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[Dollie]

Hello,
First time posting here however have loved reading the wonderful knowledge that’s posted on here.😊

I’m 48 I think late peri as pre hrt my periods were around 72 days ish but very light and hit & miss. Started hrt a couple of years ago but initially changed the progesterone part quite alot (tried 3 mirena & patches) just didn’t get on with them so finally settled on x2 pumps of gel & the cyclical 14 days on x 200mg utrogestan & 14 days off, felt ok on this however last 6 months there was no withdrawal bleed or any bleeds at all, felt very bloated, and also felt like that feeling of being constantly due on my period most days (give or take a few). I spoke to the dr twice, just said it’s fine not to have a bleed as lining not built up and perhaps I’m approaching menopause. I then saw a doctor who is more HRT educated & she advised me to go onto continuous as perhaps my body would do better with consistency.

So I’m on day 21 of x2 pumps gel & x1 utrogestan continuously.
So far, mood seems more stable & I feel less stressed the bloating has gone & I don’t have that permanent feeling of my period is coming. however the fatigue is awful, I’m a single mum to a 10 year old and work full time, so finding this hard,  had really tender boobs but this went off a couple of days ago, at first had bad stomach cramps but after a week these tailed off, so just exhausted, a bit light headed & spaced out & a little nauseous. My question is I started bleeding (not spotting) on day 16 and still bleeding now on day 21 (5 days), it was heavy, bit of clotting & bright red (sorry if tmi), as much as I’m aware when you change (especially if still peri) irregular & erratic bleeding can occur I’m confused as to why I had no bleeding for past 6 months on the cyclical?

Also forgot to mention since I’ve been on this regime I’m starving all the time and had a sore achy leg and pain in my hand, but these are also feeling better now.
 
Not sure whether to give it longer if I can survive the fatigue & monitor the bleeding or just to go back to cyclical? I will inform the doctor tomorrow anyway but it’s alot of trial & error & just wondering if anyone had been in the same kinda position.

Thank you all for taking the time to read this & I hope to hear from somebody soon 🤗

[bombsh3ll]

This sounds like a poor quality of life to accept long term, bleeding or not, and I wonder if you have considered any of the numerous alternatives to micronised progesterone, or the addition of androgen replacement.

There are multiple bleed free oral options plus the IUS, regardless of whether or not you have naturally ceased menstruating.

[Dollie]

Hello bombsh311,

Thx 4 taking the time to reply.

In all honesty no I hadn’t even thought about androgen replacement as I wanted to get settled on an hrt regime that worked and see how I felt initially.

No doctors have ever suggested any other progesterone alternatives other than the patch and mirena (I’ve tried both).

When I was cycling the gel and utrogesten for 14days on & 14 days off I felt ok (better than pre hrt) but never got that amazing feeling but does anyone? So I settled on that after a few cycles really as in I guess my body no longer reacted so drowsy to the utrogesten. But I never bled for 5 months and it just felt like I needed to have a period due to that constant heavy bloated feeling like your eggs are dropping, doctors just said its fine not to bleed and that feeling it’s my own fluctuating hormones in the background.i did have a scan back in march (after the rather rough mirena removal as the strings curled up and they struggled to find it, ended up in hospital so that really put me off

Just now on continuous after 21 days I’m feeling soo fatigued, light headed, brain fogged, headaches, bleeding is wearing off after 6 days, I can barely function normally and my boss is not understanding, so getting on with it best I can.

I did ask for a telephone call with the doctor I saw but she only works part time and they want me to go for a f2f appt in the morning. It’s a male doctor who I have seen previously, he is understanding but not that knowledgeable on hrt related stuff.

My thoughts are to maybe find out when I can stop this continuous regime as only been on it for 21 days and then have 14 days off to have the break from the progesterone and return to cyclical and maybe increase the gel to 2.5 pumps, perhaps I’m not getting enough estradiol to produce a bleed no idea.

I will ask the doctor 2mrw about any other alternatives but think better researching myself.

I really appreciate your reply 🙏 thank u 😊

[bombsh3ll]

There is no medical reason why you need to have withdrawal bleeds - I have been on the combined pill continuously since I was I was 29, and I am now 46, with no bleeding at all.

However if you feel better with non-continuous progestogen that's perfectly fine.

You don't need anyone's permission to stop the continuous regime, as long as you accept that taking it for half the time means using twice the dose.

And yes I would definitely consider increasing the estrogen and looking into testosterone although you would have to say it was for libido on the NHS.

But absolutely, if you don't like micronised progesterone it is by far not your only oral option, there are several other progestins that may be more tolerable for you.

At 48 you could also still use a combined oral contraceptive pill which makes for a better quality of life in many ways than menopause hormone therapy.

[Dollie]

Thank you for the other suggestion re the oral contraceptive too, again something I didn’t think about or consider.

So I’m feeling worse by the day being on continuous, I would like to stop from now so not take any progesterone tonight. My concern is in November all was cyclical & normal so I took the x200 for 14 nights, then when changed to continuous I had a 4 night break just to see if there was a withdrawal bleed which there wasn’t & started on the x1 of continuous on the 2nd of December.

If I don’t take it tonight that means I only took X1 100 for 20 nights (so less than normal) I’m worried this might cause problems?

I did get a bleed on day 16 of continuous though (who knows if it’s an actual period or just as a result of the change in cyclical to continuous) and am still slightly bleeding now.

So my plan was to stop from tonight and start back on cyclical again from the 1st to the 14th jan and all being well continue with this regime for a while.

Do you think 10 nights without the continuous utrogesten will be ok though? I know your not a doctor but nice to get another point of view, I actually cannot function another day of feeling soo wiped out and now really bad headaches, I think I might have too much progesterone at moment as all the symptoms I have seem to tie in with that. 😊

[bombsh3ll]

You could just start from today with estrogen only and take another course of progesterone in two weeks. That would give you a more comfortable Christmas and new year.

Endometrial cancer develops over years of taking unopposed estrogen, not days or weeks.

You might get a bit of irregular bleeding as your body adjusts but it sounds like you don't have a regular bleed pattern anyway, and no HRT regime 100% guarantees either regular or no bleeding.

[Dollie]

Yes that what I finally decided this evening, so good advice - thank you.
I am going to start back on the cyclical x200 from the 1st to the 14th every calendar month though this time, I want to see if that makes any difference.

I might be totally wrong but when I took cyclical before I was told 14 days on & 14 off which is more or less the same give or take a few days, however this would end up being different dates of each month & after looking through my diary ended up sometimes having the progesterone part of it like twice in 1 month, I wonder if perhaps that could have been more then enough and perhaps was keeping my lining thin so not enough to cause a bleed. It’s not that I want to have a bleed, however when you get that feeling of being constantly due on your period every day I just wanted the feeling of heaviness to end and to actually have one as it does actually help.
Thank you for putting my mind at rest to assure me that having a little break while I transition back to cyclical is ok as it can all get a bit worrisome, I bet the doctor says different tomorrow.
Do you mind me asking what combined pill you are on and how you get on with it?

[bombsh3ll]

I take Zoely and I love it, no bleeding, no hormonal ups and downs and the same stable dose every day, of estradiol and a really kind progestin NOMAC that doesn't lower your mood or your blood pressure like progesterone.

However to answer your other question yes it is common for women to use the first of the month to start the progestogen within sequential HRT.

This provides slightly more progestogen free days without losing endometrial protection.

However if inducing an artificial withdrawal bleed is your objective then I would also think about increasing the dose of estradiol, as if there is too little estrogen to thicken the endometrium then there is nothing to shed when the progestogen is withdrawn.

I should say with Zoely there are 4 yellow dummy pills at the end of each 28 day pack, similar to many birth control pills, which is also designed to induce an artificial withdrawal bleed, however I toss them and go straight onto the next strip of white active pills as I have no wish to bleed, but this is personal preference.

[Dollie]

Hi Bombs,

Oh that’s really interesting about Zoey, sounds actually quite good, I’m glad it works for you and u feel good on it.😊

I’m definitely going to start back on the cyclical on 1st of jan and see how I settle back and yes I do have a sense that I might need a little more gel, but will address 1 change at a time to monitor any side effects etc.

So today after my first night of not taking the continuous utrogesten, my headaches are the same, absolutely pounding, however this is the first day after being completely dysfunctional yesterday I feel a bit more human, I’m still really wiped out but should feel better in a couple of days I hope, also I’m guessing I might get a withdrawal bleed from being on conti from last few weeks but who knows.

I went to the doctors today and literally had to tell him what I planned to do and he said I should stick to continous as when I’m 50 I have to move over to it. I  explained there’s no way I could function so cannot do it, I put up with all the other symptoms but can’t afford to be like a zombie with brain fog, achy heavy legs, dizziness and extreme headaches. Really wish I’d never given it a go as it’s really messed my head up but it’s at least I know I’m not ready for it.

Thx for telling me about the zoely and all your advice too, it’s really helpful hearing about others experiences too as women’s hormones seem to be trial and error especially in peri. X

[bombsh3ll]

He seriously said you would just have to put up with it when you're 50?!!

I doubt he has ever told a male patient that once they hit a particular age they have to just accept a poor quality of life.

Please don't continue to get your menopause care from this doctor!

[Dollie]

I know, I actually know more than him about hrt and side effects etc, half through my own changes & experiences, some from this forum and I’ve been reading and listening to Louise newson, I find her podcasts and books quite informative.

Going forward I’m just going to trust my instincts more & go by how I’m feeling, will also try and get the hrt educated lady doctor if I can, I think she knows a bit more.

Have a lovely Christmas Bombs and thx again 🤗
Still got Zoely in the back of my mind if I don’t feel good back on cyclical thanks to you for telling me about it