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[Mandee]

Hi all,

I have been taking utrogestan 200 vaginally for the first 12 days each month alongside evorel patches since 2015.
My bleed has never started at the normal time of around 3 days after finishing the utro course. The earliest has been 5 days after and the latest was 12. The most common time is 8 days but it's rarely the same day each month.
I have searched on here and can't find any other ladies with a similar issue, just loads whose bleeds start too early.
I have also searched online and can't find anything.

Could it be that the utro takes far longer than normal to leave my system than the usual 3 days?

Before I started this regime I was on evorel sequi 50 patches and was told to start the first pack on the first day of my period which was then around the beginning of the month. My bleeds always started exactly on time, around 3 days after the end of the pack, at the same time as my natural periods which were still pretty regular at that time.
When I was switched to the 75 patch with the utrogestan I was told to take the utro on the first 12 days of the month which was a whole 2 weeks out of synch with my own cycle so I've always wondered if this is the cause. I'm 54.

Surely the meno doc should have told me to keep to the same schedule as my own cycle? I didn't know anything about this back then so never thought to mention it.

I've never had any breakthrough bleeding at other times of the month at all.

[sheila99]

It sounds as though your body is out of step with the hrt, it's supposed to be working with it not against it. I've had the same problem as my natural cycle is abnormally long. No advice from gp but I have found it better to alter the hrt to align with my cycle, if I don't the bleed can come at any time of the hrt cycle. I'd suggest taking utro to finish 2-3 days before you expect to bleed.

[Hurdity]

As I understand the thinking behind taking Utro on fixed days of the calendar month is that once you are in late peri or post-meno then you don't have much of a cycle left so the artificial cycle created by the HRT is all there is. For women in early peri who have only skipped the odd period then to me it makes no sense - as you say - you will be out of sync with your own cycle until you get further towards menopause.

However if you have been taking it since 2015 and you were peri-menopausal then as you say, then surely you also won't have much of a cycle any more or at least be late peri-menopause?

If you have always bled on the oestrogen only part albeit a bit later than you expect then I think this is fine - if you feel OK. A paper I read suggested that progesterone taken vaginally is held longer in the uterus and systemic levels can stay a bit higher for longer than when taken orally. Maybe this is what is happening in your case to some extent?

If you are still peri-menopausal then your cycle may well take over sometimes leading to bleeding at the "wrong" time. However I doubt you would now still be having a very regular cycle to be out of sync with, if you have been peri-menopausal for that long - though not impossible of  course!

Are you taking 1 x 200 mg or 2 x 100 mg?

Hurdity x

[Mandee]

Thanks for your replies.

Hurdity, that's what I thought as well regarding not having much of a cycle left now. My meno doc never seemed bothered by the utro timing but did say my bleeds go on a bit longer than normal sometimes. The longest was 12 days and very scanty, the shortest was 2, it still varies each month. Surely if my cycle has pretty much stopped then the bleeds should all be the same length?

I keep a diary and noticed last year my bleeds were almost the same length each month and I was pretty much symptom free. The three years before that they were all over the place and I felt crap with very bad sleep.

The utro hanging around in my system for longer than usual definitely looks to be the likeliest cause of the late bleeds as you say, it does seem pretty rare though as I can't find info on anyone else taking so long to start.

I have never had any bleeding at other times which is odd as the patches have never completely controlled my symptoms, especially the sleep.

I'm taking 1 x 200mg utro.