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[Hurdity]

Hi lilbebel

I reasponded to your pm so I won't reply again on here - I hadn't realised you had asked a  similar question on a post, as I answered straight from your message.

If you have any further Qs about my regime - do ask on here and then others can read.

All the best

Hurdity x

[lilbebel]

Hi lilbebel

I reasponded to your pm so I won't reply again on here - I hadn't realised you had asked a  similar question on a post, as I answered straight from your message.

If you have any further Qs about my regime - do ask on here and then others can read.

All the best

Hurdity x

Thank you very much. Will do. 

[lilbebel]

Hello everyone,

I thought I would give an update of my first full month doing cyclical HRT for post-menopause.

I started by not taking any progesterone for 16 days. During this time, I noticed a significant improvement in my energy levels and mental acuity. Also, the severity of depression lessened significantly though I still suffered with anxiety.
After 16 days, I started my 12 days of 200 mg of vaginally administered Utrogestan. I documented what I observed every day. I was okay for the first few days but after about the sixth or seventh day, my fatigue and lethargy became severe, depression set in again, emotional liability, crying, and general mental unwellness.

I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.

I wanted to thank Hurdity for her valuable insight and advice. Hurdity, if you’re around, I have a question for you. You replied to another member in February 2022 and you said:

“To decide on whether it is OK to go to long cycle you should be guided by how your bleeds are on your current regime. eg when I was on 28 days cycle in my late 50's I got no withdrawal bleed using the licensed dose of progesterone, so I knew that I could extend the cycle without problems.”

My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only. I’m just wondering what your thoughts are on this.  I’m not of course asking for medical advice. Just clarity on how you gauged what was right for your body in terms of the length of non-progesterone time.

So, I hope this helps others. I will check in every now and then with updates. I think I am just one of these women whose body needs to bleed regularly while on HRT. No matter what I do, I bleed. Everything has been checked out and I’m perfectly healthy.

[sheila99]

I know you asked Hurdity but after 40 years of a (natural) 6 week cycle my lining was thin so I continued with it in peri as soon as I changed from patches to gel/utro and am continuing with it now. I'm inclined to think that as long as you have a decent bleed it should be OK but the only way to know for sure is to scan after a few months, everything else is guesswork.

[Hurdity]

“I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.”

Yes this is exactly how I felt as a menstruating woman. We now know there are several aspects to this – there is the progesterone withdrawal – which can sometimes lead to pms type symptoms, irritability, headache etc that many women got while fertile, and experience when coming off the progesterone phase of the HRT. Then there is the effect of oestrogen. During our natural menstrual cycle oestrogen levels fall just after ovulation, and then rise again falling to a low level for the last few days before the period (coinciding also with progesterone withdrawal). After the bleed starts oestrogen rises rapidly again over the next couple of weeks – but of course with HRT it stays constant.

I used to feel exactly as you did when menstruating – tense and horrible, irritable etc during those last few days and almost a day after the bleed started I could feel all of that melting away – just like the flipping of a switch – I could almost feel the sensation of the oestrogen rising - surging through my blood stream, even though I might have period pain and a bleed, and my mood became light and buoyant again.

Since being post-menopausal it isn’t quite like that because oestrogen does not rise - but I do feel the head fog clearing once the progesterone has gone (which takes a few days) and I feel bright and normal again.

“My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only.”

I can’t remember all the details of your story but if you have been checked out then presumably fibroids, polyps or other abnormalities have been ruled out.

Since the bleed is cyclical then it is likely to do with the hormone regime. You said you used to bleed too much on lower doses of Utrogestan. I presume you had a scan and the thickness was measured? If the endometrium is at all thickened or thicker than it should ideally be, then it still has to shed so sometimes this can be an explanation for an early bleed. In any case even the guidelines if I recall correctly, state that the withdrawal bleed occurs towards the end of the progesterone phase or just after – so you’re within the bounds of normality.

As to the question of lengthening the cycle – well that does depend what thickness your womb lining is, so if it is thickened – it could take several months longer to thin down so in the meantime extending the cycle probably wouldn’t be advisable, if you want to avoid bleeding problems or more thickening maybe.

Another factor to think about is how long and heavy the bleed is – if long and heavy – then there is clearly more lining to shed, but if it is short and light despite starting at the end of the progesterone phase – then that might just be how your body works and extending the cycle may mean the bleeds still start early.  Ideally it would be good to have a scan just as the bleed is finishing when the lining is at its thinnest but if not, see what happens over the next couple of months – depending on the bleed.

In short – if the bleed is long and heavy then probably not a good idea to extend the cycle yet. If short and light then why not give it a go and try 21 days of oestrogen followed by 12 days of Utrogestan giving you just under a 5 week cycle?

Any concerns about anything including your bleeds, of course consult your doctor and ideally discuss with or at least inform your GP or specialist about what you’re doing.

Hope this helps and all the best

Hurdity x

[lilbebel]

I know you asked Hurdity but after 40 years of a (natural) 6 week cycle my lining was thin so I continued with it in peri as soon as I changed from patches to gel/utro and am continuing with it now. I'm inclined to think that as long as you have a decent bleed it should be OK but the only way to know for sure is to scan after a few months, everything else is guesswork.

Thank you very much. All input is gratefully received. Thank you for sharing your experience.
Sounds odd to say, but I’m happy with my bleed so far. It’s like a proper period as opposed to spotting. I feel like my uterus is getting a good old clean out. Of course, I hear your point about imaging being the only scientific way to measure the endometrial thickness.

[lilbebel]

“I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.”

Yes this is exactly how I felt as a menstruating woman. We now know there are several aspects to this – there is the progesterone withdrawal – which can sometimes lead to pms type symptoms, irritability, headache etc that many women got while fertile, and experience when coming off the progesterone phase of the HRT. Then there is the effect of oestrogen. During our natural menstrual cycle oestrogen levels fall just after ovulation, and then rise again falling to a low level for the last few days before the period (coinciding also with progesterone withdrawal). After the bleed starts oestrogen rises rapidly again over the next couple of weeks – but of course with HRT it stays constant.

I used to feel exactly as you did when menstruating – tense and horrible, irritable etc during those last few days and almost a day after the bleed started I could feel all of that melting away – just like the flipping of a switch – I could almost feel the sensation of the oestrogen rising - surging through my blood stream, even though I might have period pain and a bleed, and my mood became light and buoyant again.

Since being post-menopausal it isn’t quite like that because oestrogen does not rise - but I do feel the head fog clearing once the progesterone has gone (which takes a few days) and I feel bright and normal again.

“My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only.”

I can’t remember all the details of your story but if you have been checked out then presumably fibroids, polyps or other abnormalities have been ruled out.

Since the bleed is cyclical then it is likely to do with the hormone regime. You said you used to bleed too much on lower doses of Utrogestan. I presume you had a scan and the thickness was measured? If the endometrium is at all thickened or thicker than it should ideally be, then it still has to shed so sometimes this can be an explanation for an early bleed. In any case even the guidelines if I recall correctly, state that the withdrawal bleed occurs towards the end of the progesterone phase or just after – so you’re within the bounds of normality.

As to the question of lengthening the cycle – well that does depend what thickness your womb lining is, so if it is thickened – it could take several months longer to thin down so in the meantime extending the cycle probably wouldn’t be advisable, if you want to avoid bleeding problems or more thickening maybe.

Another factor to think about is how long and heavy the bleed is – if long and heavy – then there is clearly more lining to shed, but if it is short and light despite starting at the end of the progesterone phase – then that might just be how your body works and extending the cycle may mean the bleeds still start early.  Ideally it would be good to have a scan just as the bleed is finishing when the lining is at its thinnest but if not, see what happens over the next couple of months – depending on the bleed.

In short – if the bleed is long and heavy then probably not a good idea to extend the cycle yet. If short and light then why not give it a go and try 21 days of oestrogen followed by 12 days of Utrogestan giving you just under a 5 week cycle?

Any concerns about anything including your bleeds, of course consult your doctor and ideally discuss with or at least inform your GP or specialist about what you’re doing.

Hope this helps and all the best

Hurdity x

Thank you again for such a thoughtful and helpful response. There’s so much in there of value. That’s interesting to read that you had the same experience as a menstruating woman in terms of feeling like a switch was being flipped inside you once you started to bleed.

I had a scan fairly recently and got the all clear for anything irregular. The doctor concluded that my breakthrough bleeding was to do with the HRT and my body trying to adjust. When I took progesterone 100mg continuously, I would have light/moderate breakthrough bleeding every two to three weeks. It just seems that that’s how my body wants to handle this.

As I mentioned to Sheila, my period now (on day two without any progesterone) is like one of my regular pre-menopausal periods. It was typically quite heavy on the first 1 - 2 days so I will see how long it lasts and if it lightens soon. Depending on that, I’ll decide whether to extend to a 21 day oestrogen only cycle next month or hold off with the shorter one for now. I feel like a mad scientist. I have to remind myself to keep emotion out of it and try to stick to facts and data. I’m hoping that I eventually find the right sequence length for me and of course, I understand that that will change as my body does.

Never in a million years though I would be buying tampons and leading once in menopause. There are always new things to learn.

Thank you for your patience and support in explaining everything to me. 🙏🏻