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[secret.sherlock]

Hi all,

I'm in need of advice. I've been dealing with perimenopause symptoms for 9 years and I'm worn out.

Went on HRT a couple of years ago, Oestrogel and Utrogestan for 12 days every cycle. Always had a withdrawal bleed at the end of the 12 days until recently. For the past couple of months, it has been very light. The last cycle there was nothing. Then 2 weeks later, I started getting cramping, tenderness, etc and now I've had a period. Thing is, this is the day I'm meant to start the 12 day Utrogestan. So do I take it tonight or start counting 14 days from now and then take it?

GP said I could think about going continuous or wait till my next birthday (I'm 49). If my own hormones are reducing further, I might as well start now. But how do I do that? Start taking one every day now?

Can't get an appointment with the GP, can't talk to her on the phone. I don't know what do.

[sheila99]

The old version of conti might be useful where you take it for 25 days out of 28. This allows a bleed if there's been a build up. Be aware that if you go on conti too soon you're likely to have breakthrough bleeding which may lead to unnecessary intrusive investigations for 'unexplained bleeding'.

[secret.sherlock]

Thanks, I appreciate the advice.

What you said is what the GP said too at my last appointment, wait till my next birthday next year by which time I'll have been on HRT for 4 years.

I'm happy to stay on conti but what do I do now? Do I restart the clock and wait 14 days before starting the Utrogestan?

[sheila99]

Medical advice is to continue with hrt cycle regardless of when/if you bleed. If you don't have a strong cycle of your own you may as well, if you do imo it's better to change the hrt cycle to fit on with your own.

[bombsh3ll]

Personally I am not a fan of using sequential hormone therapy in perimenopause because trying to synchronize it with an ongoing natural menstrual cycle is like playing pin the tail on the donkey. Every month. It's a mug's game.

The bottom line is you can do whatever you want with the progesterone as long as you take the prescribed amount in a given time period, or at least don't deviate from it by much.

If you are prescribed 24 or 28 capsules per month, you can take 2 daily for 12 or 14 days, or one daily every day, or like Sheila said one for 25 out of 28 days.

If you don't mind all the bleeding it is absolutely fine as long as you are taking the minimum amount to protect your endometrium.

What I would not do is wait for day whatever of your cycle to either start it or stop it. This tends to result in undertreatment in perimenopause because either periods become closer together so you end up with say far more day 1's and day 2's than day 14-28's. Or in late peri cycles become infrequent and you wait weeks for another "day 1".

So if someone is really wedded to sequential micronised progesterone in peri it is often better to use day 1 of each calendar month and just accept the chaotic bleeding than tie yourself in knots trying to predict it.

[Seasidegirl]

Can I jump on this rather than adding a similar thread?

I've just moved to continuous in an attempt to even out my thyroid flares which are very cycle based.   I'm 55 and was still have regular periods 18 months ago when I started HRT.     I've had very regular bleeds5 days after stopping sequential progesterone ever since. 

I'm at 3 weeks vaginal progesterone and would usually expect a bleed around tomorrow/ next day. 

I know we are all different but I don't know what to expect?  I've had no breakthrough bleeding this month or previously but I henge no idea how strong my natural cycle is?

Any thoughts?

[bombsh3ll]

That's just it, trying to predict when bleeding will occur in late perimenopause is like trying to time the stock market.

If your bleed pattern has been regular on sequential up until now this suggests you are probably just having withdrawal bleeds, which can be induced in 80 year olds by giving them sequential.

This is actually how combined HRT was designed, and it was intended for postmenopausal women only back in the 70s so of course the artificial withdrawal bleeding on it was regular.

After it became apparent that whilst this prevented endometrial cancer Vs using estrogen alone, it had high discontinuation rates as women didn't want their periods back - shame nobody had asked in the product development phase.

So continuous combined was developed, but then nobody knew what to do with all these fixed dose sequential products that had cost a fortune to develop and market, plus perimenopause was starting to be recognised, so someone thought I know, let's give the sequential to all these perimenopausal women, assuming that because it induced regular bleeds postmenopausally, it would do so in peri.

This was not based on any science it was an economic solution to salvage an unpopular product, and as a look round this site will tell you, chaotic and unpredictable bleeding with so much angst over what day to start progesterone is rife.