u/lrondberg

The American College of OBGYN has just updated their 2018 guidelines on post menopause bleeding. The 2018 guidelines said that a normal transvaginal ultrasound was enough of an investigation. The new guideline recommends endometrial biopsy even when the ultrasound shows a thin lining in most cases.

There is no differentiation between bleeding in someone on HRT or not unlike the British Menopause Society which treats the workup differently when HRT is involved.

Now if they would only make a guideline on pain management for this barbaric procedure.

https://journals.lww.com/greenjournal/fulltext/9900/updated\_guidance\_regarding\_the\_role\_of.1505.aspx?

Figured would share since I know people are often nervous changing doses (I was very)
I was fine on .05 mg patch, progesterone and vaginal estrogen for a solid 2 years and then, some warm flashes cropped up here and there. Nothing like the full on hot flashes prior to HRT but the thought of those happening again are terrifying. I was also not sleeping as well as I had been and feeling more tired so my doctor upped me to .075. I have also been diagnosed with Osteopenia so figured the increased estrogen may be better. It has been two full months now.

Pros: No more "warm flashes". Energy level seems a little bit better and orgasms seem stronger. No change in libido which isn't what it used to be.

Cons: Sleep is actually worse dammit. Some minor weight gain. I did not gain an ounce the whole time on the lower estrogen but my weight slowly ticked up immediately after starting the higher dose. I weigh frequently (old bad habit) and had been very steady if not losing a little here and there the entire time on the lower patch. I also have a vaginal discharge that is reminiscent of puberty when we started getting the milky white discharge that looked like smeared cream cheese on your underwear. My doctor said this is normal with the increased estrogen and it means the vagina is sufficiently estrogenized but I find it kind of annoying and gross.

I will stick with it now. The better bone benefit is appealing, I am at high risk of Osteoporosis from several factors and am not currently lifting weights (i know i know...) and really struggle with adequate dietary calcium but overall the increase didn't really move the needle in a more positive way.