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[Eastside]

Hi all. I hope you are well. I finally succumbed to trying HRT: Evorel 50 and 200mg Utrogestan cyclically. It's only the first month, so I'm not totally sure what to expect. I finished Utrogestan on day 26, which was 4 days ago. But no bleeding of any kind yet. I have painful boobs, which is normal, but that's it. My periods were always quite regular anyway. So I'm getting a bit twitchy. Perhaps this is normal at first to have delayed bleeding or no bleeding? Also, I'm now very confused about what I should consider as day 1 of my new cycle, as I haven't bled yet. Does anyone have any thoughts? Many thanks!

[LittleClaire]

Hi,

I am also on the same dose of utrogestan as you with a 75 Evorel Patch, and since increasing to this level one month ago I’ve completely missed my period that was due 2 weeks tomorrow. I’m not pregnant as I’ve tested a few times but my boobs have been sore also. I wonder if that’s a side effect. I’m thinking it might take a little while to settle down

[Eastside]

Thank you for replying. Hmm, perhaps so. I just find there are lots of information gaps like this. The Utrogestan leaflet just says you will normally have a few days' withdrawal bleeding after this time e.g day 26. It also says elsewhere in the leaflet 'you will have a bleed once a month'. It doesn't say when, or the normal window in which to expect that, what to do if it doesn't happen, and what to then count as your next cycle if you don't bleed. I've just spotted elsewhere on the leaflet it says "you might get some bleeding at the end of each month, like a period'. So which is it? Who wrote this thing?!😊

[LittleClaire]

Yes I agree it’s not really clear is it! We aren’t told adequate information I don’t think. I wasn’t even told when I first went on HRT not to stick the patches above my waist. Yes it’s on the information leaflet but 9/10 people don’t read it all and I would have thought with the risks etc a GP would think to relay that information to a patient in the surgery. I’m thinking also maybe with periods they are all over due to the fluctuations in peri anyway so even HRT may not regulate this to once a cycle at the end of the progesterone dose.

[Eastside]

Oh gosh, you should have been told that. Mind you, come to think of it, I wasn't either! I scrutinised the info leaflet.

There is another forum post on a similar topic https://www.menopausematters.co.uk/forum/index.php/topic,66654.0/prev_next,next.html#new

if that's the correct link. Not sure it exactly answers the question, though. Although the poster said she had a bleed after 5-7 days or something. As for me, my periods were always quite regular, give or take a few days, up until a month ago, so I'm presuming any irregularities are down to the Utrogestan.

I am loathed to bother the GP/nurse again, but I kind of feel I may want to do it out of principle now as I think there shouldn't be so many important info gaps leaving us guessing and making possible errors. If I find out anything else, I'll post it.

[LittleClaire]

Thank you, I’ll have a look at that other post. It does seem fairly common, especially if your periods were regular before starting HRT. Mine were too, and even when I started on Evorel Sequi (50 and conti) my periods still came when they were meant to it’s just this first one since the increase I’ve missed. Don’t worry about bothering your GP, it’s their job plus even if it’s just to put your mind at rest

[Eastside]

Thank you. I just wish we weren't left guessing. I read the leaflet again and it does list lack of periods/irregular periods as a side effect - for other HRTs rather than Utrogestan. It also says to talk to a doctor or pharmacist about any side effects.

Also found this online on NHS. If I was reading between the lines, I would maybe think that you ignore whether you've had a bleed or not, in terms of calculating the dates of your monthly cycle, and just go with 28 days, whether you have a bleed or not. But, that could of course be wrong:

Sequential combined HRT is taken in 28-day cycles. This means that you take oestrogen every day, but you only take it with progestogen for 10 to 14 days of your cycle. You then repeat the cycle without a break.

You'll usually have withdrawal bleeding at the end of each course of progestogen.

And this from the NHS suggesting one should have a bleed:

Sequential combined HRT
You'll usually be recommended to take sequential (cyclical) combined HRT if you have menopause symptoms but still have periods.

There are 2 types:

monthly HRT if you're having regular periods – you take oestrogen every day, and take progestogen alongside it for the last 10 to 14 days of your menstrual cycle every month

3-monthly HRT if you're having irregular periods – you take oestrogen every day, and take progestogen alongside it for around 10 to 14 days every 3 months

You should have a period at the end of each progestogen cycle. If there is no bleeding at these times, speak to your doctor.

If you started on sequential HRT during perimenopause your doctor may recommend changing to continuous combined HRT post-menopause.


So my conclusion is to wait until Tuesday and then, if no bleed, get on to my GP!

I do hope something falls into place for you

[Eastside]

I've submitted an enquiry to the company that makes Utrogestan (Besins Healthcare). I'll post any reply of any use. I just have zero tolerance for shoddy information provision these days! 😂

[bombsh3ll]

Why question good fortune?!

Not everyone bleeds when they "should", or at all, on sequential hormone therapy.

If you have finished the course of progesterone, just start counting again from day 1, rinse and repeat.

If you find you are largely bleed free after several months to a year on this regimen, you could consider moving to continuous progesterone at 100mg daily.

[Eastside]

Thank you! It's great that you've been able to find out that not everyone bleeds. I've only seen patchy/mixed info about that, which is exactly my point. According to an NHS site I saw, I should be having a bleed..so who knows 🤔😜
Sadly, it's not really good fortune for me as I feel like crap, have extremely painful boobs and a stomach ache. But, you can't have everything, I guess. 😂 Thanks again for replying

[LittleClaire]

I suppose it does say you “should” have a bleed ie not everyone does. Hopefully it’s just our body getting used to the increase in hormones and things will settle. I too feel bloated, sore boobs and achy like I want to come on, it just hasn’t happened. Like bombshell said I’ve just started again counting from day 1 when I stopped the progesterone and will see what happens again next month. Let us know if you hear back from the company I’d be interested in their response.

[sheila99]

If you have a cycle of your own it's very likely your own cycle will determine when you bleed, I found my own cycle was always stronger than the hrt one. Medical advice is to stick to the 28 day cycle regardless of when you bleed but I started counting again on day 1 of my bleed, otherwise the two cycles get further and further out of step.

[Eastside]

Thank you both. Ok that's useful to know about counting day one as being after you stop progesterone. That's also interesting to hear about the natural cycle taking precedence. Mine tend to come early rather than late, so according to my natural cycle, I'm two days late. So I'll see what happens and will post anything further I find out.
I hope you feel better soon, LittleClaire

[joziel]

Eastside, one major reason many women don't bleed on HRT is because they are not taking enough estrogen. 50 is a pretty low dose of estrogen. There is mass hysteria around estrogen in traditional menopause care and the upshot of that is tiny micro doses of estrogen (much less than a woman would have pre-menopausally in a normal cycle and much less than even in the combined pill, although that is synthetic) and then usually a heavy-handed dose of progesterone....

The end result is estrogen receptors get down-regulated from continuous progesterone use when women use that (which is not something ever occurring naturally, since we only make progesterone at ovulation and have it for half the cycle) and the tiny dose of estrogen in licensed doses of HRT means that not enough endometrial lining is built up to be shed when you then stop the progesterone.

I experienced all this myself. Only when I increased my estrogen to around 400-650pmol did I begin to bleed again. If you're not taking enough estrogen to cause a bleed, then you also won't be taking enough to get the other growth proliferative benefits of it. If you want to check out this perspective in more detail, look up Dr Felice Gersh on YouTube especially her estrogen dosage video there.

Having said that, it can take up to 5 nights off utrogestan before you start to bleed. That's what it routinely takes for me, at the moment.

[Eastside]

Thanks so much joziel. There's so much to learn. Before starting HRT I was having very regular, fairly heavy in part periods. So there must have been enough of a balance. The nurse did explain that I was on a low dose, and that was much lower hormone ratio than I would have had in my 30s. I think it's probably worth getting back in touch with them if no bleed after today (today is day 5). Like you say, the balance might be off, or perhaps I don't really need it at all. I was deffo having some symptoms, but I only went on HRT to try to establish what might be hormonal and what might be psychological, given I have previous trauma and generalized anxiety. So far, after a month, HRT has made little, if any, difference. Anyway, thank you. I'm sure it'll become clear at some point! 🤪