Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: galare73 on January 31, 2025, 08:36:24 AM
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Hi. I haven't posted for a while as i’ve been trying to figure out what to do.
I’m in peri-menopause and currently take 2 utrogestan (vaginally) on days 1-12 and also 1 pump of oestrogel daily. I stopped the hrt for a few weeks as i was bleeding regularly so wanted a break. I was on evoral 50 patches at the time.
I it started again as i was experiencing symptoms but went onto the gel instead so that i could control the dose easier.
My first period started the day before the prog was due and it was the most awful period. Very painful and heavy, huge clots too. Unusual for me. I had to use the prog during this which wasn't very easy. After i had finished the prog i had a small bleed.
So today, i have started another period. My prog is due to start tomorrow.
Is this normal? I was always led to believe that you have a period after the prog, not before it starts. I really don't want to have 2 periods a month. I am considering stopping the hrt for good as my periods weren't an issue before i started it.
Is anyone in or has been in the same situation? Can anyone give me some advice please?
Thanks
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It may be that your own hormones are kicking in.
Why did U consider HRT, which symptom would you like to ease first? U could put the product names into the search box; individually; to read appropriate threads; make notes.
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Thanks for replying.
I originally started hrt last year as i was having hot flushes, night sweats, trouble sleeping, frequent weeing, low mood… the usual symptoms. All of those symptoms went away after about 3 weeks, which was great.
I don't really have those symptoms anymore apart from mood changes but i do have a lot of joint pain.
It’s the frequent periods that bother me. They should be getting less frequent, not more! :(
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How were your moods during your menstruating years? Mine were cyclical!
Joint pain can be due to loss of oestrogen as muscles may become lax.
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My moods were ok really. In fact, my periods never really bothered me too much at all.
I’m reluctant to increase the oestrogen gel too as that will cause more bleeding?
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In my opinion the combined pill is a far better way to manage (by that I mean completely bypass) perimenopause, rather than messing around with cyclical progesterone.
Taking cyclical micronised progesterone when you're still having periods is rather like trying to time the stock market, and seldom produces a regular 28 day cycle as many clinicians (usually men, or women remote from menopause) believe it does.
The combined pill on the other hand, if taken continuously ie active pills every day, can keep you bleed free and hormonally stable.
I take Zoely and don't deal with any of the hormonal issues and crime scene periods that others my age are having.
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Thanks for that, it’s very interesting.
I haven't been offered the combined pill. However i do have migraines with an aura so would that be an issue?
I will do some research. :)
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Ok so migraines with aura contraindicate the combined pill.
However you could take the progestin component as a standalone using either desogestrel 150mcg per day (2* cerazette pills) or drospirenone (slynd).
Either of these should shut you down if taken daily. A transdermal estrogen should then be added eg patches or gel.
This achieves the same ends as a combined pill but without the very small increase in stroke risk that migraineurs face.
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galare, before trying other meds, let's try to get you sorted with what you're on - because you haven't been on it for long right?
The main issue seems to be how to sync the P to your own cycles. Why are you taking the P on days 1-12? That's the opposite of what you should be doing. Progesterone is made during the luteal phase of the cycle, so if you are taking it for half the month you should be taking it from day 16-26.
If you bleed, stop taking it and count that as day 1. When you get to day 16, take it again. If you get bleeding (not light spotting, but what seems to be a period and goes on for more than one day or gets heavier), stop taking it and count that as day 1 again. It may take a few cycles to get in sync.
If you have just started a bleed, don't begin the P tomorrow - let yourself have a bleed and shed the lining. Work with your body, not against it. Your body naturally produces P during the second half of the cycle. Give it to your body then.
It doesn't have to be exact, but you do have to roughly take about the same amount as you'd take from day 16-26 which is 11 days of it. So if your cycle is 21 days (say), you would count back 11 days from 21 and start there, day 11. That way you get your full amount of P in during one cycle.
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Sounds like your body's really rebelling against the current HRT. Two periods a month is rough. I'd definitely talk to your doctor, they might need to adjust your dosage or even the type of HRT. Stopping completely might seem appealing, but it's worth exploring other options first to manage those symptoms.
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Thankyou bombsh3ll and Minicat for your advice.
Joziel - Thanks. The bleeding that started yesterday is a full on period with pain, fairly heavy too.
I started the hrt 1st July last year. It has been tweaked and different types used to try and get a satisfactory outcome but nothing really works 100%. I should start the prog tonight but as you say, it doesn't sound correct. Thats just the routine my gp first put me on and it hasn't changed.
I think i will have to make another appointment to try and get all this resolved because i don't feel happy with it. I’m having more periods now than i had before starting to take the hrt! I’m quite tempted to ask for a scan just to check all is ok in there too.
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galare, I would suggest you research elsewhere besides what your GP has recommended ;D because sadly the fact is that if you put your faith in one doctor, you will end up in a mess with HRT - statistically. Unless you get lucky with your one doctor and do your research. But the standard of knowledge is really poor generally amongst doctors.
Ie - it is well documented *everywhere* that sequential HRT should be taken (P) days 16-26 or the second half of the cycle. If your doctor has recommended anything else, they are assuming (wrongly) that body identical P is somehow strong enough to override your natural cycle and the only important thing is that you take it for half the cycle (not which half) and frankly that's crap.
If your doctor is making assumptions like that, you can be sure they don't know enough to help complex cases like yours. You will either be taken off it or put on something with a synthetic progestin in it, before really trying to sync the utrogestan with your cycle.
Sadly it behooves women to take the initiative themselves in all this, do their own research, be their own doctors, and sift through all the information available and the experience of others (which really I've personally found far more useful than anything else).
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Thanks for that. There is a ‘menopause nurse’ at my health centre who i think i will arrange an appointment with. My sister has seen her and she said she is great. Would be interesting to see if i get different advice.
I tried the synthetic prog and i had awful side effects with it so went onto the micronised instead. Because i take it vaginally i have no issues with it at all.
Hopefully i can get somewhere with this!
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Hi galare73
You say you're in peri-menopause and outlined your symptoms prior to starting HRT last July, but can you tell us what your periods were doing prior to starting HRT? This would give an indication of roughly where in menopause you are and perhaps how much of your natural cycle is happening?
Some women begin to get symptoms before peri-menopause starts, so it seems like peri-menopause - but in reality is the late reproductive phase when ovaries are still functioning regularly albeit starting to go awry. In this phase periods do get closer together before they get further a part and start to be skipped when anovulatory cycles start to occur. This phase is the hardest to treat and is when the combined pill can be a good option.
I'm not sure why the combined pills designed for peri-menopause QLAIRA and ZOELY (that bombshell is taking) are contra-indicated for migraines with aura.
For example QLAIRA contains estradiol and dienogest, neither of which are contra-indicated on their own for migraines with aura. I suspect that the contra-indication listed in the product information "Combined hormonal contraceptives (CHCs) should not be used in the following conditions...... " which includes "History of migraine with focal neurological symptoms" is a blanket contra-indication initially applied to the very strong synthetic contraceptive pills containing synthetic oestrogens, rather than from trials using Qlaira or Zoely. As such they may be permitted by menopause specialists - at a menopause clinic.
However that doesn't apply to you as you have bad side effects with synthetic prog!
But - as above if you are not yet properly in peri or in very early peri then it is tricky and maybe if your tolerance improves, perhaps taking it for a longer period of time in the cycle may help - so for 21 days per cycle rather than 12-14? This may reduce the amount of bleeding though perhaps not the occurrence, though if you are only using 1 pump of gel that is a low dose so you woud not expect much of a withdrawal bleed due to that alone especially if using the licensed dose of progesterone....
As joziel I would reset your cycle and the first day of the main heavy bleed count as Day 1 and then take it from there and see if it synchronises.
Hurdity x
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I think a lot of the confusion about when to take cyclical or non- continuous progesterone comes from the instructions to take it from day X to day X.
Cyclical HRT is based around the myth of the 28 day menstrual cycle - which isn't even most premenopausal women as 28 days is the average not the majority.
Normal cycles can range from about 21-35 days, and that's before you factor in perimenopause, which can make things less predictable.
In basic terms, instead of thinking of day 1, day 14 etc, you start it 2 weeks before you expect to get your next period. This *should* have you stopping it about the same time your period comes.
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Thanks both.
These are the dates of my periods 6 months prior to starting the hrt:
08/01
22/01
16/02
15/03
04/04
28/04
19/05
01/07 started HRT
Fairly regular but random in places. Normal to light bleeding and very little pain. My symptoms sort of happened very quickly. I feel i was ok one day and the next started having the hot flushes and night sweats.
I’m going to phone the health centre on Monday and ask for an appt with the menopause nurse.
I’m wondering whether to stop both the oest and the prog until i’ve seen the nurse? Or just stop the prog as suggested? I have a wedding in 3 weeks, i’m a bridesmaid (old one!) and would really like all this to not interfere with the day. >:(
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Those are some pretty short cycles even before you started HRT. You had two in January and two in April so it's no wonder timing micronised progesterone is proving difficult.
I know you have tried oral synthetic progestins but what about an IUS?
It won't help you for the wedding in 3 weeks but it might be the best bet longer term if you can't tolerate a suppressive progestin.
If you plan to see the nurse soon, you could just take the estrogen in the meantime. You are on a very low dose and hyperplasia only starts to become a concern after several months on a standard dose of unopposed estrogen.
If you stop the estrogen you may experience a return of the vasomotor symptoms.
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I will stop the progesterone until i get to see the nurse. I’m hoping she will amend the dose to the latter half of the month as you have all recommended. If that settles my periods then great, if not, then i will look into an ius. It’s not something i’ve been too keen on using really.
Hopefully just tweaking the prog will sort the issues.
Thanks :)
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galare, you don't need a nurse to approve switching P to the second half of the month. I'm afraid you're going to need to be a bit more proactive and not rely on healthcare practitioners to know everything about HRT.
For example, from the NHS website: https://www.nhs.uk/medicines/hormone-replacement-therapy-hrt/utrogestan-micronised-progesterone/how-and-when-to-take-utrogestan/
"The usual dose of Utrogestan is 2 capsules (200mg) taken once a day, on days 15 to 26 of your 28-day HRT cycle."
Since your cycles were so short, again, you will need to adjust when you take utrogestan. You will not make it (for example) to day 26 if you have a 21 day cycle. You will end up completely out of sync.
You need to take 11-12 days of utrogestan per cycle, so if many of your cycles are 21 days, that means beginning your utrogestan around day 11 - so that you get the full amount in each month.
It's unlikely the nurse will say this, because they just don't consider basic things like cycle variability or are under the misapprehension that utrogestan can override it.
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Hi
Unfortunately this is all so new to me that i have very little knowledge or experience of hrt. All i know is that what i’ve tried so far has been pretty rubbish but it doesn't help that i’ve been taking the prog at the wrong time. I will definitely be quoting the info off the nhs website at my appt.
I have no idea what my normal cycle is anymore with the prog causing me to have 2 periods a month. I’m hoping that taking the prog on the correct days then i will just have the 1 period.
And then once i am into the new routine i can then develop a proper cycle again.
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Just a quick update for those who have helped me.
I saw the nurse. Tried to get me to have a coil fitted again. She has suggested a take 1 prog instead of 2 for 25 days and see if that helps.
Don't feel the appt was very helpful really but we’ll see how it goes.
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That's not going to help at all. If you already have bleeding issues, you need more P and you need it during the half of the month you are supposed to be taking it.
You have a choice to either follow the advice of ill-informed, uneducated healthcare providers OR to seek out another healthcare provider with better knowledge OR to take the advice here.
I'm not sure why you're continuing to follow advice you have no faith in....
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I don't agree with what the nurse has said today and was quite surprised she suggested it.
I should be taking the prog days 16-25 according to the nhs website but i don't know when that is as i haven't had a normal cycle for a long time.
I am just at the end of my last bleed so what do you suggest?
I have had to increase my gel to 2 pumps this week too as my joints really hurt and i have itchy skin.
I’m really struggling to get my head around all this. :(
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galare, it's not complicated once you have it figured out.
If you just finished your last bleed, count the first day of that as day 1.
If your cycles are often short at 21-23 days, then begin P around day 11 (at 200mg, not 100mg).
Stop taking it on day 21. OR stop taking it when you bleed, if that is from day 18-19 onwards and next cycle begin it a couple of days earlier (day 9) to get the full dose in.
Let us know how it goes.
2 pumps of gel is fine but really just the starter dose, equivalent to 50mcg patch. You can take up to 4 pumps easily via your GP surgery.
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Ok, i will do that thanks. Because i’ve been having 2 bleeds a month my cycle has only really been approx 15 days. Should i still calculate as you suggested using a 21 day cycle?
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Yes, for at least one cycle - in case taking the P all over the place is the reason in itself that your cycles have been like this.
If you bleed on day 15, then just stop to allow that bleed for 3-5 days re-start day 9.
If you are only on 1.5 pumps of gel and you are bleeding every 2 weeks, it is very likely that you are bleeding because you need MORE E. Taking too little E can cause bleeding as well - it's not all about taking too much. 1.5 pumps of gel is nothing, and 2 isn't much either - but stick to that for this cycle. As you increase E you might find you go longer and get better cycles back....
If you can't get the longer cycles back, then you can just stop to allow a bleed (whenever it happens) for 3-5 days and then start P again (at 100mg, as that is basically continuous P, but just with a break to bleed).
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Ok great, thanks for all your help :)
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Hi Galare73, I just read over your comments and a few others and I just want to say it's not unusual for your own cycle to override the HRT cycle, mine did it right up until my 55th birthday, my body has been behaving like the text book model of a post menopausal woman since my birthday, but I'm not putting bets on not ever having another bleed, the last one was only ten weeks back!
Joziel has said some suggestions and I don't mean to contradict her because she knows her stuff, it might be the same thing I'm saying, not sure, I ramble too much and read too little sometimes.
When I tried Utrogestan I bled regardless of when the utrogestan was taken, the GP simply didn't believe I was taking it properly, but I was taking it daily on the dot, so it was unhelpful to be told to take it on time and my problem would go away!
When I keep count of the quantity lost in my menstrual cup, I get to over 200ml. Meanwhile the NHS website says 30ml is an average period, OMG, imagine losing 30ml as the doctor must have imagined, they call 80ml heavy!
So when sequential Utrogestan meant having TWO periods a month (Or PostMeno bleeding as it must be called) I was not impressed at all. That's getting close to losing a pint of blood every month and I don't even weigh enough to be allowed to donate blood, so that was a problem. I had to go onto continuous HRT (tibolone) and just have periods when I had them, about once a month, that's far better than twice a month.
My advice is to continue with HRT but tweak it to suit your own body. That does mean going a little astray on what the doctor's instructions are, but they give instructions knowing very little about HRT medicines or what they do to women, so it's not the same as going against a doctor in a field where they've been trained or done research, this is a field where most are untrained, even in general practice it's not compulsory, or so I've read and the research is very sketchy indeed.
It costs a bit to get a doctor trained in menopause to work with you as an individual, but if you really are planning on quitting HRT, getting a private doctor and continuing HRT would be a better move imo, if you can afford it. You can usually get the prescriptions on the NHS after they write to your GP, but your GP can prescribe more variety if a specialist advises them to.
For now, I'd time taking the utrogestan according to your bleeds, because you already tried the other direction where you timed your bleeds to the pharmaceuticals except it didn't work, like so many of us have found.
On day one of a bleed, count that as day one, no matter where you are since the bleed before.
After starting day one as your first bleeding day, wait until you reach day 12 of that cycle, then start taking Utrogestan, usually 200mg daily.
What can happen then;
You bleed before the end of the Utrogestan days, in this case stop utrogestan and count it as day one again.
You don't bleed before the end of the utrogestan, you might be starting to align the two cycles, when you bleed is day one again, or day 29 becomes day one again if you don't bleed that cycle.
You start bleeding every 28 days on the dot, then take it as directed by the instructions on the pack. (it happens to some women, evidently)
You don't bleed ever again, yay, probably too much to hope for yet, but that would mean you could go onto continuous HRT, that includes Tibolone, which is my favourite by a country mile.
How are things for you at the moment?
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Hi flo69
Thanks for all of your advice.
My last period started on 31/01 so i am going to count that as day 1. I will start the prog on 11/02 for 10 days (unless i start bleeding again).
Hopefully i can get into some sort of pattern going forward.
Since increasing the gel it has helped my symptoms so will continue on 2 pumps.
I have received great help on here from members, compared to the seemingly lack of knowledge from the health professionals, so will continue following/asking on here rather than going back to the drs!
:)
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Hi
I thought i would give a little update for those who gave me advice now that it’s been a couple of months.
Last month i changed my routine to what was advised. I started bleeding 2 days before finishing the prog so stopped it and had the bleed. It was fine, a short lightish bleed.
I started the prog again on day 11 but took it for an extra 2 days because of stopping it 2 days early last month.
My prog ended 5 days ago. I haven't had a bleed yet. I have been expecting one but no sign so far. I have gone upto 3 pumps of gel too.
I wonder whether this is correct or not? I have always has a bleed after finishing the prog. This is the frustrating thing with hrt, you dont know when your periods have naturally stopped!
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There is a difference between a bleed and a period. Do you know what your serum estradiol levels are? It is very difficult to advise without knowing bloods. You can get a test from Randox Health for £50 if you don't want to go to the GP (use the Tasso arm/shoulder test - as long as you don't apply gel to your shoulders).
As I said before, it sounds like you may still need more E. If you stop P and no bleed happens, it means that not enough lining has built up to bleed that month. Which in turn suggests low E. You will bleed if there is sufficient build up during the month as a result of taking estrogen. If there is not enough build up, then you are also not getting enough estrogen for other health benefits - because these things go together. (Look up Dr Felice Gersh on YouTube and her video called Estrogen Dosing.)
It can take about 4-5 nights without P before your bleed starts. If you get to 6 nights off P and no bleed has started, begin taking it again. Stop it again in another 21-28 days and see if you bleed then. Whenever you do bleed again, on your next cycle, don't start it on day 11, start it on day 15 as for the usual sequential cycle. It looks like you don't need that - and (as I said above) the reason you might have been getting some break through bleeding is because you were on such a low dose before and have now raised the dose of E.
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Thanks for that info.
No, i don't know what my levels are. The gp has never tested them. Can’t really afford the £50 test atm, maybe a bit later in the year.
I agree about my oestrogen levels though, i think they could be low. I recently increased to 3 pumps but i think i will go upto 4. My gums have been very sore which i believe is a symptom? Also sleep is a bit off and waking to need the toilet again.
I am planning to arrange an appointment anyway as i want to go back onto the patches, its tiresome putting gel on every night and waiting ages for it to dry!
I will restart the prog tonight as it’s been about 8 days now since no bleed and see how i get on. If i bleed before the 21-28 days i assume i stop it and restart as normal? Just when i thought my body was adjusting! I’ll get there eventually.
Thanks again :)
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Yes, I would go up to the 4 pumps and then - if you still have any symptoms or are bleeding - go to your GP and request a blood test. Guidelines say that if you are at the max licensed dose (4 pumps) and still have symptoms, you should be tested to check you're absorbing. So, even if you don't have any symptoms but are just bleeding, I'd exaggerate a few or conjure some up to demand that blood test. Then you will know more about what to do. If I were you, I'd do that first with the gel. Then request the switch to patches, that way you can compare serum levels and symptoms and decide which you prefer on the max licensed dose of both.
Yes, if you bleed before 21-28 days, stop and allow that bleed to happen without interference from P.
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Ok, i’ll try all that and see how i go.
Thanks again