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[privatepeanut]

I started on HRT back in January this year so 8/9 moths ago o a low dose with sequi Utrogestan as still having regular periods.  All good.  I increased HRT dose and have been on a standard full dose for the last couple of months and have had breakthrough bleeding on days 18 roughly for the past coupe of months. No expected period at the end of the cycle either. So am thinking this may well be due to my increasing HRT dose.
I can't get an appt at my GP or call with nurse for a few weeks so my question is, do I:

- Carry on with my sequi Utrogestan 200mg days 15-27? (dificult because I don't know what 'day 1' is anymore!)
- Swith to a conti regime of 100mg every day?

Thanks

[sheila99]

It's likely your own cycle is out of step with the hrt one. It can get difficult when you're own cycle becomes irregular. Medical advice is to carry on with hrt cycle regardless but I found it better to realign the hrt to my own cycle. My own cycle was always stronger than the hrt one.
  They say you can try a conti to regime after a year but if you still have a cycle of your own it's likely you'll get breakthrough bleeding (and then there's all the panic about post menopausal bleeding when in reality it's just your own period).

[bombsh3ll]

When you say a standard full dose, what dose of estradiol do you mean?

If you have increased the estrogen without increasing the progesterone, it may be that your progesterone is insufficient to oppose the new dose.

However in perimenopause bleeding can become erratic with or without hormone therapy, and regardless of whether it is cyclical or continuous.

Either option is reasonable until you can get an appointment as both provide the same amount of progesterone overall.

It depends whether you want seesawing progesterone levels and the aggro of constantly chasing a moving target with the cyclical regime, or the lower maintenance and hormonally stable continuous regime, accepting that you MIGHT get some unpredictable bleeding (or you might get none).