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[patch]

help!!

Hi all!

I have a HRT question and hope someone can help!  I asked my doctor, but he said this area wasn't his forte and to wait until I went to a clinic I'd found that my council run. But the waiting list was three months, and today (my appointment was this afternoon after a three month wait) I've found out that my appointment has been put back another two months!

Here's the question: I'm on sequencial HRT patches (evorel sequi), but because my periods are irregular, they've gone completely out of synch with the progestogen part of the four-week patch cycle (my natural periods come anywhere between three and five weeks apart at the mo). The patches have no effect on whether my natural period occurs or not; they don't pull my body into their timetable or anything (been taking them for about seven months).
I'm pretty sure it can't be good for me to take a progestogen out of synch with my body's own production of progesterone - I'd be all progesterone'd up for about three weeks out of every four, and presumably have continuous periods, since progestogen induces a bleed!
So do I keep on resetting when I take my progesterone to at least try to fit in with my natural irregular monthly cycle, which would mean that some months I'm taking just a week or so of estrogen-only patches before I start taking the estrogen and progestogen combi ones, or...I don't even know what!

I simply don't know when to take the progestogen patches, as they aren't strong enough to overcome my body's natural bleeds, which are irregular, so I feel I should try to make the patches fit in with my natural rhythm - but that's irregular, so how do I know when to take the progestogen so it fits in with my periods?!

To be honest, I've taken the estrogen-only patches for the last three months, because I was figuring that if I'm getting a natural bleed, all be it irregular and unpredictable, then I can't be getting a build-up of the endometrial lining of my womb (which progestogen is there to stop). Does that seem reasonable?

Any opinions very much appreciated, as I'm going nuts here trying to figure it out alone!

[Dancinggirl]

Hi and welcome to MM patch
I am certainly no expert but I think you have caused a lot of the problems by changing when you use your progesterone.  In peri meno your own hormones will fluctuate so if you weren't on HRT you would still get the odd period.  HRT used properly should override this underlying fluctuation but it can take some months and occasional random bleeds can occur. Trying to fit your HRT withdrawal bleed in with what you perceive as your natural period is not going to work. You may think you are getting a natural period but in fact your body is giving random bleeds because the HRT is not in control. I hope that makes sense.
If you were to stop HRT you may find that you get few if any periods. Many women who are not on HRT find that through the peri stage, that can be many years, they get times when their periods are regular and then long gaps between. HRT will just normalise your hormone balance and the withdrawal bleed is an artificial bleed that keeps your lining from building up.
For the next 2 months, before your next appointment, I would simply stick to the HRT regime as it is supposed to be used as per the instructions and see how you go. You haven't given your body time to adjust to the HRT regime.
I do hope that helps.  Keep posting.   DG x

[Hurdity]

Hi patch

As you yourself have said, if your natural periods are themselves variable, unfortunately then you can't hope to synchronise with them as you don't know when they are going to occur.

The main problem with having oestrogen only patches is that you are not having the right amount of progestogen to oppose the oestrogen - only your own progesterone. The amount of progesterone needed to thin the womb lining is dose dependent ie the more oestrogen you have, the more progestogen is needed to thin the lining. Therefore you may well end up having an over-thickened lining and more irregualr bleeding than you should have.

If the patches are having no effect on your natural periods then it sounds like your cycle is still very strong. Can you tell us something about yourself eg how old, what your symptoms are ( were) and what your periods were doing before you started HRT (eg have they been irregualr 3-5 weeks for a year or so?) and how long you've been on it.

I understand your desire not to have too much progesterone but you do need to have sufficient. As your cycle gets weaker some cycles will be anovulatory ( you don't ovulate) and you won't produce any progesterone which you will need to shed the lining that builds up eg over a couple of months.

The only way you can regulate your cycle is to take some sort of contraceptive pill - Qlara is the one that has been mentioned on here, because the oestrogen is bio-identical, but it does involve having 3 weeks of progestogen - you would get a monthly bleed on these.

Sorry I can't be of more help!

Hurdity x