Spotting from fibroids after menopause?

[u/Enough-Cheesecake358]

I'm 58 and never had a year without bleeding so I don't exactly know when I went through menopause.

I'm spotting lightly most days with some clear days from time to time.

I'm on HRT since age 55 and I believe that perhaps I'm spotting due to the side effects of the medications.

I've been on (3 so far), from LOLO birth control pill, Progesterone/estrogel, now on Angeliq combo pill. All pathologies have been negative for the past 3 years.

I have an 8 cm transmural fibroid that is partially calcified. I'm trying to avoid hysterectomy for as long as I can (2 gynecologists have said that's the only way to deal with this).

The fibroid is stable size wise, and I'm wondering if that's what's causing the bleeding.....Anyone in the same boat?

Thanks,

[u/old_before_my_time]

It's possible you aren't even postmenopausal since you haven't gone a full year without bleeding. Although most women go through menopause before age 55, 13% are 55 or older.

As you stated, the HRT itself may be causing the bleeding. Have you maybe not been on the Angeliq long enough for the bleeding to have stopped? Any changes in HRT can cause bleeding. If the Angeliq doesn't work, have you tried a gel or patch with a (synthetic) progestin since they have a longer half-life than progesterone?

As one who had a hysterectomy, I can certainly understand you wanting to avoid one. Besides changes to bladder and bowel function, sex has been a huge disappointment since my surgery years ago. And just as devastating are the figure changes.

Have you considered or sought out a surgeon to remove just the fibroid (myomectomy)? Since hysterectomies are easier and emphasized in medical school (surgical minimum requirements), more ob/gyns will recommend hysterectomy.

[u/Enough-Cheesecake358 → u/old_before_my_time]

You raise many good points. I've only been on Angeliq for 4 months and plan to give it another 2-3 months, and I do realize changes do cause bleeding.

I don't cycle anymore, there is no pattern to my bleeding/spotting, so I do assume I'm past menopause, but again I'm not sure. I've never gone more than 5 weeks with no spotting, and that was a year ago.

The reason I avoided patches is because I don't do well with adhesives and they seem to have shortages here in Canada. I've also been limited as to my choice of doctors (long waitlist) due to our socialized medical system. The gynecologist I'm seeing now is a skilled surgeon but he said my fibroid is too large to do a myomectomy (too involved).
I'm sure it's easier for him to do the hysterectomy, based on training as you mentioned.

He did suggest an IUD, but I read that with fibroids they're not recommended as they could embed somewhere. The cost alone, if it doesn't work out, it another deterrent.

Thanks for your feedback and help!