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[Lizab]

I'm 39, on estrogen patch 50 with 10 days/month progesterone 200. My bleed always begins about day 9 of progesterone. I have been feeling well on this and having moderate periods. The only light periods I've ever had in my life were on Mirena years ago and my last few natural periods before starting hrt. I had stretched a few cycles this summer to about 7, 5 and 7 weeks by delaying progesterone.

My current cycle was 4 weeks, and I am on day 5 of my period. It doesn't show any sign of letting up and I'm worrying. Normally by day 5, since starting hrt, things are tapering off and often day 5 is the end. This seems heavier, not the flooding, clotting, leaking kind of heavy like I experienced before my periods began to skip, but a continually moderate bleed. I'm beginning to feel slightly run down like I felt during those anemic times. Also, I usually don't have any complaints beyond day 2 but my lower back is a bit achy.

Any ideas? I'm not sure what to make of this. Maybe I wasn't shedding sufficiently over the summer having too many estrogen only weeks? Should I be more careful about sticking to the 4 week cycle and hope it works out? My doctor had suggested 8-12 week cycles form the beginning, but I opted for monthly. He basically handed me the script and told me either way was fine, whatever I felt better with. Or, should I go back to a slightly longer cycle?

I'm confused because everything I read suggests more bleeding equals need for more progesterone, but I seemed to have lighter bleeding with more estrogen-only weeks.

I hope that all makes sense if anyone can offer advice. By the way, it's been about a year since it all went to shit for me and thanks to the compassion and advice on here I'm going strong! Thanks!

[Lizab]

Another possibility I just thought of is that my body is throwing some hormones in the mix too and this is simply a stupid long period for no reason at all. I just expected with a controlled amount of hormones going in, what comes out would be consistent too. Is it normal to get variation when on hrt?

[dangermouse]

My friends cycles went from 28 days to 35 on Studds regime (3 pumps a day) and now she's stopped its gradually reverted back to 28, so yes it does at least change the length for some.

[Lizab]

Thanks for replying, dangermouse! It's not really the length of overall cycle that concerns me, as apparently no matter how short or long I make the cycle, my period comes day 9 of progesterone. My concern is with the length and flow of my bleed. Does that vary even on cyclical hrt?

[dangermouse]

I would suspect it does but I never tried it for long enough to know.

It may be as with natural hormones that extra oestrogen makes a heavier bleed and extra progesterone makes a lighter one, so you may need more progesterone and/or less oestrogen.

HRT users would know more though.

[Hurdity]

Hi Lizab

Sorry I can't remember if you are post-menopausal or not? If you are not - and still peri then your bleeds will be very variable depending on your own cycle which will still be going on. If it regularly starts on Day 9 can't you change the days you take the progesterone so that you stop the prog two days before the bleed and see if it will sync with your own cycle?

Re heavier and lighter bleeds and more or less progesterone and oestrogen - it is not as simple as that! Oestrogen stimulates the womb lining to grow in a dose-dependent way. Progesterone changes the lining from "proliferative" to "secretory" in a dose-dependent way. If you then stop or reduce progesterone the lining comes away as a bleed. In addition if you take progesterone and oestrogen together for a longer time the progesterone prevents the oestrogen from causing the uterus lining to grow by interfering with the oestrogen receptors.

So a high dose of progesterone after high or lengthy doses of oestrogen - can cause a heavier bleed as it will act better on the lining that has built up and shed it better. Too little progesterone in the same circumstances could mean it won't all be shed. Extra progesterone taken over a longer period of time (and then stopped) as I said should reduce the bleed - but not if the lining has built up from oestrogen only.

I wouldn't worry about length or flow esp if peri. Are you taking the prog orally?  If so the variability in absorption can cause variation in how much lining is shed.

You are not on a high dose of oestrogen so I wouldn't worry at this point. Didn't you also just increase from 37.5 to 50 mcg? This would account for heavier flow. Also changing cycle length of HRT will have an effect too. When to get checked out is bleeding at the wrong time - ie between cycles.

Is that clear or confusing - hopefully the former?


Hurdity x

[Lizab]

I was still peri when I started hrt end of last year and my dose increase was in the spring. I had tried syncing the progesterone but regardless it starts day 9, if I begin progesterone early or if I delay it by weeks, doesn't seem to matter. What you say makes sense. Maybe my bleeds seemed lighter the last few months because I was doing a slightly longer cycle, so perhaps 10 days of progesterone relative to 6 weeks of estrogen wasn't shedding as thoroughly as 10 days to 4 weeks.  Regardless, I was overly worried. It has stopped today, and as for my achy lower back, my husband reminded me that I sticked firewood over the weekend, so that was probably the cause. Thanks for walking me through it. It can be so confusing at times.