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[Mojo-swaptop]

I visited my GP yesterday and she has upped my HRT  from evorel sequi to evorel 75 with a separate norethisterone tablet, which is all great.
However the instructions on the norethisterone tablets are to take them on days 1 - 12 of a 28 day cycle.
 I'm not sure this is right as I currently use the combined patch of evorel sequi in the second half of the cycle (days 14 - 28) and previously when I was using oestrogel and utrogeston I took the utrogeston on days 15 - 26, so I would have thought I should take these new tablets in the second half of the cycle as well (on days 15 - 26 maybe).
I will send a query to the drs on Monday to clarify but in the meantime I would appreciate thoughts/advice on this from you lovely ladies.

Thank you
Mojo-swaptop x

[LittleClaire]

Yes definitely double check with the surgery as sequential HRT is meant to mimic your own cycle and the progesterone part is usually the second half of the cycle. They might have just printed the instructions wrong on the box, recently they had me taking 200mg progesterone tablets with an Evorel 100 patch, I got a phone call after 2 months saying it should be 300mg progesterone and they’d given wrong instructions! X

[bombsh3ll]

You don't need to get too hung up on what "cycle day" it is.

You just need to take it for the minimum number of days known to provide endometrial protection.

If you are still having a menstrual cycle yourself, it is generally suggested to time the progestin to coincide with your luteal phase so that the withdrawal bleed overlaps with menstruation.

However this can be very hit and miss because the 28 day menstrual cycle is rare outside of textbooks and more so in perimenopause.

Therefore if you are reasonably confident when your next period is due, you could start the progestin two weeks before this.

If you are no longer having regular periods, or find yourself losing track, simply using day 1-14 of the calendar month can work out better.

Where people often fall down with sequential HRT is getting so preoccupied with waiting for day whatever to start the progestin that they end up undertreated as weeks have gone by without reaching that day, or they stop it prematurely if they begin to bleed during the course.

[Mojo-swaptop]

Thank you both

Mojo-swaptop x

[Mojo-swaptop]

Unfortunately I didn't hear back from my GP about this so I've decided to take the norethisterone on days 15 - 26 to keep my cycle and schedule inline with how it is at the moment.

Mojo-swaptop x

[sheila99]

Just in case you have side effects from norethisterone you only actually need 1mg but they come in 5mg only. I cut them in half (with GP agreement).

[Mojo-swaptop]

Thank you Sheila, I didn't realise you only needed 1mg. It's a shame they only come in 5mg and not smaller doses.

Mojo-swaptop x

[Hurdity]

Just to clarify - as there is often confusion about days of cycle. Day 1 is supposed to be the start of the bleed on a regular cycle. However on Evorel sequi Day 1 would actually be the start of the oestrogen only patch even though the bleed may actually come later. On Utrogestan which is only taken normally for 12 days per month - as you say this is Days 15-26 and anticipating that the bleed will come a couple of days later.  So in that case the oestrogen only part of the cycle is longer and starts on Day 27!!!

Basically irrespective of when the bleed comes you just carry on like that but as bombshell says if your periods are infrequent then you can - say - start the norethisterone the same calendar date each month, otherwise just start the norethisterone as you propose - days 15-26, ie the start of the second part of the cycle. On a regular cycle it;s easier just to keep counting 4 weeks from the first day you started the progestogen and then start again...

Hurdity x

[Mojo-swaptop]

Hi Hurdity,
Thank you for your reply.
When I first started on HRT in May I was on oestrogel and utrogeston, and was told to start the gel on the first day of my period and count that as day one and then start the utrogeston on day 15 til day 26 and this created a 28 day cycle for me. My periods/bleed didn't always line up but I stuck with the 28 day cycle, which also worked well when I switched to evorel sequi in August, as that follows a 28 day pattern too.
So rightly or wrongly I started 28 day cycles for using HRT and so I don't mess with my cycle and schedule I plan to keep to the cycle I created.

Mojo-swaptop x

[Mojo-swaptop]

Hi again ,
I have a slightly related question, if I'm taking the 5mg tablets of norethisterone does anyone know if that would make my periods/withdrawal bleeds lighter or heavier?
My periods have always been quite heavy and painful (at least for the first day or two) so I'm wondering if they will get better or worse or stay the same.

Mojo-swaptop x

[bombsh3ll]

It may make them lighter however it is a much higher dose than needed for endometrial protection.

To me, if you are happy to take a progestin, it makes no sense not to take one that will suppress your own cycle, and take it continuously in a bleed free regime.

Examples include but are not limited to
Desogestrel 150mcg
Provera 5-10mg
Drospirenone 4mg (Slynd)

If you are under 50 and healthy a combined pill taken continuously can be a better option as that's your estrogen as well.

However the above examples can be combined with your estrogen of choice.

If you enjoy spending every 4th week bleeding then sequential HRT is fine, as long as you know it's optional.