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Author Topic: Should i continue with the hrt? Advice please  (Read 3816 times)

galare73

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Re: Should i continue with the hrt? Advice please
« Reply #15 on: February 01, 2025, 07:55:24 PM »

Thanks both.
These are the dates of my periods 6 months prior to starting the hrt:
08/01
22/01
16/02
15/03
04/04
28/04
19/05
01/07 started HRT
Fairly regular but random in places. Normal to light bleeding and very little pain. My symptoms sort of happened very quickly. I feel i was ok one day and the next started having the hot flushes and night sweats.
I’m going to phone the health centre on Monday and ask for an appt with the menopause nurse.
I’m wondering whether to stop both the oest and the prog until i’ve seen the nurse? Or just stop the prog as suggested?  I have a wedding in 3 weeks, i’m a bridesmaid (old one!) and would really like all this to not interfere with the day.  >:(
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bombsh3ll

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Re: Should i continue with the hrt? Advice please
« Reply #16 on: February 01, 2025, 10:52:11 PM »

Those are some pretty short cycles even before you started HRT. You had two in January and two in April so it's no wonder timing micronised progesterone is proving difficult.

I know you have tried oral synthetic progestins but what about an IUS?

It won't help you for the wedding in 3 weeks but it might be the best bet longer term if you can't tolerate a suppressive progestin.

If you plan to see the nurse soon, you could just take the estrogen in the meantime. You are on a very low dose and hyperplasia only starts to become a concern after several months on a standard dose of unopposed estrogen.

If you stop the estrogen you may experience a return of the vasomotor symptoms.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #17 on: February 02, 2025, 07:52:00 AM »

I will stop the progesterone until i get to see the nurse. I’m hoping she will amend the dose to the latter half of the month as you have all recommended. If that settles my periods then great, if not, then i will look into an ius. It’s not something i’ve been too keen on using really.
Hopefully just tweaking the prog will sort the issues.
Thanks  :)
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #18 on: February 02, 2025, 02:40:11 PM »

galare, you don't need a nurse to approve switching P to the second half of the month. I'm afraid you're going to need to be a bit more proactive and not rely on healthcare practitioners to know everything about HRT.

For example, from the NHS website: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/utrogestan-micronised-progesterone/how-and-when-to-take-utrogestan/

"The usual dose of Utrogestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle."

Since your cycles were so short, again, you will need to adjust when you take utrogestan. You will not make it (for example) to day 26 if you have a 21 day cycle. You will end up completely out of sync.

You need to take 11-12 days of utrogestan per cycle, so if many of your cycles are 21 days, that means beginning your utrogestan around day 11 - so that you get the full amount in each month.

It's unlikely the nurse will say this, because they just don't consider basic things like cycle variability or are under the misapprehension that utrogestan can override it.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #19 on: February 02, 2025, 03:16:39 PM »

Hi
Unfortunately this is all so new to me that i have very little knowledge or experience of hrt. All i know is that what i’ve tried so far has been pretty rubbish but it doesn't help that i’ve been taking the prog at the wrong time. I will definitely be quoting the info off the nhs website at my appt.
I have no idea what my normal cycle is anymore with the prog causing me to have 2 periods a month. I’m hoping that taking the prog on the correct days then i will just have the 1 period.
And then once i am into the new routine i can then develop a proper cycle again.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #20 on: February 07, 2025, 10:44:16 AM »

Just a quick update for those who have helped me.
I saw the nurse. Tried to get me to have a coil fitted again. She has suggested a take 1 prog instead of 2 for 25 days and see if that helps.
Don't feel the appt was very helpful really but we’ll see how it goes.
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #21 on: February 07, 2025, 01:32:25 PM »

That's not going to help at all. If you already have bleeding issues, you need more P and you need it during the half of the month you are supposed to be taking it.

You have a choice to either follow the advice of ill-informed, uneducated healthcare providers OR to seek out another healthcare provider with better knowledge OR to take the advice here.

I'm not sure why you're continuing to follow advice you have no faith in....
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #22 on: February 07, 2025, 01:52:17 PM »

I don't agree with what the nurse has said today and was quite surprised she suggested it.
I should be taking the prog days 16-25 according to the nhs website but i don't know when that is as i haven't had a normal cycle for a long time.
I am just at the end of my last bleed so what do you suggest?
I have had to increase my gel to 2 pumps this week too as my joints really hurt and i have itchy skin.
I’m really struggling to get my head around all this.  :(
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #23 on: February 07, 2025, 03:00:21 PM »

galare, it's not complicated once you have it figured out.

If you just finished your last bleed, count the first day of that as day 1.

If your cycles are often short at 21-23 days, then begin P around day 11 (at 200mg, not 100mg).

Stop taking it on day 21. OR stop taking it when you bleed, if that is from day 18-19 onwards and next cycle begin it a couple of days earlier (day 9) to get the full dose in.

Let us know how it goes.

2 pumps of gel is fine but really just the starter dose, equivalent to 50mcg patch. You can take up to 4 pumps easily via your GP surgery.
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #24 on: February 07, 2025, 04:38:50 PM »

Ok, i will do that thanks. Because i’ve been having 2 bleeds a month my cycle has only really been approx 15 days. Should i still calculate as you suggested using a 21 day cycle?
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joziel

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Re: Should i continue with the hrt? Advice please
« Reply #25 on: February 07, 2025, 07:57:44 PM »

Yes, for at least one cycle - in case taking the P all over the place is the reason in itself that your cycles have been like this.

If you bleed on day 15, then just stop to allow that bleed for 3-5 days re-start day 9.

If you are only on 1.5 pumps of gel and you are bleeding every 2 weeks, it is very likely that you are bleeding because you need MORE E. Taking too little E can cause bleeding as well - it's not all about taking too much. 1.5 pumps of gel is nothing, and 2 isn't much either - but stick to that for this cycle. As you increase E you might find you go longer and get better cycles back....

If you can't get the longer cycles back, then you can just stop to allow a bleed (whenever it happens) for 3-5 days and then start P again (at 100mg, as that is basically continuous P, but just with a break to bleed).
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #26 on: February 07, 2025, 08:24:41 PM »

Ok great, thanks for all your help  :)
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flo69

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Re: Should i continue with the hrt? Advice please
« Reply #27 on: February 08, 2025, 01:28:12 PM »

Hi Galare73, I just read over your comments and a few others and I just want to say it's not unusual for your own cycle to override the HRT cycle, mine did it right up until my 55th birthday, my body has been behaving like the text book model of a post menopausal woman since my birthday, but I'm not putting bets on not ever having another bleed, the last one was only ten weeks back!

Joziel has said some suggestions and I don't mean to contradict her because she knows her stuff, it might be the same thing I'm saying, not sure, I ramble too much and read too little sometimes.

When I tried Utrogestan I bled regardless of when the utrogestan was taken, the GP simply didn't believe I was taking it properly, but I was taking it daily on the dot, so it was unhelpful to be told to take it on time and my problem would go away!

When I keep count of the quantity lost in my menstrual cup, I get to over 200ml. Meanwhile the NHS website says 30ml is an average period, OMG, imagine losing 30ml as the doctor must have imagined, they call 80ml heavy!

So when sequential Utrogestan meant having TWO periods a month (Or PostMeno bleeding as it must be called) I was not impressed at all. That's getting close to losing a pint of blood every month and I don't even weigh enough to be allowed to donate blood, so that was a problem. I had to go onto continuous HRT (tibolone) and just have periods when I had them, about once a month, that's far better than twice a month.

My advice is to continue with HRT but tweak it to suit your own body. That does mean going a little astray on what the doctor's instructions are, but they give instructions knowing very little about HRT medicines or what they do to women, so it's not the same as going against a doctor in a field where they've been trained or done research, this is a field where most are untrained, even in general practice it's not compulsory, or so I've read and the research is very sketchy indeed.
It costs a bit to get a doctor trained in menopause to work with you as an individual, but if you really are planning on quitting HRT, getting a private doctor and continuing HRT would be a better move imo, if you can afford it. You can usually get the prescriptions on the NHS after they write to your GP, but your GP can prescribe more variety if a specialist advises them to.

For now, I'd time taking the utrogestan according to your bleeds, because you already tried the other direction where you timed your bleeds to the pharmaceuticals except it didn't work, like so many of us have found.

On day one of a bleed, count that as day one, no matter where you are since the bleed before.
After starting day one as your first bleeding day, wait until you reach day 12 of that cycle, then start taking Utrogestan, usually 200mg daily.
What can happen then;
You bleed before the end of the Utrogestan days, in this case stop utrogestan and count it as day one again.
You don't bleed before the end of the utrogestan, you might be starting to align the two cycles, when you bleed is day one again, or day 29 becomes day one again if you don't bleed that cycle.
You start bleeding every 28 days on the dot, then take it as directed by the instructions on the pack. (it happens to some women, evidently)
You don't bleed ever again, yay, probably too much to hope for yet, but that would mean you could go onto continuous HRT, that includes Tibolone, which is my favourite by a country mile.

How are things for you at the moment?
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #28 on: February 09, 2025, 05:30:17 PM »

Hi flo69
Thanks for all of your advice.
My last period started on 31/01 so i am going to count that as day 1. I will start the prog on 11/02 for 10 days (unless i start bleeding again).
Hopefully i can get into some sort of pattern going forward.
Since increasing the gel it has helped my symptoms so will continue on 2 pumps.
I have received great help on here from members, compared to the seemingly lack of knowledge from the health professionals, so will continue following/asking on here rather than going back to the drs!
 :)
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galare73

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Re: Should i continue with the hrt? Advice please
« Reply #29 on: April 12, 2025, 08:03:37 AM »

Hi
I thought i would give a little update for those who gave me advice now that it’s been a couple of months.
Last month i changed my routine to what was advised. I started bleeding 2 days before finishing the prog so stopped it and had the bleed. It was fine, a short lightish bleed.
I started the prog again on day 11 but took it for an extra 2 days because of stopping it 2 days early last month.
My prog ended 5 days ago. I haven't had a bleed yet. I have been expecting one but no sign so far. I have gone upto 3 pumps of gel too.
I wonder whether this is correct or not? I have always has a bleed after finishing the prog. This is the frustrating thing with hrt, you dont know when your periods have naturally stopped!
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