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[Castaspella]

Hello! My cycles used to be quite long (35 days ish.) I started HRT about three months ago and they’ve significantly shortened (started bleeding at 20 days last month.) I’m now technically on CD24 and only started taking utrogestan for 12 days yesterday. I know that I will start to bleed in a couple of days and then still be taking utrogestan for the whole of my period.

How can I get this all to sync up? Or do i just keep going and see where I am at the magical 6 months of taking HRT mark? Thank you!

I should say: 44, on two pumps gel and 200mg utrogestan

[CLKD]

 

[Castaspella]

Yes definitely a bit overwhelming!

Ah thanks for the welcome :-)

[GraceM]

How are you taking your utrogestan at the moment - are you taking it for 12 days within a 28 day cycle or are you counting from day 1 of your period and then taking it 16 days later? 

[sheila99]

Medical advice is to stick to the 28 day utro cycle regardless but I found it better to alter the hrt cycle to fit in with own. My own cycle was always stronger.

[joziel]

The first thing you need to rule out, is whether the cause of your early bleeding is related to too little estrogen.

2 pumps is really not much estrogen. If you don't take enough estrogen, it won't be able to sustain the lining of your uterus - which will break down more frequently and shed. The type of bleeding which is usually caused by this is quite light.

So I would first and foremost do a blood test on day 3 of your cycle to check your E levels. (This is hopefully when your own E is low, so you will see what you're getting from the HRT.) You want your E to be at least around 450pmol. Some people are okay with lower, but the bare bare bare minimum is 270pmol and that is pretty low....

Assuming your E is over 450pmol (by the way, it is very unlikely that with 2 pumps of gel, you are over 450pmol...), then you need to work out the utrogestan as follows:

You need at least 11 days of utrogestan per cycle to protect yourself. If you bleed consistently around day 20, then you need to count back from there to determine when to start it. Which takes you to day 10 as your start date. So you would start utrogestan on day 10.

Ta da.

But I reckon you are probably not on enough estrogen because very few women are....

[bombsh3ll]

What you are trying to do is a mug's game in my opinion, and a far better option in perimenopause that is often overlooked is taking the combined oral contraceptive pill (or patch or Nuvaring) continuously.

This shuts down your own cycle, adds a stable daily dose back, gets rid of your periods as long as you skip the hormone free interval, and often contains a much more therapeutic dose of estrogen than standard menopause hormone therapy.

I take Zoely which is a combined pill with body identical estradiol and a really kind progestin.

No bleeding, no hormonal ups and downs and a much better quality of life than my friends who are on nothing or trying to sync sequential progesterone with a perimenopausal menstrual cycle, which is like playing pin the tail on the donkey.

[joziel]

Not sure I can agree with that bomb, I've been tailoring things as described for over 2 years now and it works great.

[Castaspella]

How are you taking your utrogestan at the moment - are you taking it for 12 days within a 28 day cycle or are you counting from day 1 of your period and then taking it 16 days later?

12 days within a 28 day cycle. When I began HRT I started the whole shebang on day 1 of my period, so began estrogen on day 1 and started utrogestan 2 weeks later. I initially did 14 days but have reduced to 12 from last cycle

[Castaspella]

The first thing you need to rule out, is whether the cause of your early bleeding is related to too little estrogen.

2 pumps is really not much estrogen. If you don't take enough estrogen, it won't be able to sustain the lining of your uterus - which will break down more frequently and shed. The type of bleeding which is usually caused by this is quite light.

So I would first and foremost do a blood test on day 3 of your cycle to check your E levels. (This is hopefully when your own E is low, so you will see what you're getting from the HRT.) You want your E to be at least around 450pmol. Some people are okay with lower, but the bare bare bare minimum is 270pmol and that is pretty low....

Assuming your E is over 450pmol (by the way, it is very unlikely that with 2 pumps of gel, you are over 450pmol...), then you need to work out the utrogestan as follows:

You need at least 11 days of utrogestan per cycle to protect yourself. If you bleed consistently around day 20, then you need to count back from there to determine when to start it. Which takes you to day 10 as your start date. So you would start utrogestan on day 10.

Ta da.

But I reckon you are probably not on enough estrogen because very few women are....

This is so helpful, thank you!

[GraceM]

How are you taking your utrogestan at the moment - are you taking it for 12 days within a 28 day cycle or are you counting from day 1 of your period and then taking it 16 days later?

12 days within a 28 day cycle. When I began HRT I started the whole shebang on day 1 of my period, so began estrogen on day 1 and started utrogestan 2 weeks later. I initially did 14 days but have reduced to 12 from last cycle

That's good, as long as you are getting the prescribed dose within a 28 day cycle.  I guess you are best to continue as you are and hope that things settle,

[bombsh3ll]

The problem with using sequential hormone therapy like this in perimenopause is that the progesterone is not strong enough to shut down your own cycle, and because the mythical 28 day cycle is not most people's experience, at least not every time, you are constantly chasing a moving target.

Many women on this regime end up with chaotic bleeding, and spend more days bleeding than if they were on no treatment at all.

[joziel]

Not really bomb, the reason periods become so chaotic is because hormones are all over the place. If you stabilise the hormones (with high enough doses that they actually replicate physiological doses) then you can easily override a cycle. See Dr Jerelyn Prior's approach to treating endometriosis with body identical progesterone... Very high doses which stop normal cycles.

[bombsh3ll]

I do believe that there is a dose of natural progesterone that can achieve menstrual suppression - this happens in pregnancy although other factors are also involved there.

However most women using micronised progesterone with their HRT will have difficulty obtaining such doses and tolerability also becomes an issue the more the dose increases.

Ultimately it doesn't really matter whether the sequential HRT is aggravating menstrual irregularity or whether this is occurring endogenously and the treatment is simply not strong enough to combat it, the net effect is the same.

I won't experience any of that on the pill though, and I know it's not for everyone but I do feel it should be more widely known about that alternative, bleed free options exist as sequential MHT is often presented as the only option in peri.

I do plan to use progesterone (or progestin if not tolerated) sequentially myself when I move onto MHT but I will only be doing that postmenopausally when I no longer need menstrual suppression.