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[Ticaleur]

Evening folks! I have a query that I can’t seem to find an answer for elsewhere. I have now been on Estrogel and Utrogestan (continuous) for 6 weeks and had a couple of weeks of bleeding as is expected. Is this classed as a period? Do I need to count 12 months from this date or the date of my last normal period? Thanks and Merry Christmas x

[Nas]

Bleeding at the start of a new HRT regime is usual.
Your last natural period would have been at least 12 months ago, so this is break through bleeding I expect, as opposed to a period.

 

[Ticaleur]

It wasn’t 12 months ago, I asked to go on continuous and the gp agreed, it was in May so I don’t know whether to start counting again or whether to count from the HRT bleed.

[Taz2]

If you are on HRT you will have no way of knowing when your last natural period is so there is no point in counting at the moment. Continuous HRT can give annoying bleeding for the first six months or even continuous bleeding (as in my case). I'm not sure how old you are?

Taz x

[Ticaleur]

Hi Taz, I’m 49. I was on pop for quite a few years but came off during pandemic as I was too busy to go to gps for review and couldn’t get appt so I hadn’t had a period on that for years. Over the months off this I had a couple of periods the last being in May. Noticeable perimenopause symptoms, looking back for probably a couple of years at least, didn’t know that’s what it was at the time. Been on HRT since start of November and it made a huge difference very quickly. Had a two week very heavy bleed after 2 weeks and then it’s stopped and nothing since that. I guess I just play it by ear then. Thanks Taz
Clare x

[Taz2]

Has your GP arranged for you to have regular scans as you are young to be on continuous progesterone?

Taz x

[Ticaleur]

No, I have a review after 3 months but I was on pop with no problems, she didn’t see an issue with it.

[Taz2]

I wasnt allowed to change from sequi to continuous until aged 54 which the menopause clinic said was the earliest I could swap. That was quite a few years ago now so things might have changed. It's different to being on the POP of course as that wasn't adding in oestrogen. Gets complicated 

Taz x 

[Ticaleur]

I’m kind of anxious about this now. What would they be scanning for? The way the gp said it was some women like to have regular bleeds so would have monthly breaks. I said I’d rather not as no bleeds on pop didn’t want to start and no risk of pregnancy. Usual guidance was 12 months after last period but just guidance. My sis is 2 years younger than me, had womb ablation for endometriosis, early menopause, is on exact same continuous protocol. This is working well for me so far but I suffer from health anxiety and I’m now worried I’m doing something risky. My gp has left the practice now, I don’t have anyone to go to.

[Ticaleur]

https://www.nhs.uk/conditions/hormone-replacement-therapy-hrt/types/

The nhs website doesn’t mention age just says that sequi can be useful for maintaining regular periods so you know when they naturally come to an end. And continuous usually recommended after 12 months no period. Maybe I’ll discuss with whoever I see for 3 month review? The gp didn’t say any of this stuff she gave me the options and was okay with my preference.

[Ticaleur]

Just concerned you’ve mentioned scans like something bad could be happening…

[Nas]

Think you have two choices with HRT, either sequi or continuous.
Sequi is definitely the correct option if you are still having periods, albeit erratic because as  you rightly mention, this will give you a reliable bleed each month and you will know when your periods naturally phase out.

Continuous is only suitable if you have been period free for at LEAST 12 months.

Bleeding on ANY new HRT regime within the first 6 months is pretty usual. After six months, it needs to be investigated. This is usually via a scan/biopsy. Mainly they are checking for the thickening of the womb lining.

I’m wondering whether you would be better taking the utrogestan sequentially rather than continuously, as you haven’t been period free for 12 months yet?

Also be aware, some HRT regimes can just make you bleed unfortunately, even when periods are over and done with for years! Sometimes there is a cause, e.g polyp, cyst, fibroids etc. Sometimes there is no direct cause.

For some women, utrogestan doesn’t keep the womb lining thin ( hence bleeding) and an alternative progesterone is required instead.

I wouldn’t worry unduly. If the bleeding persists or becomes problematic, then it will be time to chat to the GP I expect.

[sheila99]

As you're not meno you should be on a sequi regime. If you want to be bleed free you can use a mirena which will keep the lining thin. Using a conti regime when you're not meno is likely to lead to unexpected bleeding and/or build up of lining (which should be avoided because of the increased risk of cancer).
  Age doesn't have much to do with it as you can be meno at 30 or peri at 60, the important thing is if you're meno or not.