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[SueRoe]

In other womens' experiences, how long after the combined phase of sequential HRT patches ends does it take for the "withdrawal bleed" to start? Last month nothing happened for ten days and I felt so ropey (anxious, glum, poor sleep) without the progesterone that I went back onto the combined patches after 10 days rather than the 14 days in the instructions. This month the same thing. I need to get an appt with my GP anyway but I'm curious to know if this is a common occurrence. I'm on FemSeven Sequi  patches. Thanks.

[Taz2]

Hi Freda - usually the bleed happens within around four days of the start of the new pack but some women don't get a bleed. Because FemSeven are known for their sticking difficulty I wonder whether you are not absorbing the hormones properly? Is the patch stuck firmly down at all times? The hormone is contained in the adhesive so unless the whole patch is stuck to the skin the hormones aren't delivered in the right dosage.

Taz x

[SueRoe]

Thanks for that. Looks like I'm not going to get a bleed on FemSeven (Aw shucks!). FemSeven stick to me really well so I do think I'm getting the full dose of progesterone, Taz2. Certainly when I was on the pill it was about 4 days into the pill-free week that the withdrawal bleed started which ties in with what Stellajane says.

[Hurdity]

I use Utrogestan as my progesterone and my bleed always comes 2-3 days after the last dose. This last cycle I took synthetic progestogen tablets and the bleed came a day later.

Its a pity that with the patches you have to take the progestogen for 14 days because with the tablets it's only 12.  This means that there is very little time to be free of the progestogen ( ie having gone through the withdrawal few days) and finish your bleed. You would find that once the progestogen has left your system and you'd finished your period you should feel even better - that is one of the drawbacks of the combi patches.

As Taz says some women don't get a bleed. When I was first post-menopausal and still on a monthly cycle I stopped getting a bleed - but still had the progesterone withdrawal symptoms (PMT) which was annoying, as well as some of the side effects from the progesterone itself (foggy head, tiredness headache etc). This was from a different progesterone (Cyclogest). I am now on a longer cycle and also have a small fibroid so I have proper bleeds now.

Hurdity x

[SueRoe]

I feel far better WITH progesterone than without. I'd have it every day if possible!

[Suzyq]

Me too Freda - I do have progesterone every day even though just peri - my specialist just put me on a combi regime as he felt (and I agreed) that I felt bad because my progesterone was non-existent! I feel much much better on this regime ...

[SueRoe]

Are there any health disadvantages to being on a combi regime when you are still peri Suzyq? Do we actually need to have a bleed when we aren't fully post menopausal? Presumably not if your specialist has approved it. I need to have my facts right before seeing my GP!

[Hurdity]

It is usual to prescribe sequi HRT when you are still peri because your own hormones are still fluctuating and if you are put onto conti HRT, your cycle can break through and gives rise to a lot of irregular spotting and bleeding.

However those who use a Mirena are in effect on conti HRT anyway - becase this delivers a continuous dose of progestogen directly to the uterus. I presume the dose is so high that eventually the spotting and bleeding stop - and I think in many women who are not even peri-menopausal, their periods stop with a Mirena.

As far as I know there are no health disadvantages altough the research carried out into HRT ( the big study) found breast cancer rates to be higher in women using oestrogen and progestogen, so it could be argued that progestogens should be kept to a minimum.

However this research was flawed and with HRT consisting of equine oestrogens and a synthetic progestogen, and increasingly it is thought safer to use bio-identical HRT ie estradiol and progesterone - which is what I use (Estradot and Utrogestan), However I am still on a cycle even at 61.

Hurdity x