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[Marshabookworm]

I've decided to pluck up the courage and start HRT. I'm on day 4 of my period. It came 8 days early this month and is very light, but I assume it counts?

I'm on gel and progesterone tablets. Do I start the progesterone now along with the gel? Or do I use the gel and start the tablets in 2 weeks? I'm very confused!

[bombsh3ll]

Trying to fit sequential hormone therapy in with your own cycle during perimenopause is notoriously difficult because it is based on the myth of the 28 day cycle, and you are constantly chasing a moving target.

Therefore it is worth being aware that this is not your only option, and that there are multiple bleed free alternatives including continuous COCP, the IUS or a continuous oral progestin that can make for a better quality of life during perimenopause.

However if you are keen on cyclical micronised progesterone, the standard advice is to take estrogen alone from day 1 (first day of bleeding) to day 14, and then add the progesterone for the next 2 weeks. 

Another option is to ignore your own cycle and just take the progesterone for the first 14 days of the calendar month.

Whatever you find suits, it is important to make sure you are taking the prescribed amount of progesterone every month.

Some women end up waiting until day whatever, and it never comes, or keep starting from day 1 if they bleed and never getting to the progesterone phase, and this starts to cause problems with underuse of the progesterone.

[Marshabookworm]

So if I'm not bothered about sticking to a cycle I could just take the progesterone from today for 14 days and, in theory, have another bleed at the end of those 14 days?

I didn't get any choice in what I went on, the GP just gave them to me!

[bombsh3ll]

Yes, it doesn't matter medically when you take the progesterone, as long as you take it for 14 days out of 28, or per calendar month if doing it that way.

In theory the belief is that if you take the progesterone during the second half of your own cycle i.e. the luteal phase, and then stop it, any withdrawal bleeding *should* coincide with natural menstruation.

However this idea was thought up by male gynaecologists several decades ago, and is often not very successful in clinical practice, as what usually happens is very chaotic bleeding and more days spent bleeding overall than untreated women.   

[sheila99]

As you have a cycle of your own it would be much better to fit the hrt around your own cycle. If they get out of step you can end up with 2 bleeds a month. So start oestrogen now and take utro for 12 days, days 15-26 then you should bleed again around day 1. I bled according to my own cycle which was always stronger than the hrt one, sometimes with an additional hrt induced bleed if they got out of step.