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[Blue Kingfisher]

Hi everyone,

I’m wondering if any wise ladies can advise why I may not have had a withdrawal bleed since stopping progesterone. I stopped it 9th April so about 2.5 weeks ago. Under the advice of the doctor I was trying 200mg Utro pessary vaginally for 21 days with 2.5 pumps oestrogel. This made me very unwell and obviously this mega dose does not suit me. I still haven’t had a withdrawal bleed and wondered what this meant.

I’m inclined to give myself a longish break from progesterone now and go back to using it for less days each month (like 7) to see how that feels now I’m on a lower dose of oestrogel (last time I tried just taking it for 7 days a month I was on 5 pumps oestrogel so I’m hoping the lower oestrogen dose may be better for me when on the 7 day regime). I tried the 21 days as some people have this theory that perhaps you just aren’t on ‘enough’ progesterone rather than on too much…..there was only one way to find out and it was painful.

Thanks for any advice

[sheila99]

I am in the same boat. Now I'm late peri and have little cycle of my I rarely bleed (4 gel, 200mg x 12 days utro, 6 week cycle). I have a scan in a couple of weeks to check the thickness as I'm concerned it may be building up. I haven't heard that using for longer helps. Do you have a cycle of your own? It could be your body overriding the hrt cycle (my own is always stronger) or perhaps there hasn't been a build up. I don'ttthink  missing the odd cycle is a problem but missing many may be.
IMO 5 pumps gel and 7 days utro is perhaps a bit risky. I would stick to the 12 days if you can tolerate it.

[Blue Kingfisher]

Hi Sheila, my plan was to try 2.5 pumps oestrogel (my current dose) with 7 days Utro. I used to be on 5 pumps but that was a while ago. I’ve no idea if I have a natural cycle or not but I used to always get a withdrawal bleed after stopping Utro when on 5 pumps oestrogel. I’d just like to understand what no withdrawal bleed is a sign of. e.g. too low oestrogen for a withdrawal bleed to now take place. I’ve no idea but would be helpful to know. Hopefully someone will have some insight for us.

[VanillaLover]

I would be interested in this too. My own cycle has overridden the utrogestan withdrawal so far for 6 months of HRT - period arrives before I finish utrogestan. Last month I thought I was getting in sync …period arrived four days after withdrawal.

This month I’m on day six and no sign. Though I do feel very much like it’s coming!

I believe that lack of a withdrawal bleed could be because the uterus has not thickened much in response to the oestrogen? Or maybe it is simply your own hormones are too strong still. I’m not sure!

As pp said missing one month is not a problem in itself …

I take 200mg for 14 days of month btw

[Hurdity]

On average, the extent to which the uterus lining grows in response to oestrogen is dose dependent ie more oestrogen = thicker lining. Similarly the amount of progesterone needed to thin or shed the lining is also dose dependent. Higher doses of progesterone for longer will be more effective (on average) than lower doses for shorter duration - but depends on the dose of oestrogen too. The licensed doses of progesterone in all combi HRT products are worked out to be effective for the majority of women - on average - as a result of studies.

As has been said - if you still have a cycle ie ovulate - this can override the HRT cycle. If you are post-menopause then you are pretty much just getting hormones from the HRT.

So why would one not bleed?

The main explanations I suggest are: 1. the lining has not built up sufficiently to be shed (due to lower oestrogen dose or absorption 2. the progesterone dose has thinned the lining during its use so that there is no lining left to shed 3 . the progesterone is not being absorbed. If 3 then the lining would continue to build up until it became too thick and then would be shed randomly and spontaneously as abnormal bleeding.

If using 200 mg progesterone vaginally for 21 days, unless the lining was thickened under previous oestrogen doses - this should be more than sufficient to shed any lining that has built up, because it is greater (longer duration) than the licensed dose. The other explanation is that you haven't absorbed it, though the capsules are designed to be used vaginally  as well as orally so no particular reason why not.

It is better to use for a longer duration than shorter - research has shown -  ie the 7 days is not advised as it does not give enough time for the progesterone to do its job - but under supervision of your doc, of course this can be tried.

Of course we are not identical machines so what is happening in your case I can't say ....

Does that help?

sheila - I'm not sure what you mean by this "I haven't heard that using for longer helps." ? ie helps what?

Hurdity x

[VanillaLover]

Thanks Hurdity that’s very useful to me

[Blue Kingfisher]

Thank you Hurdity! Extremely helpful as ever 

I’m now on 2.5 pumps of oestrogel & Utrogestan. When I was on 4 pumps of oestrogel & Utro I had a bleed like clockwork, always 3 days after stopping Utro. I’m having low oestrogen symptoms, dry down below, flushing, night sweats & insomnia. My oestrogen was tested via blood test 2 weeks ago and it was 105.

I think I need to increase to 3 pumps & see how I feel?