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[Armadillo]

Hello

I really don't feel comfortable posting this publicly but have googled and read various threads on here and not found the answer or found conflicting info.... so well here goes

I am in peri-menopause - it is truly horrid and a very nasty effect on me.

I have had horrible side effects from progesterone patches etc we tried last year.  My GP has been talking to the hospital consultant for me as I havent been well enough to attend appointments so i cant ask my questions there. 

The plan was 3 months of estrogel and then 12 days of cyclogest pessary twice a day.  I have just reached the cyclogest phase and so far my body seems to be coping well with it. 

However I have questions and as I didn't see the Hospital Doctor (my GP and him chatted on phone a few times and then he left me a prescription to collect from hospital chemist).

1)  Can we make love whilst I am on the 12 days of cyclogest?  If so i'm not sure how to time this.  Due to my health it's quite rare I'm well enough, have the desire etc..so it would be nice not to exclude the option.

2) Is there a pattern as to when my period should start eg during the 12 days / after the 12 days?

3)  I had a really heavy period (flooding etc) towards the end of my 3 months estrogel and before starting the progesterone suppository... is this just my body settling in or should i be concerned?  I know i can get spotting on estrogel but didnt expect the erm..magnitude despite always aving heavy periods.

I am planning to see my GP soon... but it does happen that I'm not well enough so my husband goes for me and takes a list of questions... so it's not always as simple as speak to my GP.

Thank you for reading and any advice, links ideas.

[Hurdity]

Hi Armadillo

Don't worry - we talk about anything on here and no-one knows who we are in real life, fortunately!

Sorry to hear about your peri-menopausal symptoms and bleeding too.

The thing is - if you are peri-menopausal, it depends how often your natural periods were as to how your body responds to HRT. Let's say you were in late peri-menopause - eg a period every 4 months. Then - adding the gel will cause your womb lining to build up, and also some of your cycle will be pottering along in the background with your own oestrgoen - but not enough to produce ovulation.

So - in this scenario - if you suddenly ovulate (just before the 3 months is up) - you will produce your own progesterone and after this you will get the natural bleed/period - but it could be much heavier than usual because of the extra oestrogen gel you've been using (depending on the dose of course). Even under this scenario (but you won;t know if this is the case) it would be good to take the progesterone as all of the lining might not have come away if it had been thicker than normal due to the extar oestrogen.

If you didn't ovulate during the 3 months on oestrogel only but still got that heavy bleed - then the reason would most likely be due to oestrogen breakthrough bleeding caused by overthickening of the womb lining in the absence of progesterone. In this scenario it would be imperative to take the progesterone in order to shed the rest of the lining.

You should not get spotting on oestrogel at all - any spotting or bleeding on oestrogen only is abnormal bleeding (unless due to a natural period). You would probably know if it was a nartural period as you should have had other sugns - pms, tender boobs, headache etc prior to the bleed maybe?

Also that is really a VERY long cycle and not one that mnost eould recommend - although again if you are on a very low dose of oestrogen it could be OK. A 3 month cycle is the longest that is usually recommended (and that would usually be 12 weeks - with 10 weeks of oestrogen only followed by 2 weeks of progesterone (along with the oestrogen).  Looks like your cycle is almost 15 weeks - which would usually be far too long to go without a wuithdrawal bleed ( due to lining build-up). I'm actually very surprised by this prescrption and especially to start a new regime with this.

To answer your questions - well try - I used Cyclogest for almost 4 years when I first started hRT. I did 11 days x 400 mg (2 pessaries) per 28 days. I could never do it twice a day as I've had several children so daytime pessaries are a complete no-no for me - they would just not stay in place

1) I really can't remember about the intimacy during the Cyclo part and I know we were more active in that department back then!!! Quite honestly if you are in the mood just go for it but maybe stick another one in afterwards if the occasion arises just to be on the safe side - i think that's what I used to do. Also with my 400 mg I used to put one in each orifice - I will leave that to your imagination - but note they are pessaries/suppositories. Obviously used as pessaries they reach the destination better - as suppositories they (well more of it) are absorbed systemically but will get to the uterus eventually - just via a different route.

2) Your period should start soon after the first missed prog dose but ideally not before - but if you are peri or your lining has built up it could happen earlier. When you are post-meno the ideal scenario is as above. This time (I'm just on the bleed now) it started just hours after the first missed prog dose (I've changed patches recently) but in the past it was always a couple of days following.

3) I think I answered that question first above.

Incidentally I'm not sure why you have been prescribed Cyclogest as there is a licensed progesterone for use as part of HRT - Utrogestan - which can be used vaginally off-licence or orally (but probably you wouldn't want to take it like this).

I'm sorry to hear you are generally unwell - is this due to menopause? However I would really make sure you try to go to the doctor yoyurself to talk about all of this because s/he is bound to have questions and you will be better placed to answer and discuss the options. Just make an appointment and if you are well enough on the day - then go, if not, cancel andmake another one - or perhps make a couple of appointments in advance if you're able to do this - really so much better if you go? Failing that please do ask for a telephone consultation with yourt doc so that you speak to him/her rather than a proxy (husband) - however lovely and helpful he is!!

Also - not knowing your situation - but have you had other blood tests etc if you have other symptomns - thyroid and such like?

Anyway hope this helps and all the best - do tell us how you get on and hope you settle into a regime that works for you? Apologies if I've rambled on too much and for the typos - would take as long to check it all through!

Hurdity x

[Armadillo]

Hello Hurdity

Thank you so very much for that reply.

I have chronic illness and have been very poorly for too many years.  the peri-menopause cerainly isnt helping things though and was making me extra poorly... it took us a while to work it out..i just new it was a different poorly to all the years before... that probably doesnt make sense.

I have very weird reactions to medicines that I really shouldnt but my body tends to go into over drive so the oral tablets and patches wrecked me.  My peri-menopause symptoms were impossible to carry on with.. and the changes in my cycle were awful. 

loads of blood tests done and they are routinely checked.

My GP - it's actually a man as the 'menopause knowledgeable gp' dismissed me completely is amazing.  He's been working with me an dmy husband for 8 years... over various things and knows my history better than the others.. he is however really hard to get an appointment with.  We do usually have phone appointments but this was the only one available.. i will do my best to go..but my husband going is better than missing it and often my GP will phone as a follow up.

I've just checked the name its definitly cyclogest.... i tried ultragest as oral and was very poorly so they decided not to suggest that.  I have also been told to only insert vaginally as its less likely to cause me a reaction.

I waited until the bleed stopped still taking 1 pump of estrogel twice a day until starting the pessary as i thought the flow would effect absorption but as soon as i could i started the,

Again becuase of my other conditions they have started me on a long course of estrogel before joining in the progesterone (i still use both?) .. hence 12 weeks  then 12 days of both. 

I wondered if the earlier bleed was just things having gone so long.. but will mention to my GP.

It's good to know when to expect the next bleed... grim but i have to organise extra carer shifts for laundry and physical support as i am always much weaker and poorlier..so just having someone around to give my husband a break helps hugely... it also effects what i can eat (smell, taste change + nausea and energy).. daft all the things we have to plan


Anyway thank you so much... really appreciate the help.

I tried talking to mum but despite her saying she had a rough time she then said she has never met anyone who had a peri-menopause quite like mine... sigh

I am hoping this year to be well enough to see the hospital dr if necessary.. i think it was left as try it then my GP can report back...otherwise we were all discussing the drastic action of a hysterectomy... as i was so badly affected so often an dmy health isnt strong at best of times... i'd really like to avoid that