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[rferdi]

This is my first month on cyclical HRT (still in peri), yesterday was day 8 of 200mg Utrogestan and at night I noticed some light bleeding had started. Today is still light but ongoing, if this is my natural period it has come 4 days before it was due (usually on day 25).

I did estradiol for days 1 to 14 and then on that day 14 I started the 200mg Utrogestan, which I'm supposed to take till day 28.

Now I'm a bit confused, should I continue taking the Utrogestan anyway till day 28, regardless of the bleeding, or should I consider this bleeding as day 1 and so stop the progesterone and do the estradiol only for the next 14 days? 

I know this has been asked before and I've been searching the forum for an answer, but have found differing opinions, so I thought I'd make my own post and ask again.

[Delso]

I understand your confusion, I was about to ask advice for something very similar so will monitor the responses. I'm in peri and I've been on my regime of HRT for 8 months now,  and this month my bleed came 5 days before the end of utrogestan phase. 

I carried on taking the utro (from advice I saw from similar post before, due to shredding lining). I think I'll then start utro again from day 15 of this bleed to try and sync my cycle again. 

Hopefully someone more knowledgeable will come to offer you the guidance you need , especially as you are in your 1st month🙏

[bombsh3ll]

If you have already started the progesterone I'd finish the course.

If you start counting from day 1 over again every time you bleed, you could potentially end up with inadequate progesterone for endometrial protection as you would keep doing day 1-14 over and over and never completing 2 weeks of progesterone.

[joziel]

I'm pretty experienced with all this timing P malarkey.

I'd stop the P and go with the period your body wants to have. Not having enough P for one month is totally fine. You need to get back on track for future months.

The first day of blood is Day 1. Count forwards how many days YOU think YOUR body will take before the next period. The standard advice of taking P from day 14-26 is assuming periods every 26-28 days. If your period is coming sooner than that (mine is currently every 23 days), then you need to work out when to start the P to enable you to get the full number of days in, next month.

If your period usually comes on day 25, that is 3 days earlier than the standard woman they are assuming everyone is. So you would need to start your P on day 11 of your cycle to get the full amount in before your next period. If that isn't quite early enough, bring the start forwards another day the next cycle.

This is the stuff they don't teach us and for some reason we have to teach each other. If you don't do this, you end up with bleeding all over the place randomly. In fact I wonder if some of the random bleeding issues people have on utrogestan are because they are NOT doing this...

[rferdi]

Thanks for your reply Delso, I hope this thread helps you figure it out as well 

Thanks for both your replies bombs3ell and joziel, they both make sense even though so different.

Right now I'd say I feel a bit more inclined to try and go with my body's period frequency, which seems more natural, although it's also true that this month's not been the usual 25 days but only 21. So say next month my body decides it's another 21 day cycle, but I'd started Utrogestan on day 11 (because I was expecting a 25 day cycle as usual), then that'd be another month where I wouldn't have taken progesterone for enough days.

What I mean is, if now in peri it's when our periods begin to be a bit unpredictable and aren't always around the same duration like they used to be, this makes it difficult to try and time progesterone correctly, doesn't it.

[K45]

Hi rferdi

Thanks for posting this as it seems to be a common issue on cyclical hrt. I am 6 months in and have found bleeding can start anything from day 7 on utrogestan to 5 days after finishing the course! The best advice I had was to just keep taking it regardless as otherwise you would be constantly chasing a moving target as in perimenopause your cycle can vary significantly. I wish GPs would cover this aspect when they prescribe HRT as it is apparent that many of us don't bleed at the normal expected time on utrogestan.

[rferdi]

Thank you K45, I'd be curious to know how many days do you take the Utrogestan, is it for 12 days or 14-15? As this seems to be yet another thing that varies, depending on the doctor's preference apparently.

[sheila99]

The licensed dose is 12 days. Medical advice is that you continue the hrt cycle regardless but I suspect this advice was given by someone who hasn't had to live through it. If you don't have a strong cycle of your own this makes sense but my cycle always overrode the hrt one so I took utro according to my own cycle. If you can tell when you ovulate or if, like me, you get sore boobs with progesterone it's easy to sync the hrt cycle with your own. If not you need a crystal ball!

[K45]

Thank you K45, I'd be curious to know how many days do you take the Utrogestan, is it for 12 days or 14-15? As this seems to be yet another thing that varies, depending on the doctor's preference apparently.

Hi, GP prescribed 14 days so originally day 15-28 of my cycle. I know many others just do 12 days as I believe 14 days is just so it's easier to remember.

[joziel]

"What I mean is, if now in peri it's when our periods begin to be a bit unpredictable and aren't always around the same duration like they used to be, this makes it difficult to try and time progesterone correctly, doesn't it."

rferdi, at that point you would probably be best switching to continuous but taking a 3-5 day break to allow a bleed. That enables anything that has built up to shed on schedule so no doctors get worried about unscheduled or unpredictable bleeding.

If a period comes slightly early one month, that's fine. I mean, 2 days less of utrogestan isn't going to be harmful. And if that begins to happen every month, with a shorter cycle, you just move forwards when you start it.

As I said... it's the people who keep taking it continuously who end up with erratic bleeding. When their own body wants to shed (have a proper period) probably due to a drop in estrogen from ovaries, it can't shed properly because we're giving it the opposite message with the utrogestan. So it doesn't fully shed and then you get breakthrough bleeding and spotting at other times of the month - and then you don't know where you are...

[bombsh3ll]

Just to add that nobody has to bleed at all unless they want to - there are multiple period free options if you get sick of trying to second guess your cycle.

Sometimes people just get handed the old two weeks on, two weeks off progesterone and made to feel like it's that or nothing.

I suspect that it produces the intended regular bleeding pattern far less often than those who write the guidelines believe it does.

[joziel]

There are not really multiple period-free options if you still have a strong cycle and you don't want to use synthetic progestins or the Mirena coil...

[rferdi]

"What I mean is, if now in peri it's when our periods begin to be a bit unpredictable and aren't always around the same duration like they used to be, this makes it difficult to try and time progesterone correctly, doesn't it."

rferdi, at that point you would probably be best switching to continuous but taking a 3-5 day break to allow a bleed. That enables anything that has built up to shed on schedule so no doctors get worried about unscheduled or unpredictable bleeding.

If a period comes slightly early one month, that's fine. I mean, 2 days less of utrogestan isn't going to be harmful. And if that begins to happen every month, with a shorter cycle, you just move forwards when you start it.

As I said... it's the people who keep taking it continuously who end up with erratic bleeding. When their own body wants to shed (have a proper period) probably due to a drop in estrogen from ovaries, it can't shed properly because we're giving it the opposite message with the utrogestan. So it doesn't fully shed and then you get breakthrough bleeding and spotting at other times of the month - and then you don't know where you are...

For some reason I never saw this reply, I just read it and it's been very helpful as I'm again having the very same issue and was searching for answers, so thank you!