Menopause Matters Forum
Menopause Discussion => Postmenopause => Topic started by: lilbebel on May 03, 2024, 01:00:56 PM
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Hello ladies,
In my previous post, I had been trying to stop postmenopausal bleeding. Everything was checked out and it’s just a HRT imbalance. Anyway, I increased my dose of Utrogestan and everything stopped bleeding for almost a month. I didn’t take my progesterone last night. I woke up this morning and I’m having a full period like bleed. I’m thinking I may fare better doing a cyclical regimen. My reasons are two; my body seems to want to bleed anyway so I may as well let it, and the higher dose of progesterone was making me very depressed. I may consider the coil, but I’m reluctant because I don’t like the idea of having something in me that I can’t remove if I get depressed from it. I have some questions.
1. For those in post menopause, do you keep your oestrogen patch on for the time that you are not taking progesterone?
2. How quickly does your withdrawal bleed begin and last after stopping taking your progesterone?
3. Do you do two weeks on 200 mg progesterone and two weeks off or do you use a different schedule?
4. I noticed my mood is much better this morning after stopping progesterone for only one night and starting a bleed. Do any of you experience something similar? Improved mood when you’re not using the progesterone?
Obviously, I will discuss with my gynaecologist too, but I’m very interested to hear feedback from other women who are progesterone sensitive and get on well with the cyclical regimen in Postmenopause. Many thanks in advance.
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I use a 6 week cycle, 2x100mg utro x either 10 or 12 days (depending on how dopey I am). They told me there's a slightly higher risk of endometrial cancer this way but I prefer that to being permanently doped. I bleed a day or 2 after stopping utro. Oestrogen all the time.
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I take Utro vaginally days 1-14 plus Oestrogel, then just Oestrogel for the remainder of the month. Bleed normally starts on the third day after stopping Utro and can last around a week, with just a brown discharge for the last few days.
Utro knocked me out orally, so have to take vaginally. Don't think I could take it for more days, as it does irritate my bladder but it doesn't seem to affect my mood or anything else, taken that way. I only take 100mg though and will need to get a scan done.
Specialist would have preferred me to take Utro continually by now but this is the only way I can tolerate it and for many reasons, I don't want a coil either.
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I use a 6 week cycle, 2x100mg utro x either 10 or 12 days (depending on how dopey I am). They told me there's a slightly higher risk of endometrial cancer this way but I prefer that to being permanently doped. I bleed a day or 2 after stopping utro. Oestrogen all the time.
Thank you for your reply. Much appreciated. Do you notice that you are more clearheaded and feel like yourself on the days that you do not take progesterone? If yes, Is the difference noticeable quickly?
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I take Utro vaginally days 1-14 plus Oestrogel, then just Oestrogel for the remainder of the month. Bleed normally starts on the third day after stopping Utro and can last around a week, with just a brown discharge for the last few days.
Utro knocked me out orally, so have to take vaginally. Don't think I could take it for more days, as it does irritate my bladder but it doesn't seem to affect my mood or anything else, taken that way. I only take 100mg though and will need to get a scan done.
Specialist would have preferred me to take Utro continually by now but this is the only way I can tolerate it and for many reasons, I don't want a coil either.
Thank you for sharing your experience. This is helpful. Do you notice that your mood is better and you feel more like yourself on the days when you are not taking the progesterone?
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No, it doesn't seem to affect my mood or energy levels taken vaginally, just local irritation/soreness. Whether it would if I took 200 mg, I don't know. But oral was awful - felt worse than not taking HRT, a complete zombie and got worse with every dose.
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No, it doesn't seem to affect my mood or energy levels taken vaginally, just local irritation/soreness. Whether it would if I took 200 mg, I don't know. But oral was awful - felt worse than not taking HRT, a complete zombie and got worse with every dose.
Thank you. I’m sorry you felt so bad on the oral progesterone. I am exactly the same. Cannot tolerate it.
What I’m realising as I Journal my days on higher doses of progesterone. It seems to get worse each day. I was taking 100 mg vaginally and seemed to be doing okay. My doctor upped my dose to stop breakthrough bleeding and it hasn’t stopped the bleeding and tanked my mood.
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It can be very difficult when you are prog intolerant. Might be worth trying a cyclical regime to give your body a break, especially if you feel the progesterone builds up in your body. Some people say they eventually get used to it. I've been on my regime for nearly three years but am always relieved when it gets to day 15 and I can just take Oestrogel on it's own again.
I've not had any breakthrough bleeding and my specialist wasn't too worried about whether I was taking enough Utro, as I was having a regular bleed in the correct pattern. Guidelines have tightened up a bit now and do recommend higher doses of prog if you are on higher doses of oestrogen (4 pumps in my case), so I do need to sort out a scan, as I'm not under anyone now.
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It can be very difficult when you are prog intolerant. Might be worth trying a cyclical regime to give your body a break, especially if you feel the progesterone builds up in your body. Some people say they eventually get used to it. I've been on my regime for nearly three years but am always relieved when it gets to day 15 and I can just take Oestrogel on it's own again.
I've not had any breakthrough bleeding and my specialist wasn't too worried about whether I was taking enough Utro, as I was having a regular bleed in the correct pattern. Guidelines have tightened up a bit now and do recommend higher doses of prog if you are on higher doses of oestrogen (4 pumps in my case), so I do need to sort out a scan, as I'm not under anyone now.
I think you’re absolutely right. And I do feel like it builds up in my system. I haven’t taken any now in 36 hours and I feel like me. It’s unbelievable the difference. I don’t have this heavy lethargic malaise in my body and my mind is clear and I’m not horribly depressed. It really is crazy. It was that bad. I’m going to give this cyclical approach a go. Yes, I’ll still have difficult days every month but at least it won’t be every day of my life. I’ll get a break which will give me the strength to get through the tough days. Thank you so much for sharing. It’s been very helpful. I wish you the best.
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Definitely worth trying cyclical but I think if you are that sensitive to natural progesterone and you've tried synthetics (not ideal I know but sometimes you have to weigh up all the options) then perhaps see if you can get an assurance from your doctor that they would remove a Mirena coil pronto if it was intolerable, if that is your main concern with it. I would hope that given the severity of your mental health issues from this, they would be agreeable to that.
I wish you good luck with it all.
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I too have had lots of breakthrough bleeding and considered the cyclical route but my gynaecologist refused as so long past menopause. I am very progesterone intolerant and the mirena was horrendous only lasted 3 days. I take femosten conti tablets 1/5 a much gentler progesterone
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Definitely worth trying cyclical but I think if you are that sensitive to natural progesterone and you've tried synthetics (not ideal I know but sometimes you have to weigh up all the options) then perhaps see if you can get an assurance from your doctor that they would remove a Mirena coil pronto if it was intolerable, if that is your main concern with it. I would hope that given the severity of your mental health issues from this, they would be agreeable to that.
I wish you good luck with it all.
Thank you. Yes, that is my main concern. I would need to know they would remove it without delay if I had a poor mental health response.
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I too have had lots of breakthrough bleeding and considered the cyclical route but my gynaecologist refused as so long past menopause. I am very progesterone intolerant and the mirena was horrendous only lasted 3 days. I take femosten conti tablets 1/5 a much gentler progesterone
Sorry you also suffer from progesterone intolerance. I’m glad they removed the Mirena quickly for you and that you found a treatment that is more gentle on your mental health.
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I use a 6 week cycle, 2x100mg utro x either 10 or 12 days (depending on how dopey I am). They told me there's a slightly higher risk of endometrial cancer this way but I prefer that to being permanently doped. I bleed a day or 2 after stopping utro. Oestrogen all the time.
Thank you for your reply. Much appreciated. Do you notice that you are more clearheaded and feel like yourself on the days that you do not take progesterone? If yes, Is the difference noticeable quickly?
I've never been on conti so normal for me is not on it. It takes several days to feel at my worst and clears 2-3 days after stopping. I don't notice a difference between 100 and 200mg but it was noticeably worse with my own progesterone too.
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I use a 6 week cycle, 2x100mg utro x either 10 or 12 days (depending on how dopey I am). They told me there's a slightly higher risk of endometrial cancer this way but I prefer that to being permanently doped. I bleed a day or 2 after stopping utro. Oestrogen all the time.
Thank you for your reply. Much appreciated. Do you notice that you are more clearheaded and feel like yourself on the days that you do not take progesterone? If yes, Is the difference noticeable quickly?
I've never been on conti so normal for me is not on it. It takes several days to feel at my worst and clears 2-3 days after stopping. I don't notice a difference between 100 and 200mg but it was noticeably worse with my own progesterone too.
Thank you.
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Hi lilbebel
I reasponded to your pm so I won't reply again on here - I hadn't realised you had asked a similar question on a post, as I answered straight from your message.
If you have any further Qs about my regime - do ask on here and then others can read.
All the best
Hurdity x
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Hi lilbebel
I reasponded to your pm so I won't reply again on here - I hadn't realised you had asked a similar question on a post, as I answered straight from your message.
If you have any further Qs about my regime - do ask on here and then others can read.
All the best
Hurdity x
Thank you very much. Will do. :)
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Hello everyone,
I thought I would give an update of my first full month doing cyclical HRT for post-menopause.
I started by not taking any progesterone for 16 days. During this time, I noticed a significant improvement in my energy levels and mental acuity. Also, the severity of depression lessened significantly though I still suffered with anxiety.
After 16 days, I started my 12 days of 200 mg of vaginally administered Utrogestan. I documented what I observed every day. I was okay for the first few days but after about the sixth or seventh day, my fatigue and lethargy became severe, depression set in again, emotional liability, crying, and general mental unwellness.
I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.
I wanted to thank Hurdity for her valuable insight and advice. Hurdity, if you’re around, I have a question for you. You replied to another member in February 2022 and you said:
“To decide on whether it is OK to go to long cycle you should be guided by how your bleeds are on your current regime. eg when I was on 28 days cycle in my late 50's I got no withdrawal bleed using the licensed dose of progesterone, so I knew that I could extend the cycle without problems.”
My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only. I’m just wondering what your thoughts are on this. I’m not of course asking for medical advice. Just clarity on how you gauged what was right for your body in terms of the length of non-progesterone time.
So, I hope this helps others. I will check in every now and then with updates. I think I am just one of these women whose body needs to bleed regularly while on HRT. No matter what I do, I bleed. Everything has been checked out and I’m perfectly healthy.
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I know you asked Hurdity but after 40 years of a (natural) 6 week cycle my lining was thin so I continued with it in peri as soon as I changed from patches to gel/utro and am continuing with it now. I'm inclined to think that as long as you have a decent bleed it should be OK but the only way to know for sure is to scan after a few months, everything else is guesswork.
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“I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.”
Yes this is exactly how I felt as a menstruating woman. We now know there are several aspects to this – there is the progesterone withdrawal – which can sometimes lead to pms type symptoms, irritability, headache etc that many women got while fertile, and experience when coming off the progesterone phase of the HRT. Then there is the effect of oestrogen. During our natural menstrual cycle oestrogen levels fall just after ovulation, and then rise again falling to a low level for the last few days before the period (coinciding also with progesterone withdrawal). After the bleed starts oestrogen rises rapidly again over the next couple of weeks – but of course with HRT it stays constant.
I used to feel exactly as you did when menstruating – tense and horrible, irritable etc during those last few days and almost a day after the bleed started I could feel all of that melting away – just like the flipping of a switch – I could almost feel the sensation of the oestrogen rising - surging through my blood stream, even though I might have period pain and a bleed, and my mood became light and buoyant again.
Since being post-menopausal it isn’t quite like that because oestrogen does not rise - but I do feel the head fog clearing once the progesterone has gone (which takes a few days) and I feel bright and normal again.
“My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only.”
I can’t remember all the details of your story but if you have been checked out then presumably fibroids, polyps or other abnormalities have been ruled out.
Since the bleed is cyclical then it is likely to do with the hormone regime. You said you used to bleed too much on lower doses of Utrogestan. I presume you had a scan and the thickness was measured? If the endometrium is at all thickened or thicker than it should ideally be, then it still has to shed so sometimes this can be an explanation for an early bleed. In any case even the guidelines if I recall correctly, state that the withdrawal bleed occurs towards the end of the progesterone phase or just after – so you’re within the bounds of normality.
As to the question of lengthening the cycle – well that does depend what thickness your womb lining is, so if it is thickened – it could take several months longer to thin down so in the meantime extending the cycle probably wouldn’t be advisable, if you want to avoid bleeding problems or more thickening maybe.
Another factor to think about is how long and heavy the bleed is – if long and heavy – then there is clearly more lining to shed, but if it is short and light despite starting at the end of the progesterone phase – then that might just be how your body works and extending the cycle may mean the bleeds still start early. Ideally it would be good to have a scan just as the bleed is finishing when the lining is at its thinnest but if not, see what happens over the next couple of months – depending on the bleed.
In short – if the bleed is long and heavy then probably not a good idea to extend the cycle yet. If short and light then why not give it a go and try 21 days of oestrogen followed by 12 days of Utrogestan giving you just under a 5 week cycle?
Any concerns about anything including your bleeds, of course consult your doctor and ideally discuss with or at least inform your GP or specialist about what you’re doing.
Hope this helps and all the best
Hurdity x
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I know you asked Hurdity but after 40 years of a (natural) 6 week cycle my lining was thin so I continued with it in peri as soon as I changed from patches to gel/utro and am continuing with it now. I'm inclined to think that as long as you have a decent bleed it should be OK but the only way to know for sure is to scan after a few months, everything else is guesswork.
Thank you very much. All input is gratefully received. Thank you for sharing your experience.
Sounds odd to say, but I’m happy with my bleed so far. It’s like a proper period as opposed to spotting. I feel like my uterus is getting a good old clean out. Of course, I hear your point about imaging being the only scientific way to measure the endometrial thickness.
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“I started to bleed on day 12 of using the progesterone and on day one without progesterone and I already feel an improvement, most notably in terms of mood. I’m still very tired. It’s as though the commencement of bleeding flipped a switch in my brain and I feel much calmer and more like myself. This is exactly how it played out when I was a younger menstruating woman. As soon as I would bleed, the darkness would lift.”
Yes this is exactly how I felt as a menstruating woman. We now know there are several aspects to this – there is the progesterone withdrawal – which can sometimes lead to pms type symptoms, irritability, headache etc that many women got while fertile, and experience when coming off the progesterone phase of the HRT. Then there is the effect of oestrogen. During our natural menstrual cycle oestrogen levels fall just after ovulation, and then rise again falling to a low level for the last few days before the period (coinciding also with progesterone withdrawal). After the bleed starts oestrogen rises rapidly again over the next couple of weeks – but of course with HRT it stays constant.
I used to feel exactly as you did when menstruating – tense and horrible, irritable etc during those last few days and almost a day after the bleed started I could feel all of that melting away – just like the flipping of a switch – I could almost feel the sensation of the oestrogen rising - surging through my blood stream, even though I might have period pain and a bleed, and my mood became light and buoyant again.
Since being post-menopausal it isn’t quite like that because oestrogen does not rise - but I do feel the head fog clearing once the progesterone has gone (which takes a few days) and I feel bright and normal again.
“My question is that my body seems to want to bleed by itself on day 12 of the 200 mg of progesterone. Based on your comment, does that mean that I should not do too long of a cycle? I would like to extend the 16 days to, perhaps 21 days on oestrogen only.”
I can’t remember all the details of your story but if you have been checked out then presumably fibroids, polyps or other abnormalities have been ruled out.
Since the bleed is cyclical then it is likely to do with the hormone regime. You said you used to bleed too much on lower doses of Utrogestan. I presume you had a scan and the thickness was measured? If the endometrium is at all thickened or thicker than it should ideally be, then it still has to shed so sometimes this can be an explanation for an early bleed. In any case even the guidelines if I recall correctly, state that the withdrawal bleed occurs towards the end of the progesterone phase or just after – so you’re within the bounds of normality.
As to the question of lengthening the cycle – well that does depend what thickness your womb lining is, so if it is thickened – it could take several months longer to thin down so in the meantime extending the cycle probably wouldn’t be advisable, if you want to avoid bleeding problems or more thickening maybe.
Another factor to think about is how long and heavy the bleed is – if long and heavy – then there is clearly more lining to shed, but if it is short and light despite starting at the end of the progesterone phase – then that might just be how your body works and extending the cycle may mean the bleeds still start early. Ideally it would be good to have a scan just as the bleed is finishing when the lining is at its thinnest but if not, see what happens over the next couple of months – depending on the bleed.
In short – if the bleed is long and heavy then probably not a good idea to extend the cycle yet. If short and light then why not give it a go and try 21 days of oestrogen followed by 12 days of Utrogestan giving you just under a 5 week cycle?
Any concerns about anything including your bleeds, of course consult your doctor and ideally discuss with or at least inform your GP or specialist about what you’re doing.
Hope this helps and all the best
Hurdity x
Thank you again for such a thoughtful and helpful response. There’s so much in there of value. That’s interesting to read that you had the same experience as a menstruating woman in terms of feeling like a switch was being flipped inside you once you started to bleed.
I had a scan fairly recently and got the all clear for anything irregular. The doctor concluded that my breakthrough bleeding was to do with the HRT and my body trying to adjust. When I took progesterone 100mg continuously, I would have light/moderate breakthrough bleeding every two to three weeks. It just seems that that’s how my body wants to handle this.
As I mentioned to Sheila, my period now (on day two without any progesterone) is like one of my regular pre-menopausal periods. It was typically quite heavy on the first 1 - 2 days so I will see how long it lasts and if it lightens soon. Depending on that, I’ll decide whether to extend to a 21 day oestrogen only cycle next month or hold off with the shorter one for now. I feel like a mad scientist. I have to remind myself to keep emotion out of it and try to stick to facts and data. I’m hoping that I eventually find the right sequence length for me and of course, I understand that that will change as my body does.
Never in a million years though I would be buying tampons and leading once in menopause. There are always new things to learn.
Thank you for your patience and support in explaining everything to me. 🙏🏻