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[Greyhoundgal]

Hi everyone

I only started HRT 3 months ago, and am on my 3rd 25 day cycle of 100mg utrogestan, as I was still having irregular periods. I've been having very heavy withdrawal bleeds - straight back to the bad old days of peri - as well as fatigue and fluid retention.
My GP has suggested I switch onto a 12 day cycle of 200mg utrogestan from days 15 to 26 of my next cycle, as he says this will give a lighter withdrawal bleed.
I'm a bit confused, as his reason for prescribing the original 25 day cycle of utrogestan, was that it gave a lighter bleed than the 12 day cycle.
Has anyone made this switch from 25 days/ 100mg to 12 days/ 200 mg? Did you experience a lighter bleed on this protocol? Did you experience any other changes/ symptoms with a change in regimen?
This all seems to be a very inexact science, and I'd be really grateful to hear about other's experiences.

[Clarella]

I haven’t had any experience I’m afraid but my Gp did say something about using utrogestan vaginally “can be better for bleeding.”

I’m not sure why the cyclical would work better; potentially a stronger dose of utrigestan. I have seen some women use more than 100 on continuous. Or mirena?

[Greyhoundgal]

Thank you for replying. I'm considering trying the vaginal route once I've tried this new protocol. The GP mentioned the mirena as an option, but I have fibroids, and don't tolerate synthetic progesterone at all in any dose, so am keen to avoid this option.

[Hurdity]

Hi Greyhoundgal

  or should I say welcome back? We used to have a greyhoundgal I seem to remember but maybe she left???

OK so what were your periods doing before you started HRT? How long a cycle, how heavy the bleeds? It could be that if you were having irregular periods then you were having some anovulatory cycles and your lining was thickening as the eggs were ripening but they didn't develop so you didn;t ovulate, so the lining was not shed as it should be. In this case the lining gets thicker and leads to heavier periods. Now that you have started HRT, you are taking progesterone each month so you could be shedding the lining that was already there and it should eventually settle.

Both the 25 day and the 12 day prog regime are cyclical so potentislly give you a withdrawal bleed, but the 25 day one is lower dose. The nearer you are to menopause (ie infrequent ovulation) then the more likely the 25 day regime will work well giving you a lighter or non-existent bleed ( once your lining has thinnsed down).

If your natural periods were still fairly frequent then the 12 day x 200 mg regime would be better as your natural cycle will still be coming into play.

Does this help?

Hurdity x

PS As I wrote this  and just about to post, I see you have fibroids so this could also be causing a heavier than usual bleed - and that being the case then a longer dose of prog would be more preferable, once a possible thicker lining has been shed?

[Greyhoundgal]

Thank you, Hurdity, for your detailed reply. My periods had reached the stage of being very erratic - with cycles as long as 70 days, followed by 3 periods that were 15 days apart each. So I have no clue where that leaves me uterine lining wise, so to speak.
Generally speaking, the utrogestan doesn't seem to be suppressing bleeding at the lower dose, as I have started heavy, crampy"periods" at day 22 of each 25 day cycle.
I'm beginning to despair as  the first 6 weeks of HRT resolved my meno symptoms, and now I'm wondering if it's worth taking HRT if it's going to bring back the bleeding issues that late peri was resolving..
If this new regime fails I'm going to speak to the GP about taking the utrogestan vaginally.
Thank you so much for your thoughts and comments.

[joziel]

Hey, don't despair!

So firstly, when your GP put you on 25 days on and 5 days off utrogestan, that was actually a continuous regime. I know it had 5 days off, but the 'old' continuous regime had 5 days off - then they realised that actually this caused bleeding and you didn't really want women on continuous to bleed. So they changed it to be 100mg every night. So, if your GP is still using an old-style continuous regime, it suggests to me that maybe they don't know loads about HRT... The continuous regime (either of them!) is supposed to be for post-menopausal women, not peri. If you are not post-menopausal and they put you on a continuous regime, again, it suggests they don't know loads about HRT.

In putting you on 200mg for 2 weeks and then stopping, that is the sequential regime. It is for women in peri-menopause who are still expecting to bleed at some point and need to schedule the bleed. When you stop the progesterone, you will bleed.

I haven't heard of either being associated with lighter bleeding. But if you are expecting to bleed, you wouldn't be on a continuous in the first place because you would just get unpredictable breakthrough bleeding.

Finally, the Mirena coil is one to consider. It is a very low dose of progesterone and not much of it gets into your system, compared with a progestin pill. (They have measured serum blood levels of the progestin in women on it.) Fibroids are known to cause nuisance bleeding and the Mirena coil is known to really help with that. If you don't get on with it and have progestin side effects, you can get it removed - don't forget that it's your body and you can request that After 6 months on the Mirena, most women stop bleeding altogether. And it lasts 5 years. So most women who try it, love it.

Otherwise, utrogestan is not always the best option for problematic bleeding but there might be ways to use it that would help - you would need to be working with a very knowledgeable menopause specialist GP though. For eg, I am peri (44yo) and I am on 200mg continuously - and (as of yet) not bleeding at all. I'm on that dose to suppress my endo. 100mg didn't work for that purpose, continuously. But so far 200mg seems to be. So you could increase the utrogestan. And if you then got breakthrough bleeding, you might be able to schedule it with the 25 days on and 5 days off approach - with lighter bleeding because you'd been taking a higher dose of the progesterone. Or you might be able to have a break every 3 months to schedule a bleed - that used to be a regime which has gone out of use as well, but was safe.

[Me and the Pause]

Could I please jump onto this thread?
I came here looking for this exact topic
I was put on 3 month utrogestan 100 with a week off because the continuous utrogestan100 was causing unscheduled (all be it light bleeds). I’ve been doing this 3month on and this week was my 1 week off, but had no proper bleed, just break through watery discharge couple of days

My GP has sad I should go back to sequential utrogestan 200 for 12 days. As I used to be absolutely fine on this. They changed it purely on my age 52 and having been on HRT for 2.5 years.
I just don’t know when to start and I’m actually getting weird anxiety/panick attacks since being off utrogestan this week. I’m on holiday and don’t want to do another week of no progesterone.

Would it be ok to do next 12 days on utrogestan 200and then break?

Hey, don't despair!

So firstly, when your GP put you on 25 days on and 5 days off utrogestan, that was actually a continuous regime. I know it had 5 days off, but the 'old' continuous regime had 5 days off - then they realised that actually this caused bleeding and you didn't really want women on continuous to bleed. So they changed it to be 100mg every night. So, if your GP is still using an old-style continuous regime, it suggests to me that maybe they don't know loads about HRT... The continuous regime (either of them!) is supposed to be for post-menopausal women, not peri. If you are not post-menopausal and they put you on a continuous regime, again, it suggests they don't know loads about HRT.

In putting you on 200mg for 2 weeks and then stopping, that is the sequential regime. It is for women in peri-menopause who are still expecting to bleed at some point and need to schedule the bleed. When you stop the progesterone, you will bleed.

I haven't heard of either being associated with lighter bleeding. But if you are expecting to bleed, you wouldn't be on a continuous in the first place because you would just get unpredictable breakthrough bleeding.

Finally, the Mirena coil is one to consider. It is a very low dose of progesterone and not much of it gets into your system, compared with a progestin pill. (They have measured serum blood levels of the progestin in women on it.) Fibroids are known to cause nuisance bleeding and the Mirena coil is known to really help with that. If you don't get on with it and have progestin side effects, you can get it removed - don't forget that it's your body and you can request that After 6 months on the Mirena, most women stop bleeding altogether. And it lasts 5 years. So most women who try it, love it.

Otherwise, utrogestan is not always the best option for problematic bleeding but there might be ways to use it that would help - you would need to be working with a very knowledgeable menopause specialist GP though. For eg, I am peri (44yo) and I am on 200mg continuously - and (as of yet) not bleeding at all. I'm on that dose to suppress my endo. 100mg didn't work for that purpose, continuously. But so far 200mg seems to be. So you could increase the utrogestan. And if you then got breakthrough bleeding, you might be able to schedule it with the 25 days on and 5 days off approach - with lighter bleeding because you'd been taking a higher dose of the progesterone. Or you might be able to have a break every 3 months to schedule a bleed - that used to be a regime which has gone out of use as well, but was safe.

[joziel]

Hmm, I'm not sure why your GP has taken you off a continuous protocol and put you back onto a sequential, if you aren't having any bleeding problems on your 3 months regime with a week off? It might be worth asking them exactly what their reasoning is.

A continuous protocol is what you're 'aiming' for - in that, it is safer for the uterus (less risk of build up), to be on continuous progesterone over sequential. Sequential is just supposed to be used for a few years (can be just one year) until a continuous protocol is possible. A continuous protocol is preferable, all things being equal.

Why does your GP want you to have a bleed? You don't need to bleed. If you're going to bleed, you will - you will get break-through bleeding. That's a sign you should be on sequential. If you're not getting break through bleeding on the 3 month regime and even when you withdraw progesterone, there's no bleed happening, then your body has reached the point where it doesn't need to bleed and a continuous regime should be best. A 1 week break would still be considered a continuous regime, BTW.

In addition, sometimes there are situations where women do best on continuous progesterone even though they are peri and should officially be on sequential. That's the case for me, with endo. And having anxiety or emotional issues relating to the withdrawal of progesterone would be another indication for continuous progesterone even in peri. Especially if you're not having bleeding issues...

[Me and the Pause]

Sorry probably didn’t make myself clear. I never had break through bleeding on 12 day U200 sequential last year. Then Put on
U100 continuous and kept getting random bleeding. So got changed to U100 3 months on 1 week off still getting bleeding (all be it watery brown discharge) during 3 months. But then I’ve been off the utrogestan this week and haven’t had any bleeding. So he said just go back to sequential u200 12 days of month.
He has referred me to a gynaecologist, because of the random bleeding.
You’re right the goal is consecutive-

Hmm, I'm not sure why your GP has taken you off a continuous protocol and put you back onto a sequential, if you aren't having any bleeding problems on your 3 months regime with a week off? It might be worth asking them exactly what their reasoning is.

A continuous protocol is what you're 'aiming' for - in that, it is safer for the uterus (less risk of build up), to be on continuous progesterone over sequential. Sequential is just supposed to be used for a few years (can be just one year) until a continuous protocol is possible. A continuous protocol is preferable, all things being equal.

Why does your GP want you to have a bleed? You don't need to bleed. If you're going to bleed, you will - you will get break-through bleeding. That's a sign you should be on sequential. If you're not getting break through bleeding on the 3 month regime and even when you withdraw progesterone, there's no bleed happening, then your body has reached the point where it doesn't need to bleed and a continuous regime should be best. A 1 week break would still be considered a continuous regime, BTW.

In addition, sometimes there are situations where women do best on continuous progesterone even though they are peri and should officially be on sequential. That's the case for me, with endo. And having anxiety or emotional issues relating to the withdrawal of progesterone would be another indication for continuous progesterone even in peri. Especially if you're not having bleeding issues...

[joziel]

Right, that makes more sense.

Except, I don't know why he's referred you to a gynaecologist?

You said "I never had break through bleeding on 12 day U200 sequential last year. " So it just sounds like you were changed to continuous too early and needed to go back to sequential?

[Me and the Pause]

Oh he’s referred me because he’s concerned by the bleeds.  5 months ago I had to have a hysteroctopy my lining was 13mm !!  All came back fine.
I had 2 natural periods after hysteroctopy as I came off all HRT.
But now he is still concerned 🤷‍♀️
I was thinking of going for 2 weeks without U as I’ve done 1 week already. Sick of all this changing about.