thickened endometrium

Hello,

In a previous post, you discussed the effects of estrogen on the uterine lining after menopause, and  that "After menopause, if one is given estrogen every day and progesterone for two weeks of each month, you will have periods in menopause for as long as you are on the hormones."

I am concerned that I am not having withdrawal bleeding on continuous sequential HRT. No others symptoms or problems -- feeling great!

I wanted to do HRT on this schedule to keep uterus healthy , i.e., endometrium flat ... But my 1st and only ultrasound, after only 8mos of  HRT (Vivelle dot .1mg x2 weekly and 14 days of 200mg Prometrium each month), shows thickened endometrium at 1.2 cm?? US was done on day 4 after last Prometrium tab -- maybe too soon in cycle? In addition, report notes a "paraovarian cyst and small amount of fluid in endomentrial canal." My doctor recommends reducing estrogen , but i'm wondering if maybe increasing dose might be enough to cause withdrawl (withdrawal) bleed, thus thinning endometrium? Last estradiol blood levels were 52 pg/ml (highest of all readings), progesterone at 12.7 ng/ml and testosterone at 27.8 ng/dL.

I am 52 years and last period was age 47 -- could length of time since last period have something to do with no withdrawal bleed?  If increasing dose is out of safety realm, should reduing estrogen  dose  help endometrium thin and if so, to what dosage? Is there any other approach that might be used to cause the endometrial stipe to shed?  Should I be concerned about any other details at this point or just wait until next US?

Thank you.

[Machelle Seibel, MD]

A.Your hormone levels seem to be in a good range.  Unless you got an ultrasound before starting the hormones, though, it wouldn

[sooz92]

Thank you very much for your response. I had forgotten to mention my doctor did suggest stopping the patch a few days as well -- perhaps every third month -- to see if we can get lining to shed.

I will try this approach after next progesterone-cycle. If no luck, then I will go for the biopsy. Although not anxious to do an "invasive procedure" right off the bat, your information helped me realize that it could be useful in determing whether too much estrogen or progesterone, in addition to any precancerous changes.

One final question: since I'm on sequential HRT, do I need to be careful about when in the cycle the biopsy is done in order to get accurate reading for hormone concentration?

Again, thank you. Your information has been very helpful!