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[Dee36643]

Hi Everyone,

I’m coming to the end of my 3rd month on Evorel Sequi (50) and so far so good, brain fog all gone as is fatigue thank goodness. However, I’m wondering about what to expect with my period frequency

I know that the advice is to wait 3-6 months to see how cycles settle down, but I’m not really noticing any change with frequency

For those that haven’t seen my previous post, I’m 48 and periods have been fluctuating between 25-31 days for a few years with a couple of big outliers but not many. Evorel has made my period heavier, and a lot more clotty, but so far I’ve had 2x 26 day periods and now I’m at day 28 and still no period although random cramps suggest it’ll be along soon.

One thing that keeps confusing me is that my period is happening around the time that I apply my last conti patch (combined estrogen and progesterone) - sometimes before and sometimes after, but that then means that my cycle isn’t in keeping with the patch schedule.

Basically, I’m still having to apply my last conti patch even though my period may have already happened, whereas I assumed that it would come when I finished the conti patches and switched back to the estrogen only patches. This means, as the numbers above show, that my periods are still fluctuating even though I accept it’s only a few days either way.

I know that other people have also had questions around what to do or whether this is normal, but I guess I’m just looking for some reassurance that this is normal and as long as my period occurs in the 4th week of applying the patches then this is just how it’s going to be going forward. My GP told me after month 1 that a shorter period would likely be my new normal, but this doesn’t appear to be right.

I’d appreciate some help to understand if I’m likely to have periods within week 4 but with no guarantee of day - because my body is obviously still doing its own thing - whether the 50mg is the right dose and what would higher or lower doses do. I read somewhere that HRT would override your normal cycle but I’m not seeing this. It’s all so confusing

I know there are a few other ladies out there in their first few months of Evorel 50, have you had similar experiences?

Thanks

[sheila99]

My own cycle was always stronger than the hrt so you're likely to bleed when your own body decides. Though perhaps f they get badly out of sync you can get a hrt induced bleed too 

[bombsh3ll]

HRT is generally not strong enough to suppress your own cycle, and many women end up with chaotic and unpredictable bleeding when they use sequential HRT in perimenopause. It's a lose-lose situation in my opinion as you have your periods AND the iatrogenic withdrawal bleeds, which often don't match up as one is fixed and one is increasingly variable.

Sequential HRT was originally developed for postmenopausal women, in whom it does usually produce regular withdrawal bleeds only, because they are no longer menstruating as well.

Back then perimenopause wasn't really acknowledged, if you were still having periods then you must be imagining your symptoms, if you were lucky you might have got some valium.

Most postmenopausal women didn't want their periods back, and so in the 1990s continuous HRT was developed.

The sequential preparations that nobody now wanted were repurposed for economic reasons to treat those still menstruating, and the myth that this will regulate your cycle arose secondarily.

If you don't mind all the bleeding there's nothing wrong with it, it is a nuisance but not harmful.

However there are multiple bleed free options that can achieve amenorrhoea even if you are not yet postmenopausal, that you could discuss with your provider.

[Dee36643]

Thanks Both, it certainly is a minefield. I still have some time to see if this settles down, but will certainly keep my options open - the ability to sleep and be a reasonably functional human being are more important at the moment, especially when it comes to employment so will persevere.

I don’t mind having a bleed, I mean we’ve all been there  it’s not like it’s new! I just assumed that HRT would make things more regular. Oh well, hopefully I’ll at least continue to have a bleed in the 4th week and having a regular week is better than nothing.

Incidentally, and this may be a stupid question, but what happens when you get to menopause when taking HRT? I understand that many women move to continuous rather than sequential HRT, but up until then I assume that bleeds still occur so how do you know when your natural period has ended?

Thanks again

[sheila99]

The short answer is that you don't know! My hrt bleeds were much shorter, lighter and PMT free compared to my own. I think you can move to conti after 1 year or after a certain age (which I forget), but beware if moving too quickly because if you have another period it becomes an 'unexpected bleed' which warrants panic about cancer and intrusive investigations.
  If you're in the early stages of peri you might find a combined BCP such as zoelly suits you better as it does shut down your own system also you have a regular (optional) bleed.

[bombsh3ll]

I was just going to say about the combined pill if you are under 50, which is a much better option in perimenopause in my opinion if taken continuously.

I take Zoely and don't bleed at all.

A combined pill shuts down your own cycle and adds back a stable daily dose of hormones, typically much more generous than standard HRT doses.

However if you are over 50 you would struggle to get a combined pill prescribed especially if not already taking. It.

The same thing can be achieved with a suppressive oral progestin and a separate estradiol product if required but this is slightly more demanding and the dose of estrogen in MHT often tends to be much lower.