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[Goosieloosie]

Hi, I've been post menopause for 10 years (I'm now 63) and doing the utrogestan/evorel patches regime with a bleed (cycle) for 9yrs and always manage to tweak the bleed part around avoiding holidays away from home/special occasions etc but this year is a busy year for us and we are away 3 weeks, home 3 weeks and away for another 3 weeks and I'm finding it difficult to fit that around my cycles. I do not want to be using utrogestan while I'm away nor do I want to bleed while I'm away. The closest I can manage is to do 7 weekly cycles for about 3 cycle's (due to the Christmas holidays etc this is the way it has worked out) . My question is: will this be safe to do? I have done 7 week cycles in the past but usually only the odd time, mostly I try to stick with 5 weekly cycles. My Dr isn't much help as she thinks I should be on a continuous regime, I don't want to do this for lots of reasons but neither do I want to change to a complete different regime/HRT just before we go away/have a busy few months ahead. Thank you for any help or advice if anyone has an idea of what else I can do??

[bombsh3ll]

Yes this is safe so long as over the longer term you are taking enough to protect the endometrium.

Maybe you could do a few 4 weeks cycles when you are back home to thin out any buildup.

I would advise anyone taking an individualised progesterone regime that is less than the NHS supports to get a private pelvic scan every year or so for endometrial safety. This can prevent you running into problems.

Also the dose of estrogen makes a difference as well, for example if you are only on a tiny dose like 25mcg doing this is extremely safe, but if you were on say 100mcg you wouldn't want to underdose progesterone for any length of time as the endometrial stimulation is greater.

[Goosieloosie]

Yes this is safe so long as over the longer term you are taking enough to protect the endometrium.

Maybe you could do a few 4 weeks cycles when you are back home to thin out any buildup.

I would advise anyone taking an individualised progesterone regime that is less than the NHS supports to get a private pelvic scan every year or so for endometrial safety. This can prevent you running into problems.

Also the dose of estrogen makes a difference as well, for example if you are only on a tiny dose like 25mcg doing this is extremely safe, but if you were on say 100mcg you wouldn't want to underdose progesterone for any length of time as the endometrial stimulation is greater.

Thank you, this is reassuring and yes I did actually consider doing the 4 weekly regime once back a few times for any build up.
I'm on a 50 Evorel patch so I guess the 7veerks would be ok a couple of times in a row?

[bombsh3ll]

I'm sure that will be fine.

After all if you were still having a menstrual cycle you wouldn't be phoning an ambulance if you went 7 weeks once or twice!

[MrsMitch]

Hi Goosie, I asked about the bleed part of the cycle elsewhere but didn't get any answers. So as you're on the same regime for a long time, do you mind if I ask here?!
I'm wondering if when the Utrogestan is stopped (I was told to stop for 3 days each cycle) when do you bleed and do you get a proper period like bleed?
I've just done it for the first time, started to spot on the day I restarted Utrogestan and spotted for about 4 days. Will that be it each month? Because I've been advised to do this to protect my womb, I can't see spotting would achieve anything. So I'm wondering if you would mind sharing your experience on that side of things, please. Thank you.

[Goosieloosie]

Hi Goosie, I asked about the bleed part of the cycle elsewhere but didn't get any answers. So as you're on the same regime for a long time, do you mind if I ask here?!
I'm wondering if when the Utrogestan is stopped (I was told to stop for 3 days each cycle) when do you bleed and do you get a proper period like bleed?
I've just done it for the first time, started to spot on the day I restarted Utrogestan and spotted for about 4 days. Will that be it each month? Because I've been advised to do this to protect my womb, I can't see spotting would achieve anything. So I'm wondering if you would mind sharing your experience on that side of things, please. Thank you.

Hi there, not at all I'm happy to help if I can! But I do think you must be on the utrogestan daily for 27/28 days? Stopping for 3 days and starting daily again? This isn't the regime I'm on. The 3 day break in this regime is to give your body a chance to bleed if it needs to and I'm assuming as you just have a few days of spotting that it doesn't need to have a heavier bleed as the build up hasn't been that much due to taking utrogestan daily. The way I do my regime is I take it vaginally for 12 days then stop and approx 3 days later I will have a proper period like bleed lasting approx 4 days. Then I start the whole cycle again starting with day 1 of utrogestan in 5 week cycles... so I count 5 weeks from day 1 of utrogestan, stop after 12 days, bleed 3 days later for 4 days. Currently I'm wanting to stretch it to 7 week cycles as we are going away quite a bit this year and I want it to fit around that. I do not want to take utrogestan daily because I use vaginally and this would not be practical for me. I hope I have been of some help.

[bombsh3ll]

It's taking the progesterone that protects the lining of the womb.

Stopping it to spot or bleed for a few days is a personal choice and not medically necessary at all.

It can be taken every night if you prefer.

[MrsMitch]

Thank you very much, Goosie  I didn't want to pinch your thread!
I had seen the menopause specialist recently and spoke about the bleeding I was getting, again, after increasing my oestrogel.  We discussed the other progesterone available,  from a list Bombsh3ll gave me, to stop the bleeding but she told me because I've had bleeding before, a hysteroscopy and haven't had children,  putting me at higher risk of endometrial cancer, it would be sensible to have a monthly scheduled bleed. Whilst I don't particularly want that for years to come, it's far better than cancer.
So I'm trying to understand what to expect re the bleeding, really. I suppose I just assumed it'd be like a period every month, but after your comments,  perhaps not! Thank you again.

[bombsh3ll]

All the evidence shows that endometrial protection is superior when the progestogen is taken continuously.

The BMS have material regarding this on their website.

This is the reason all guidelines encourage women to switch to continuous progestogen once postmenopausal, rather than remaining on cyclical long term.

Your specialist is wrong.

Cyclical is typically prescribed in perimenopause in the belief that this leads to more regular bleeding, whereas some irregular bleeding might occur on continuous.

Ironically, whilst producing regular bleeding (where this works - it often simply results in more chaos) can reduce fear of, and investigations for, endometrial cancer, it is actually doing a less good job of protecting the endometrium than continuous progestogen.

[MrsMitch]

Your specialist is wrong.

No surprise there, then! I don't know where to go from here now tbh. I talked through all the options of different types of progesterone with her that you kindly suggested in a previous thread because, by the time I saw her, I'd been bleeding for over a month after an increase (back to dose I'd been on a few months previously) in oestrogel and was fed up with it. She just gave me reasons why each different one had various risks and as Utrogestan was the safest, but least effective in preventing bleeding, I should just have a monthly bleed.
I really don't know what to do now. Yes I'd love to never bleed again. No I'm not scared of any future bleeding or investigations having been through that before. My husband says to see someone privately but am I going to get any better advice? The specialist I saw said she's a 'big fan' of Dr Currie and has worked with her in the past. I perhaps naively thought she might actually know what she was doing.
Sorry again Goosie, this is your thread, not mine.