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[Cassie]

Something I have often thought of....when we are pre menopausal our cycles are determined by various hormones doing their thing at different times of the month.
Once we hit menopause and start using HRT, we try to mimic that cycle,  for those ladies that use it cyclically, we use Progesterone and after stopping it, a bleed is initiated by the drop in Progesterone, in a similiar fashion to what would have taken place pre meno days.
But what tells our bodies after a certain number of days, to stop the bleeding?
My pre meno bleed was always approx 7 days and I have noticed my HRT induced bleed is pretty much the same and then it tapers off by itself, is it when all the lining is shed or is it another factor that ends the bleed? 

[dangermouse]

Yes it's when the lining has all fallen away that it stops as there's nothing left to shed.

[Hurdity]

Hi there - just to clarify - the extent to which the endometrium is stimulated by oestrogen is dependent on the dose of oestrogen, and likewise the extent to which this lining is then changed in structure (ready for pregnancy etc) by progesterone is also dose dependent - ie on the amount of progesterone. Therefore it may be the case that if insufficient progesterone is taken, then not all the lining will convert in structure (in effect) and therefore may not all be shed. However all the lining that is converted is most likely shed after the drop in prog. It is a complex process and other factors are involved in the clotting mechanism etc - but in effect this is what happens. If not all the lining is shed then it can build up and then shed sporadically ( as an abnormal bleed ie oestrogen breakthrough bleeding). Interesting that you bled the same amount pre and post menopausally!

My normal bleeds were far far heavier during my normal menstrual cycle - indicating that my HRT oestrogen levels are quite low in comparison ( as I would expect given the dose I take!).

Hurdity x

[Cassie]

Thanks Hurdity, this would possibly explain why I get an occasional breakthrough bleed if I go over 4 weeks as I am using 10 x 100mg Utrogestan,perhaps not all my lining is being shed, I am due another scan soon, as I am under a private gynae, so that will give me a better idea as to whats what,  was on 12 days of Utrogestan 100mg  at one stage. Mind you I am only on 1 pump of the gel. I never know whether the bleed is due to too little or to too much Progesterone, its a real mine field!
I seem to think you posted a link a while back which gave the safety stats for using 100mg cyclically was it not 12 days that was accepted to have the lowest risk for endometrial build up.... I know 200mg is the licenced dose but am sure I read a link somewhere regarding 100mg usage?

[Cassie]

I am bumping this thread up, not sure if it was yourself Hurdity that had the info re 100mg usage of Utro and what was considered a possible safe dosage, apologies, as I know you have had your hands full on other threads and it may not have been yourself that originally posted it...

[Jenna]

I am bumping this thread up, not sure if it was yourself Hurdity that had the info re 100mg usage of Utro and what was considered a possible safe dosage, apologies, as I know you have had your hands full on other threads and it may not have been yourself that originally posted it...

Is this Hurdity's reply you are looking for, Cassie?

https://www.menopausematters.co.uk/forum/index.php/topic,23372.msg526467.html#msg526467

[Cassie]

Thankyou Jenna, I am not sure what I read back when, but this is very interesting, thankyou for posting it again.

[Hurdity]

Hi Cassie

Sorry - I've been away - feeling tired at the moment and brain not wanting to cope with complex biological questions!

I think it really is an individual thing - but the doses given are based on an average for populations of women in a particular trial - and the licensed doses are those which were shown in trials to reduce the risk of endometrial hyperplasia. There are the trials that Studd and Panay ( and Sturdee even longer ago) carried out (as far as I recall) and there are later ones with vaginal progesterone at various oestrogen doses.

Thanks Jenna - you're great at searching for response . That looks like the research summaries for the more recent work on vaginal prog.

The only way to be sure in your case is to have a scan as already suggested. Theoretically 1 pump of oestrogen is quite low but some women absorb it incredibly well - I mean I am sure someone posted that they achieved levels of 400 pmol/l on one pump and I know mine were approx 220 or similar on 50 mcg patch. It also varies with body size and fat too.

Hurdity x

[Hurdity]

You are a mind of information  I was wondering (sorry as I am duplicating this question)...if my HRT is too low, is this the reason my bleeds are wonderfully light and short (1 day + a couple of hours!!). I'm in two minds whether to go back to the doctors because a) I'm always worried they will tell me to come off it and b) I am having the odd hot flush (especially during the progesterone part) and the odd anxiety moment. BUT in fairness…all liveable with.

Sorry to ramble…what is the worst thing that could happen if I increased my dose ?

A mine, even  .....

You would have to remind us where you are in menopause, how old you are and what HRT you are using and at what dose. If your flushes are not controlled then maybe you would benefit from increasing the oestrogen dose - but you need to increase the progestogen dose correspondingly in order to protect the uterus - and it would depend on what HRT you are taking now.

Hurdity x

Pinkfizz I think you will need to delete two of the posts as the same post has come up 3 times!!!

[Cassie]

Thankyou Hurdity, I hope that you feel better soon.

[Pinkfizz]

I'm so sorry for the duplicate posts, honestly we had a fire at work (happens a lot!) and before leaving the burning building (that wasn't) I keep trying to post my comments...3 times!! Deleted and apologises .

49, 12 months on HRT, Novofem sequential combined, low does 1mg (?).

Thank you x

[Cassie]

Are you asking if its a low dose Pinkfizz? I think 1mg is considered medium to low, but am sure someone will be along to confirm that. Hope all ok after the fire!

[Hurdity]

Ooer Pinkfizz - a fire at work  .  1 mg oestrogen is a low dose according to the info on this website although there will be variation in how much different women absorb due to digestive differences amongst other reasons.

Hurdity x