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[Cassandraa]

I am in perimenopause, on my second month of Estrogel, one pump, cyclical with 12 dd Utrogestan. This is the second instance I am having breakthrough bleeding before I even start the Utrogestan. It is - and feels - very much like a normal period. I am wondering if this is my natural cycle coming through, or if breakthrough bleeding is common during the first few months of treatment, especially on a low dose. If it is the former, should I try to calibrate the timing of the HRT to my cycles (this would mean interrupting the estrogel for a few days, even though I am about 2/3rds of the way through the monthly treatment)? Or should I continue and persevere until everything hopefully settles?

I could increase the estrogel to 1.5 or 2 pumps, but am not super keen to do so due to intestinal discomfort / bloating. Otherwise I am very happy with the treatment.

Also wondering if the intestinal discomfort / fluid retention tends to settle after a few months of treatment, as this is the only thing that is really getting me down!

TIA for any feedback xxx

[Hurdity]

Hi Cassandraa

I'm not a gel user so can't really comment on the side effects although with time many side effects with HRT generally do settle as the body adjusts. If you are using utrogestan cyclically and are still very much peri-menopausal then your cycle may well break through as HRT generally does not suppress ovulation. If you are able to tie the two together that may help although with irregualr cycles it could go out of sync again. If it's a proper period then you count the first day of the period as Day 1 and that starts the cycle, taking utrogestan on Days 15-27.

You would only increase the dose of oestrogen if the current dose is not controlling your symptoms.

I hope you feel better soon and you manage to get it sorted

Hurdity x

[Cassandraa]

Dear Hurdity,

I've only just gone back to the forum and found your message (I don't think I received a notification), so apologies for the late reply!

Thank you for your feedback - it's really appreciated.  I am so relieved that your advice corresponds to what I've been doing - i.e. "resetting" the HRT treatment on day 1 of my period. I'm just wondering if it's safe to skip the utrogestan at times. Having said that, I did take utrogestan shortly after one period - but I had zero bleeding after stopping it because the uterine lining had already been shed, so I'm not sure that taking it is any use in these cases.

My gyno said I could slightly vary the number of days taking oestrogel (as long as I add the 12dd of utrogestan at the end).  I may try this and hope to get a little closer to synchronising things. 

Thank you for reassuring me  xxxx

[Hurdity]

No problem Cassandraa. Exactly - as long as you take the full course and don't go too long between cycles (of utrogestan), the exact number of days is not crucial. Do hope you manage to sort it.

Hurdity x