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[podlet]

Hi ladies,

This is all a bit of a minefield for me and I ask for your patience (especially if I am asking ridiculous questions). The more I read, the more confused I seem to be getting at the moment... My GPs have been willing to support my decision to try HRT but the different GPs have given me contradictory advice, so I feel I am still largely trying to figure this out myself.

I started HRT at the beginning of the year (evorel patches - 50 mg estradiol and noresthisterone). It was pretty horrendous (with wild mood swings and intense PMS symptoms) and I thought it might be related to the progesterone... For the last two months I have replaced the noresthisterone patch with Utrogestan and have reliably had withdrawal bleeds 3-5 days after finishing the noresthisterone or the micronised progesterone.

This month (my second month of utrogestan), it is now 7 days after stopping the utrogestan and I have not had a withdrawal bleed. Instead I am having rather intense anxiety and mood fluctuations (more so than usual and almost as bad as pre HRT).

My breasts are tender, I have had a few spots, which all feel like PMS, but no bleed.

It is really unlikely that I am pregnant (as my husband has had a vasectomy).

So my first question is: Is this normal? Don't we need to bleed to shed the womb linings?

To be honest, I am rather panicky in tryinng to remember the days of the cycle to take the utrogestan, and to be honest, I took it one day late this month. I remembered late the next afternoon and the internet told me not to double up the dose. Surely that can't be impacting me to the extent that there is no bleed.

Which bring me to my second question: Is there an easier way to take utrogestan?

This patient information leaflet tells me I can take one daily for 25 days (which may be easier to remember/process) and I see a lot of comments online where people are taking it from calendar day 15-29 ie for two calendar weeks - the same every day. And I am super confused. Because that isn't a 28 day cycle and it would vary month by month as some months are 30 and some are 31 days....
Are these latter two options safe and not increasing the risk of cancers etc?

Heeelp!

Any comments much appreciated by my wibbly self.

 

[Ermin2trude]

Hello,

Sometimes it’s worth going right back to the beginning, pre HRT, to work out what to do. I’ve just asked someone else this question - what were your periods like when you initially went to ask for HRT? What symptoms did you have?if your periods were scant/light, few and far between, your oestrogen levels have dropped. If they were really heavy, maybe closer together, then your progesterone levels dropped. Sadly there’s very few who have hormone levels that drop in a wonderful synchronised way that keep them in balance. Wouldn’t life be soooo much easier if they did 😔😏. The symptoms you are having could be due to either the oestrogen not being enough for you, or the progesterone not being enough. If your periods were really heavy then you might need to reduce your patch to 25mg. If they were scant then increasing your patch might help. Apart from PMS/sore boobs etc, do you have hot flushes/night sweats?
If you are still peri menopausal then your own hormonal fluctuations play a big part in how you feel on a daily basis. It’s a rollercoaster ride. Taking utrogestan continuously is really for post menopausal ladies and it won’t override your natural cycle….you will have breakthrough bleeds.

If you are struggling with the progesterone part, have you thought about a Mirena coil? Then you can forget about progesterone and just tinker with the oestrogen to alleviate symptoms.

Sorry you’re feeling wibbly.
Ermin x

[joziel]

So my first question is: Is this normal? Don't we need to bleed to shed the womb linings?

As long as you are taking the required amount of progesterone (12-14 days), you don't need to worry about NOT bleeding. (If you get unexpected bleeding, that indicates a build up and could need more progesterone.)

You don't say how old you are, but when this starts to happen, it's a good indication that you could move to continuous HRT. Which means taking 100mg of utrogestan every night instead of 200mg for half the month. Obviously discuss that with your doctor but there's no downside to trying it. If you're not ready for it yet, you will just get break-through bleeding. There is also the 'old' continuous regime which was to take it for 25 days out of 28 which would allow a bleed.

To be honest, I am rather panicky in tryinng to remember the days of the cycle to take the utrogestan, and to be honest, I took it one day late this month. I remembered late the next afternoon and the internet told me not to double up the dose. Surely that can't be impacting me to the extent that there is no bleed.

I doubt that is the cause. The best thing to do, is to write it in your diary. As soon as I get my period (day 1), I count forwards 14 days and write to start utrogestan and also when to stop it.

Which bring me to my second question: Is there an easier way to take utrogestan?

This patient information leaflet tells me I can take one daily for 25 days (which may be easier to remember/process) and I see a lot of comments online where people are taking it from calendar day 15-29 ie for two calendar weeks - the same every day. And I am super confused. Because that isn't a 28 day cycle and it would vary month by month as some months are 30 and some are 31 days....
Are these latter two options safe and not increasing the risk of cancers etc?


Firstly on the cancer thing, you're not going to get cancer if you take it for one day less or something. Research shows that you are protected if you take utrogestan for 12-14 days each cycle. Women who take it for 10 or less days per cycle did have an increased risk of cancer, but some women do fine taking it for a shorter period of time because they are sensitive to it - they just need to have occasional scans to be sure their uterine lining isn't building up.

As for the 25 days thing, as mentioned above, that is the 'old' continuous regime. It used to be recommended to take it for 25 days out of 28. This meant women had a bleed because it stopped for a few days. Which most women didn't want and didn't need to have if they were post-meno. So they scrapped that and brought in taking it every night.

But you are currently on a sequential regime (12-14 days per cycle), not continuous. You might be ready to switch to continuous and could discuss that with your doctor.

As for the same 2 calendar weeks each month etc - I think this depends on how strong your natural cycles still are. My own cycles are every 25 days and very strong. Whatever utrogestan I'm taking, I will bleed on schedule. (Ie even if I haven't finished my 12 days of it, I will bleed before finishing it because my body overrides it.) I still ovulate most cycles. If you have a strong cycle yourself and are in early peri, then it is best to synch it with your own cycle so everything is working as it should (ie - so you get progesterone during your luteal phase, which is when you usually get it - the last 2 weeks of your cycle). That is why on day 1, I count forwards 14 days and then take utrogestan for 12 days from there - which usually takes me a day or two into my next period.

If you don't have a strong cycle or have irregular cycles and have no idea where day 1 is, then sometimes it's just simpler to take it day 15-29 of each calendar month because your body is all over the place anyway.

I think - try to synch it but don't sweat if you can't... As long as you are getting 12-14 days of it each cycle, you don't need to worry about cancer.

[Nikkinoo]

on day 1, I count forwards 14 days and then take utrogestan for 12 days from there - which usually takes me a day or two into my next period.

I can't tell you how happy I was to find this information.

I came looking for information about how to sync my periods to my Utrogestan but I've found something much better! When I tried to explain to my GP that I thought my "normal" (i.e. pre-perimenopause) cycle of 26 days was still winning in spite of me trying to enforce a 28 day cycle via Utrogestan she just didn't get it. My cycle settled initially but was getting more and more erratic the further out of sync I got. She suggested a few tweaks but still always based on a 28 day cycle that I have never had.

By always aligning my day 1 with the meds I can have my natural cycle and the recommended 12-14 days of Utrogestan. This feels like a proper eureka moment - thank you!

[joziel]

No probs, just passing on what I've learnt from others!

Like you, I have quite a short cycle (25 days) so when I start on day 14 for 12 days, it does run into my period by a day or two - but I always take it for 12 days whatever. Then I start counting again, from day 1. That way it all stays in sync.

Doctors can say some very weird things sometimes. It just reveals what they haven't experienced yet...

[podlet]

Hello,

Sometimes it’s worth going right back to the beginning, pre HRT, to work out what to do. I’ve just asked someone else this question - what were your periods like when you initially went to ask for HRT? What symptoms did you have?if your periods were scant/light, few and far between, your oestrogen levels have dropped. If they were really heavy, maybe closer together, then your progesterone levels dropped. Sadly there’s very few who have hormone levels that drop in a wonderful synchronised way that keep them in balance. Wouldn’t life be soooo much easier if they did 😔😏. The symptoms you are having could be due to either the oestrogen not being enough for you, or the progesterone not being enough. If your periods were really heavy then you might need to reduce your patch to 25mg. If they were scant then increasing your patch might help. Apart from PMS/sore boobs etc, do you have hot flushes/night sweats?
If you are still peri menopausal then your own hormonal fluctuations play a big part in how you feel on a daily basis. It’s a rollercoaster ride. Taking utrogestan continuously is really for post menopausal ladies and it won’t override your natural cycle….you will have breakthrough bleeds.

If you are struggling with the progesterone part, have you thought about a Mirena coil? Then you can forget about progesterone and just tinker with the oestrogen to alleviate symptoms.

Sorry you’re feeling wibbly.
Ermin x

Ermin - firstly thank you soooo much for the time taken to respond to my message and for the level of detail you went in to...

My periods prior to HRT were definitely lengthening in cycle length, but were definitely getting heavier (my mooncup overfloweth in a way it hadn't before!) I had hot flushes prior to starting HRT but those have dramatically improved. As has my anxiety (mostly!). My period finally came on Sunday (super fast and heavy) and seems to be a shorter bleed (although I haven't finished yet)...

I am trying to tweak either the progesterone or the oestrogen one at a time to know what is having an effect. My previous GP appointment suggested moving to Utro and increasing my Evorel to 75mg, but I opted to only change to Utro and keep the Evorel the same..

I am wondering if my date counting was wrong too (how embarrassing!!) I think I was trying to assume a 28 day cycle like you do on the pill... Now that my bleed has been a week late, I assume I start countind Day 1 from the first day of the bleed, and not counting the days according to the previous 28-day cycle... is that correct? (how embarrassing!)

As for the mirena coil... I just can't go there again. I was one of the minority where it migrated, perforated my uterus (and got embedded in the endometrial lining), caused no end of bleeding, acne and discomfort. Trying to remove it at the GUM clinic caused a further rip in my uterus and more bleeding, and then when I finally got an appointment to get it removed under general anaesthetic, the scope when and caused a further perforation and I had an emergency laparascopy to repair the perforation.

I just don't seem to go well with the Mirena.....

That said, I appreciate the suggestion, and the incredible support - honestly feeling a whole lot less wibbly for it... <3

[podlet]

on day 1, I count forwards 14 days and then take utrogestan for 12 days from there - which usually takes me a day or two into my next period.

I can't tell you how happy I was to find this information.

I came looking for information about how to sync my periods to my Utrogestan but I've found something much better! When I tried to explain to my GP that I thought my "normal" (i.e. pre-perimenopause) cycle of 26 days was still winning in spite of me trying to enforce a 28 day cycle via Utrogestan she just didn't get it. My cycle settled initially but was getting more and more erratic the further out of sync I got. She suggested a few tweaks but still always based on a 28 day cycle that I have never had.

By always aligning my day 1 with the meds I can have my natural cycle and the recommended 12-14 days of Utrogestan. This feels like a proper eureka moment - thank you!

Whheeeeeeee Nikkinoo - so very happy I asked the question, and so happy to read your response which is so helpful for me too!!

[joziel]

With the date counting, it's your natural cycle - not anything enforced by meds. That's not like the pill, which overrides your natural cycle and causes you to have an average cycle of 28 days.

You did talk about your periods before going on HRT there, so presumably you know how many days they were then - that's the number to take now.

When I was 35, my periods were every 35-37 days. Now I'm 45, my periods are every 25 days. It's quite normal for cycles to get shorter in early peri-meno.

[meno-mel]

on day 1, I count forwards 14 days and then take utrogestan for 12 days from there - which usually takes me a day or two into my next period.

I can't tell you how happy I was to find this information.

I came looking for information about how to sync my periods to my Utrogestan but I've found something much better! When I tried to explain to my GP that I thought my "normal" (i.e. pre-perimenopause) cycle of 26 days was still winning in spite of me trying to enforce a 28 day cycle via Utrogestan she just didn't get it. My cycle settled initially but was getting more and more erratic the further out of sync I got. She suggested a few tweaks but still always based on a 28 day cycle that I have never had.

By always aligning my day 1 with the meds I can have my natural cycle and the recommended 12-14 days of Utrogestan. This feels like a proper eureka moment - thank you!

Whheeeeeeee Nikkinoo - so very happy I asked the question, and so happy to read your response which is so helpful for me too!!

This is so much easier than what I was told to do by the HRT clinic! I was told to take utrogestan from the first to the twelfth of each calendar month and that "most ladies find their cycle syncs to it", this is encouraged and I ought to get there in a few months time.

It leads to nothing but confusion to attach it to the date in the month as well as to your cycle and to the number on the pack.
Syncing two things is possible, having to sync three things when you only control the timeframe on one of them, just throws a spanner in the works.
I don't think they thought it through.
Or they were thinking of their own convenience, if all their ladies are at the same stage on a certain date in the month, they don't need to think as much.

Just how do you sync the calendar to your cycle when you can't choose when either of them occurs? My period came early this month, panic, no time to use utrogestan, I got on the phone to the clinic to ask when I take it, a week further on and I've had three or four phonecalls with professionals who don't know and aren't keen to help.

No answers to my questions of;
When? (my body didn't wait for me to take utrogestan before having a period, um sorry?),
Where? (can I try it vaginally?) and
How much? (100mg or 200mg? OK, this one got answered, it's a minimum of 200mg no matter what the route, not my preferred answer.)

Without the answers to my questions, I didn't take it, they told me to wait for further instructions and that's what I'm doing, progesterone makes me suicidal anyway, I'm only too happy to hold off on it.

I'm learning just how large the required pinch of salt is when it comes to medicines for women.

I constantly hear the murmur of talking from clinicians, but like many here, I find the smell of contradictory bull gets quite overwhelming.

[joziel]

It's important to say that 'bleeding' isn't the same as 'a period'. Bleeding can occur because your estrogen is too high or your progesterone is too low, leading to break throughs. It can also occur randomly during peri because sometimes cycles go a bit all over the place.

If you're going to start utrogestan on day 14 of your cycle, then ideally you're having regular cycles which are very predictable and you know that the period is your period because it happens right on schedule - and you don't want to be fighting that with the utrogestan.

If you're sporadically and randomly bleeding, it will be harder to fit taking utrogestan with anything - because it isn't occurring due to a predictable cycle. You still need to take it for at least 12 days each cycle to protect your uterine lining, but when you take it, is less important. And you might want to speak to the doctor about getting an ultrasound to see if the lining is too thick or trying a higher dose of utrogestan.

[GraceM]

You really shouldn't be trying to sync your utrogestan with your period.  You need the prescribed amount of utrogestan monthly.  The easiest way is to take it like it was suggested - starting on the 1st of the month for 12 or 14 days, or to take it for 2 weeks on/2 weeks off regardless of when you get a bleed.  As your cycle may lengthen, if you take your utrogestan by counting day one of your period as day 1 of the hrt cycle, you may not be getting enough progesterone to protect the womb.  I found it easiest to take it for 2 weeks on/2 weeks off when I was taking it cyclically. 

[joziel]

   We are getting the prescribed amount of utrogestan monthly. I am, anyway. It starts on day 14 and I take it for 12 days. That is what is prescribed.

Why not sync it with your cycle? Of course that's the most natural and best thing to do. Your body naturally produces progesterone during the luteal phase, after ovulation. Progesterone is only produced from the corpus luteum, which is what is left after the egg has ovulated and been released. Therefore - in the last 2 weeks of your cycle. If you want to take it in the most natural way which supports your body, you take it during the same 2 weeks your body would usually be making it.

Otherwise you will just bleed all over the place sporadically if you have strong cycles and you won't be able to predict when.

Please stop scare-mongering. No one is suggesting taking less than the prescribed amount of progesterone per month. It's great that you found it 'easiest' to take it the way you did, but you probably didn't have a strong cycle of your own at the time.

[meno-mel]

You really shouldn't be trying to sync your utrogestan with your period.  You need the prescribed amount of utrogestan monthly.  The easiest way is to take it like it was suggested - starting on the 1st of the month for 12 or 14 days, or to take it for 2 weeks on/2 weeks off regardless of when you get a bleed.  As your cycle may lengthen, if you take your utrogestan by counting day one of your period as day 1 of the hrt cycle, you may not be getting enough progesterone to protect the womb.  I found it easiest to take it for 2 weeks on/2 weeks off when I was taking it cyclically.

It might be easier to ignore where you are in your cycle, but I don't think it's the better thing to do at all.
The way suggested by Joziel is the best I've heard yet, it won't be out that much each month taking it from day 14 after your period started.
I started my utrogestan on day 14 this month, reduced it to 100mg a day and taking vaginally and it's going better than usual. My body isn't feeling as overloaded with it as usual.

[Hurdity]

Hi all

Just to say that  GraceM is not scare-mongering but is quite correct in sounding a note of caution here. As often the case, it is not black and white, so if your cycle is more or less the same each time even if longer (or shorter) than 28 days, then the idea of taking it on the 14th day should be fine. However she is right in saying that as you get further into peri-menopause, and the cycle lengthens, you could be setting yourself up for too little progesterone and potentially a thickened lining. Peri-menopause is characterised by anovulatory cycles (no ovulation) where eggs start to develop but don't mature, the oestrogen causes the lining to grow and eventually when ovulation happenes the bleeds can be heavy. HRT is supposed to regulate this so that the lining is shed approximately every month. So as a general rule of thumb you should be taking 12-14 days of progesterone every 4 weeks to a calendar month but slight variations of this will be fine. Deviation from this may well work without problems for shortish cycles, but may need monitoring.

Hurdity x