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[rachie]

I'm taking oestrogel and then 12 days of utrogestan and have been for 3 years.
When I was on the pill, I would take norethisterone to postpone a period by a few days to a week.
My periods are regular, usually to the day.
I just wondered if I can still do this as I'm now on HRT or has experience. I don't want to mess regularly with my meds, as they seem to be working for me at the mo.

[bombsh3ll]

Yes you can still use norethisterone to postpone menstruation whilst taking cyclical HRT.

It would also be a good idea to extend the micronised progesterone that cycle until you stop the norethisterone, rather than precipitate withdrawal bleeding when you don't want it.

However it is not clear if you are also currently taking a progestin only contraceptive pill?

If you are on desogestrel you can simply take two tablets daily i.e. 150mcg - indefinitely if you want to - and in most cases this eradicates bleeding.

Taking 150mcg desogestrel continuously is supported by the BMS for use as endometrial protection, so if you were to use this long term you would not need to take micronised progesterone as well, and would likely remain bleed free.

[rachie]

Hi, thank you for the reply.
No, I'm not taking any contraceptive pills and I'm on the oestrogel pump.

[Bandango42]

I'm interested in this as I always seem to get my period when I'm on holiday.

How does this work? Do you take norethisterone instead of the 12 days of progesterone? Or both together at the same time? Or another way? Sorry if I'm being dense!

[bombsh3ll]

You would take it in exactly the same way as if you weren't on hormone therapy.

Start at least 3 days before anticipated bleeding and continue until you are happy to bleed.

Norethisterone is a potent progestin and the pharmacological dose used to postpone menstruation is huge compared to the physiological dose of micronised progesterone you are taking.

In theory it should more than suffice to take the norethisterone alone for that cycle, however because all the data comes from menstrual aged women producing luteal phase progesterone, it is not possible to guarantee you wouldn't bleed.

Therefore if you are happy with this method I would recommend taking the progesterone from when you would normally start it, and continue it until you are happy to bleed. This SHOULD give you a bleed free holiday.

[Bandango42]

Great, thanks bombsh3ll that's really helpful 🙂

[bombsh3ll]

Glad to help.

On the other hand if you are not afraid of synthetic progestins and don't like bleeding, why not just take combined birth control continuously like I do and not bleed at all?

[Bandango42]

I would love to do that but my GP won't prescribe me any birth control pill due to a history of migraines. I tried to get it when I met my partner 6 years ago but was told they cannot prescribe the pill to anyone with migraines 😔

[Bandango42]

You would take it in exactly the same way as if you weren't on hormone therapy.

Start at least 3 days before anticipated bleeding and continue until you are happy to bleed.

Norethisterone is a potent progestin and the pharmacological dose used to postpone menstruation is huge compared to the physiological dose of micronised progesterone you are taking.

In theory it should more than suffice to take the norethisterone alone for that cycle, however because all the data comes from menstrual aged women producing luteal phase progesterone, it is not possible to guarantee you wouldn't bleed.

Therefore if you are happy with this method I would recommend taking the progesterone from when you would normally start it, and continue it until you are happy to bleed. This SHOULD give you a bleed free holiday.

Do I take the norethisterone and progesterone element of hrt together? Or forget the progesterone and just take the norethisterone 3 days before I would usually bleed?

[bombsh3ll]

I would take the progesterone as normal - basically you are just pretending this is coming from your ovaries as it would after ovulation in a natural cycle - and start the norethisterone at least 3 days before you would expect to bleed.

In order to not precipitate withdrawal bleeding however, I would extend the progesterone until the same time as you stop the norethisterone.

Norethisterone alone with no progesterone *probably* would suffice, however if it is important enough to warrant taking norethisterone, it isn't worth being a guinea pig.

That's a shame about the migraines, but are you aware that 2*cerazette pills daily can be used alongside your transdermal estrogen as the progestin?

This provides effective menstrual suppression and is essentially a build-your-own CHC with transdermal estrogen rather than oral ethinylestradiol.