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Author Topic: Should i continue with the hrt? Advice please  (Read 3394 times)

galare73

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Should i continue with the hrt? Advice please
« on: January 31, 2025, 08:36:24 AM »

Hi. I haven't posted for a while as i’ve been trying to figure out what to do.
I’m in peri-menopause and currently take 2 utrogestan (vaginally) on days 1-12 and also 1 pump of oestrogel daily. I stopped the hrt for a few weeks as i was bleeding regularly so wanted a break. I was on evoral 50 patches at the time.
I it started again as i was experiencing symptoms but went onto the gel instead so that i could control the dose easier.
My first period started the day before the prog was due and it was the most awful period. Very painful and heavy, huge clots too. Unusual for me. I had to use the prog during this which wasn't very easy. After i had finished the prog i had a small bleed.
So today, i have started another period. My prog is due to start tomorrow.
Is this normal? I was always led to believe that you have a period after the prog, not before it starts. I really don't want to have 2 periods a month. I am considering stopping the hrt for good as my periods weren't an issue before i started it.
Is anyone in or has been in the same situation? Can anyone give me some advice please?
Thanks
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CLKD

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Re: Should i continue with the hrt? Advice please
« Reply #1 on: January 31, 2025, 09:32:37 AM »

It may be that your own hormones are kicking in.

Why did U consider HRT, which symptom would you like to ease first? U could put the product names into the search box; individually; to read appropriate threads; make notes.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #2 on: January 31, 2025, 09:38:18 AM »

Thanks for replying.
I originally started hrt last year as i was having hot flushes, night sweats, trouble sleeping, frequent weeing, low mood… the usual symptoms. All of those symptoms went away after about 3 weeks, which was great.
I don't really have those symptoms anymore apart from mood changes but i do have a lot of joint pain.
It’s the frequent periods that bother me. They should be getting less frequent, not more!  :(
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CLKD

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Re: Should i continue with the hrt? Advice please
« Reply #3 on: January 31, 2025, 09:40:35 AM »

How were your moods during your menstruating years?  Mine were cyclical!

Joint pain can be due to loss of oestrogen as muscles may become lax.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #4 on: January 31, 2025, 09:49:57 AM »

My moods were ok really. In fact, my periods never really bothered me too much at all.
I’m reluctant to increase the oestrogen gel too as that will cause more bleeding?
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bombsh3ll

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Re: Should i continue with the hrt? Advice please
« Reply #5 on: January 31, 2025, 10:57:03 AM »

In my opinion the combined pill is a far better way to manage (by that I mean completely bypass) perimenopause, rather than messing around with cyclical progesterone.

Taking cyclical micronised progesterone when you're still having periods is rather like trying to time the stock market, and seldom produces a regular 28 day cycle as many clinicians (usually men, or women remote from menopause) believe it does.

The combined pill on the other hand, if taken continuously ie active pills every day, can keep you bleed free and hormonally stable. 

I take Zoely and don't deal with any of the hormonal issues and crime scene periods that others my age are having.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #6 on: January 31, 2025, 11:40:27 AM »

Thanks for that, it’s very interesting.
I haven't been offered the combined pill. However i do have migraines with an aura so would that be an issue?
I will do some research.  :)
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bombsh3ll

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Re: Should i continue with the hrt? Advice please
« Reply #7 on: January 31, 2025, 11:52:02 AM »

Ok so migraines with aura contraindicate the combined pill.

However you could take the progestin component as a standalone using either desogestrel 150mcg per day (2* cerazette pills) or drospirenone (slynd).

Either of these should shut you down if taken daily. A transdermal estrogen should then be added eg patches or gel.

This achieves the same ends as a combined pill but without the very small increase in stroke risk that migraineurs face.
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #8 on: January 31, 2025, 09:30:46 PM »

galare, before trying other meds, let's try to get you sorted with what you're on - because you haven't been on it for long right?

The main issue seems to be how to sync the P to your own cycles. Why are you taking the P on days 1-12? That's the opposite of what you should be doing. Progesterone is made during the luteal phase of the cycle, so if you are taking it for half the month you should be taking it from day 16-26.

If you bleed, stop taking it and count that as day 1. When you get to day 16, take it again. If you get bleeding (not light spotting, but what seems to be a period and goes on for more than one day or gets heavier), stop taking it and count that as day 1 again. It may take a few cycles to get in sync.

If you have just started a bleed, don't begin the P tomorrow - let yourself have a bleed and shed the lining. Work with your body, not against it. Your body naturally produces P during the second half of the cycle. Give it to your body then.

It doesn't have to be exact, but you do have to roughly take about the same amount as you'd take from day 16-26 which is 11 days of it. So if your cycle is 21 days (say), you would count back 11 days from 21 and start there, day 11. That way you get your full amount of P in during one cycle.
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Minicat

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Re: Should i continue with the hrt? Advice please
« Reply #9 on: January 31, 2025, 09:48:17 PM »

Sounds like your body's really rebelling against the current HRT.  Two periods a month is rough.  I'd definitely talk to your doctor, they might need to adjust your dosage or even the type of HRT.  Stopping completely might seem appealing, but it's worth exploring other options first to manage those symptoms.






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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #10 on: February 01, 2025, 07:28:21 AM »

Thankyou bombsh3ll and Minicat for your advice.
Joziel - Thanks. The bleeding that started yesterday is a full on period with pain, fairly heavy too.
I started the hrt 1st July last year. It has been tweaked and different types used to try and get a satisfactory outcome but nothing really works 100%. I should start the prog tonight but as you say, it doesn't sound correct. Thats just the routine my gp first put me on and it hasn't changed.
I think i will have to make another appointment to try and get all this resolved because i don't feel happy with it. I’m having more periods now than i had before starting to take the hrt! I’m quite tempted to ask for a scan just to check all is ok in there too.
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #11 on: February 01, 2025, 11:49:56 AM »

galare, I would suggest you research elsewhere besides what your GP has recommended  ;D because sadly the fact is that if you put your faith in one doctor, you will end up in a mess with HRT - statistically. Unless you get lucky with your one doctor and do your research. But the standard of knowledge is really poor generally amongst doctors.

Ie - it is well documented *everywhere* that sequential HRT should be taken (P) days 16-26 or the second half of the cycle. If your doctor has recommended anything else, they are assuming (wrongly) that body identical P is somehow strong enough to override your natural cycle and the only important thing is that you take it for half the cycle (not which half) and frankly that's crap.

If your doctor is making assumptions like that, you can be sure they don't know enough to help complex cases like yours. You will either be taken off it or put on something with a synthetic progestin in it, before really trying to sync the utrogestan with your cycle.

Sadly it behooves women to take the initiative themselves in all this, do their own research, be their own doctors, and sift through all the information available and the experience of others (which really I've personally found far more useful than anything else).
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #12 on: February 01, 2025, 12:26:56 PM »

Thanks for that. There is a ‘menopause nurse’ at my health centre who i think i will arrange an appointment with. My sister has seen her and she said she is great. Would be interesting to see if i get different advice.
I tried the synthetic prog and i had awful side effects with it so went onto the micronised instead. Because i take it vaginally i have no issues with it at all.
Hopefully i can get somewhere with this!
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Hurdity

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Re: Should i continue with the hrt? Advice please
« Reply #13 on: February 01, 2025, 05:38:19 PM »

Hi galare73

You say you're in peri-menopause and outlined your symptoms prior to starting HRT  last July, but can you tell us what your periods were doing prior to starting HRT? This would give an indication of roughly where in menopause you are and perhaps how much of your natural cycle is happening?

Some women begin to get symptoms before peri-menopause starts, so it seems like peri-menopause - but in reality is the late reproductive phase when ovaries are still functioning regularly albeit starting to go awry. In this phase periods do get closer together before they get further a part and start to be skipped when anovulatory cycles start to occur. This phase is the hardest to treat and is when the combined pill can be a good option.

I'm not sure why the combined pills designed for peri-menopause QLAIRA and ZOELY (that bombshell is taking) are contra-indicated for migraines with aura.

For example QLAIRA contains estradiol and dienogest, neither of which are contra-indicated on their own for migraines with aura. I suspect that the contra-indication listed in the product information "Combined hormonal contraceptives (CHCs) should not be used in the following conditions...... " which includes "History of migraine with focal neurological symptoms" is a blanket contra-indication initially applied to the very strong synthetic contraceptive pills containing synthetic oestrogens, rather than from trials using Qlaira or Zoely. As such they may be permitted by menopause specialists - at a menopause clinic.

However that doesn't apply to you as you have bad side effects with synthetic prog!

But - as above if you are not yet properly in peri or in very early peri then it is tricky and maybe if your tolerance improves, perhaps taking it for a longer period of time in the cycle may help - so for 21 days per cycle rather than 12-14? This may reduce the amount of bleeding though perhaps not the occurrence, though if you are only using 1 pump of gel that is a low dose so you woud not expect much of a withdrawal bleed due to that alone especially if using the licensed dose of progesterone....

As joziel I would reset your cycle and the first day of the main heavy bleed count as Day 1 and then take it from there and see if it synchronises.

Hurdity x
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bombsh3ll

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Re: Should i continue with the hrt? Advice please
« Reply #14 on: February 01, 2025, 06:11:07 PM »

I think a lot of the confusion about when to take cyclical or non- continuous progesterone comes from the instructions to take it from day X to day X.

Cyclical HRT is based around the myth of the 28 day menstrual cycle - which isn't even most premenopausal women as 28 days is the average not the majority.

Normal cycles can range from about 21-35 days, and that's before you factor in perimenopause, which can make things less predictable.

In basic terms, instead of thinking of day 1, day 14 etc, you start it 2 weeks before you expect to get your next period. This *should* have you stopping it about the same time your period comes.
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