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[Delso]

Hi, so it's just clocked with me that I've been taking utrogestan wrong for coming up to 2 years.
Have Lenzetto spray everyday and Utro for 14 days of cycle.  Problem is I've been counting day 1 as my bleed each month even though my bleed has come before the end of the utro end. I have been completing 14 days of utro from the 15th day from my bleed. My ovulation seems in sync from my first bleed of the cycle which is why I thought I was doing the right thing.
I'm now having more hormone fluctuation symptoms this month and concerned with the pattern I've got myself into and realise now I should have just been counting day 1 from when my utro stage ends then taking the next pack in 28 days and not linking it up from 15th day of a bleed? I'm now worried what I have in store by unchanging this pattern I've created.
I will speak to Dr's but came on here so not to feel alone in it as no one else i know is on hrt. 

[CLKD]

How do U feel overall?   What were your periods up to prior to starting HRT?  Sometimes it's hard to gauge anyway when 1 should begin.

I wouldn't worry too much unless I felt ill, when I would have been to the GP sooner. 

[Delso]

Thanks for replying

My periods would range between 23 - 28 day cycle before hrt and they do the same now. So I've assumed that my bleed is my period bleed and taken my utro from that day for 14 days but obviously that has meant ve not taking a set 28 days on a regular basis and utro start has ranged from day 23 - 28. If that makes sense!

[bombsh3ll]

You are unlikely to have caused endometrial hyperplasia in just two years on a weak estrogen with some progesterone use.

Problems like this arise from the myth of the 28 day menstrual cycle, characterised by male gynaecologists over a hundred years ago.

Prescribers often believe, and give women the impression that systemic HRT will synchronize perfectly with their own cycle in perimenopause.

This often doesn't happen, especially with micronised progesterone as it is not strong enough to shut down your own cycle, but is strong enough to induce artificial withdrawal bleeds, which don't always overlap with your own.

This frequently results in women on this regime experiencing chaotic bleeding with more days spent bleeding overall than untreated women.

Unintentional undertreatment with the progestogen is common as women try to wait until day whatever to start it, instead of just using the calendar month or two weeks on, two off, or stopping it prematurely if they start to bleed.

There are multiple bleed free options that you could discuss with your GP.

If you are really wedded to body identical progesterone and don't mind repeated episodes of vaginal bleeding, you could try a 25/28 or 25/30 regime, stopping the progesterone for a few days when you get your natural period (but not more frequently than once a month or again you risk undertreatment).

The dose for continuous progesterone or continuous with a break to bleed as above, is usually half the dose used in sequential.

[Delso]

Thank you for the info.  The mad thing was I was getting so confident with hrt and managing different symptoms and then I've been doing it wrong entirely, so that through me a bit! Thanks for being there and listening. 

[GraceM]

Given that your cycles are between 23 and 28 I wouldn't worry at all.  Supposing your cycle had changed to 40 or 50 days and you were only taking the utrogestan for 2 weeks within a 40/50 day cycle then you could maybe request a scan.  But as you have been taking it within a 28 day cycle you are fine.  From now on maybe just take them on the same date each month for 2 weeks, or start on a certain day of the week for 2 weeks on/2 weeks off.  Count your next bleed as day 1 and work it from there to see where day 14 falls.

[Delso]

Appreciate that, thank you, think that's the way to go and will keep my dr up to speed so they're aware of what is happening, cos from what I've read on here I may well get more bleeds in a month.  It's the unknown of changing the schedule when I know how bad fluctuations have made me feel before, have been in hospital with it, but it's crucial to do and I see the bravery of all the women on here so just need to do it.

[bombsh3ll]

If the fluctuations have made you feel so bad you have been hospitalised this begs the question why are you on a regime which mimics a menstrual cycle?

Some form of ovarian suppression (the combined oral contraceptive pill taken continuously is brilliant if under 50 and medically suitable) but if not there are other progestins that can switch your own cycle off and to which you can add back your estrogen of choice at a nice stable level.

Even if you really want micronised progesterone, this won't shut you down but some women still feel better taking this continuously rather than seesawing up and down.

Yes this might result in some irregular bleeding but this is not harmful and has to be weighed against your overall wellbeing and quality of life.

[Delso]

Have doctors appointment today and now feeling a lot calmer about it all, thanks for the posts.