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[befuddled]

Hello everyone

i'm hoping you can help me with a question about bleeding in the first few months of hrt.  i'm on utrogestan 100mg 25/28, I had a bit of spotting in the first couple of months, but i'm now on day 8 and having what looks and feels like a proper period after three weeks of the usual pms stuff i used to get.  Is this an hrt thing, or does it mean i still have some natural hormones sloshing about?  i'm 54, my last period around 18 months ago but a bit of spotting earlier this year, so not sure if i'm meno or late pre-meno.  If it is a period, maybe i should speak to gp about changing to sequential?  Anyway, in the meantime, should i take my utrogestan tonight and keep counting days as usual, or go without for a couple of days till the bleed stops and then start counting again as day 1?  Maybe it doesn't really matter either way and i'm just overthinking things?  Any thoughts/advice appreciated.

[Hurdity]

Hi befuddled

If during the 18 months since last period you were not taking HRT then at your age you would be considered post-menopausal. If you had a bit of spotting - and also not on HRT and that was less than 12 months since your previous period then strictly speaking you should start counting again from that point. So if you then started HRT before another 12 months had elapsed, you cannot be sure you were post-menopausal.

You haven't said how much oestrogen you are taking nor how long you have been taking it. The 25/28 day utrogestan may well not be sufficient to protect the uterus on higher doses of oestrogen, or your body could just be adjusting to the new regime ( if it's within the 6 month time frame when this is expected ie some spotting etc). Alternatively it could be another ovulation/period. You cannot know which.

I would always continue to take the utrogestan as prescribed as you need this to protect the uterus - though if it was a "normal" period following ovulation then your would have produced your own progesterone.

As always - if you are concerned about any abnormal bleeding then speak to your doctor.

Hope this helps

Hurdity x

[befuddled]

Thanks for your replies.  Yes, Hurdity, it helps, it really does.  I've been reading and hearing so much about meno/hrt lately, finding an answer to one question usually leads on to more questions, and it's all got me a bit confused now.

I'm only in month 3 of hrt, early days so i'm not worried about the bleeding, but just trying to understand what's going on.  Does the hrt regime not depend on whether i'm pre or post meno?   I'm using estradot 50mg patches, with utrogestan 100mg for 25 days, then 3 days off.  i was expecting some spotting, but the pms symptoms (heaviness, tender breasts) makes me think this one is more like a period.  But if there's no way of telling what stage i'm at, how does gp decide what route to go down (continuous or sequential) ?

The question about whether to stop utrogestan for a couple of days - sorry if i didn't explain it very well - if the body is going to bleed anyway it would be more regular and predictable if it was in sync with the 3 progesterone-free days?  so to start counting again day 1 as the day you stop bleeding??  That probably all sounds a bit vague, and i may have got it completely wrong,  that's the problem with only half-remembering things i've read.  As they say, a little bit of knowledge is a dangerous thing!!

[Hurdity]

Yes the HRT regime generally depends whether you are menopausal or not. Continuous combined HRT is for post-menopausal women and cyclical for peri. Having said that some women continue with a cycle even when post-meno due to progesterone sensitivity/intolerance or too much breakthrouygh bleeding. If you have a continuous combined regime when still peri then this can also cause unpredictable bleeding if ovulation continues sporadically.

The 25/28 utrogestan regime is ostensibly a continuous combined regime (the license is for post-menopause I think?), but recognising that if there has been a bit of build up of womb lining - it provides an opportunity for it to be shed after the 3 days off. Many docs actually prescribe Utrogestan every day for post-menopause.

The thing about syncing is that this is only possible with more or less regular periods - if you have had a random ovulation and you are pretty much almost at menopause, then trying to sync is not going to work because you may not ovulate again or for a long time, so in your position it's best just to stick to the regime, but if you continue to experience bleeding then you will need to work out what's causing it - either you've gone back to ovulating regularly, or the lining is building up, or something like fibroids or a polyp etc - amongst other reasons.

Hurdity x

[befuddled]

 Hurdity, you have a knack for explaining things so that they make sense.    Thank you again for the info, very much appreciated