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[0114tw]

Hi. I got some advice on here re cyclical HRT (gel & progesterone) and had a period following 12 days oral progesterone (I think it began 2 days after). I don’t like the side effects of progesterone in terms of mood and so this month I used it vaginally, which I think was better. However, I am yet to have a period having stopped progesterone 6 days ago. Just wondering why this might be? What do I do now, eg do I just keep going with scheduled cycle and hope that my period comes next time? Any thoughts gratefully received. Thank you in advance.

[CLKD]

I would keep to the scheduled regime, it can take 3-4 months to get into a rhythm.

U could put the product name into the search box to C what pops up.  Makes notes ;-)

[0114tw]

Thank you. Will do. Utrogestan.

[Clarella]

I’m having this issue, I finished the prog part 10 days ago and no period!

I’ve been using vaginally from the start. This happened the first time I started hrt and it eventually settled, though it’s a week later for me. 

I raised to 75 last month and so I’m guessing that’s what has happened- or I’m starting to miss periods.

Gp said vaginally is “better for bleeding.”

[Clarella]

…and period just started now. Explains why i felt soooooo tired yesterday!

[joziel]

Just keep going with the scheduled routine. Your body will slowly get into sync but it might take a few cycles.

Some women do stop bleeding and if that happens, it's an indication you're ready for a continuous HRT.

[Clarella]

Probably need to start new thread but can anyone explain why they tend to go to continuous automatically after a year, even if still bleeding?

[joziel]

Continuous provides better protection for your uterus. And some women will stop bleeding when moved to it.

Not all doctors move to continuous after a year, I think Newson does - but many keep women on sequential until they stop bleeding.

[Clarella]

Ah ok I see, thanks.

Gp mentioned it but I think has been trained by Newson.

[0114tw]

I started my period too, so it was just a matter of waiting, as suggested. Thanks everyone. It’s so useful to be able to get advice on here. I really appreciate it. I also didn’t know that some suggest  moving to continuous after 12 months. My practice said after a year of no periods.

[sheila99]

If you move to a conti regime whilst still peri you're likely to get breakthrough bleeding. Using it 27 days out of 30 can be useful in late peri as it allows a bleed if there's been a build up. I found my own cycle was always stronger than the hrt one. If you don't have a strong cycle of your own the hrt one can take over, if you still have your own cycle I found it best to adjust the hrt cycle to my own.

[Clarella]

I was told by a member of another forum who’s under a top London consultant and regularly posts hood advice the below: (my paraphrasing)

‘Moving to continuous is a choice but most GPs don't appear to understand that. Women can choose to avoid the bleeds by doing so.

sequential has a slightly higher risk of uterine cancer but a lower risk of breast cancer.

Breast cancer risk is lowest with estrogen only (and actually lower than for women NOT using any hrt), higher with sequential, highest with continuous. (Obviously this is still low.)

None of this research was on utrogestan or on vaginal use, small indications show same or lower risks.

The Guidance is to move to continuous at age 54 as 80% of women are post meno then, or 12 months after the last natural period.

If you use it before either of those can cause spotting as the smaller (daily) dose of progesterone doesn't control bleeding enough.’


My confusion is that if you’re on sequential, how do you know if your periods have stopped as it seems sequential will cause a bleed that’s not your natural period?! I’m guessing if peri symptoms started in early 40s you can guess that you’re earlier into meno?

So basically you can use the progesterone to stop bleeds if your own cycle is weak (mine can be but bleeds do get heavier as I raise my patch.)

[joziel]

I'm not at all sure about some of that info 

All the stuff about breast cancer risks, for one. All we know is that there is a tiny increase in the number of women on (any) combined HRT (sequential or continuous - the research doesn't distinguish) who get BC. The increase doesn't start until after the age of 51. The increased risk is so tiny it is debatable whether it is even statistically significant and it is far less than the increase from being obese or drinking alcohol. The research used the synthetic progesterones, not body identical.

All that stuff about continuous vs sequential risks is not anything that is in any research I've come across and sounds like opinion rather than fact/research. I mean, both are still using the same amount of progesterone because sequential is using 200mg a night for half the month and continuous is using 100mg a night for the entire month - the overall progesterone intake is the same in both groups.

In terms of bleeding, many peri women are on continuous for one reason or another - I am because I have mild endo and continuous is recommended for endo sufferers. A woman can always try continuous and if it leads to problematic break-through bleeding, then go back to sequential. You're not committed to stay on one or the other. Sequential doesn't always cause a bleed - many women don't get them even when their progesterone stops and that is an indication they are ready to move to continuous.

By the way, women have used the POP for aeons in peri-menopause and it is a progesterone which is taken every day (continuous) and leads to either unpredictable spotting for a few days/a light breakthrough bleed or not bleeding at all - and you can take it until you're 55. But no one gets their pants in a twist about that. I don't get why people are worried about 'unscheduled bleeding' with HRT in younger peri women either (ie 40s) who wouldn't be expected to be post-menopausal yet and whose spotting on a POP would be completely acceptable. 

[sheila99]

Perhaps they panic as it could be an indication of cancer, presumably younger women get it too just in smaller numbers. I think there is research that indicates the risk is slightly higher in meno women who remain on sequi rather than conti but I don't think it's much. I think there's a post from hurdity with a pointer to it (or my memory may be failing here  ).  They panicked when my lining was 6.7mm after 8 weeks without a bleed (scheduled bleed didn't happen), I thought it was surprisingly thin, the panic seemed to be purely because of my age. Perhaps they just don't have enough experience of non standard cases to make any meaningful judgement.