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[Emzib0b]

Hello,

I’ve been on HRT since April last year (Evorel patches and Utrogestan 14 on/14 off). I started on 25mcg Evorel, then 37.5mcg, and have been on my current dose of 50mcg since November.

My irregular cycles have been doing their own thing in the background and mostly overrode the HRT cycle. I’d miss a period, have a few short/normal length cycles for a few months, then have another late/skipped cycle, and so on. I used to be able to tell if I was having a ‘real’ cycle as my body would give clear signs when I was ovulating and I would have a period 12-14 days afterwards. The late/skipped cycles have been happening more frequently as times goes on. In the last five months or so my own cycles have been 43, 44, and currently 67 days. In the first half of 2022 I had a 74 and a 51 day cycle (with some short cycles in between), the 74 day cycle was prior to starting HRT.

Whenever my own cycle was late or skipped I would have a very predictable Utrogestan withdrawal bleed. I take my last Utrogestan on a Thursday night and a bleed would start the following Monday.

I had no withdrawal bleed in Oct/Nov (I had a 43 day cycle so it wasn’t because I’d recently had a period) and a tiny bit of spotting once a day for three days last month (which occurred on the expected days for my withdrawal bleed).

I took my last Utrogestan last Thursday (2nd March) and expected to get a bleed on Monday, especially given I shed so little the previous month). No bleed, until this morning, which surprised me. I don’t know yet if it will be a proper bleed or just a bit of spotting again. Is this bleed a withdrawal bleed that’s simply happened later than usual? I’ve had no signs of ovulation since the end of December (which was followed by a period at the beginning of Jan) so I don’t think this is my own cycle, but I could be wrong! I suspect it’s going to harder and harder to tell what my body is doing the further along perimenopause I go?

I was also wondering if I’m not producing much of my own Oestrogen at the moment, given the longer cycles and minimal/absent shedding after a Utrogestan cycle?

Any thoughts would be greatly appreciated. I’m feeling very confused about it all! 

[Hurdity]

Hi Emzibob

If you are right about your cycle then this could well be the explanation for lack of withdrawal bleed on the utrogestan - ie your cycle is absent and not breaking through.

You have been on a low dose of oestrogen, although for the past few months it is medium dose - and you don't say what dose of Utrogestan and how you take it - I presume 200 mg orally which is the licensed dose? For most women this will be plenty enough to keep the womb lining thin on low to medium oestrogen doses, and also you are taking it for 14 days ( more than the licensed dose) so it does indicate the womb lining may well not be building up sufficiently to need to be shed.

So yes, likely you are not producing much of your own oestrogen. Production becomes very variable during peri-menopause with unpredictable spikes and falls and some anovulatory cycles (and sometimes cycles characterised by very high oestrogen), but as you get further towards menopause and cycles become sporadic, on average oestrogen production also drops off - it is normally produced by the developing eggs.

Don't worry about it, and just focus on the fact that hopefully you are feeling better on HRT and on the right dose of oestrogen - but keep an eye out for abnormal bleeding.

Hope this helps

Hurdity x

[Emzib0b]

Hi Emzibob

If you are right about your cycle then this could well be the explanation for lack of withdrawal bleed on the utrogestan - ie your cycle is absent and not breaking through.

You have been on a low dose of oestrogen, although for the past few months it is medium dose - and you don't say what dose of Utrogestan and how you take it - I presume 200 mg orally which is the licensed dose? For most women this will be plenty enough to keep the womb lining thin on low to medium oestrogen doses, and also you are taking it for 14 days ( more than the licensed dose) so it does indicate the womb lining may well not be building up sufficiently to need to be shed.

So yes, likely you are not producing much of your own oestrogen. Production becomes very variable during peri-menopause with unpredictable spikes and falls and some anovulatory cycles (and sometimes cycles characterised by very high oestrogen), but as you get further towards menopause and cycles become sporadic, on average oestrogen production also drops off - it is normally produced by the developing eggs.

Don't worry about it, and just focus on the fact that hopefully you are feeling better on HRT and on the right dose of oestrogen - but keep an eye out for abnormal bleeding.

Hope this helps

Hurdity x

Hi Hurdity,

Thank you so much for the information and reassurance.

I’m on 200mg Utrogestan, taken orally. I presume I am absorbing it properly because it has done what it’s meant to in the past, and I should be more concerned about bleeding too frequently, rather than infrequent bleeds?

I honestly thought I might have found my sweet spot with 50mcg Evorel as I felt so much better (emotionally) within less than a week of the dose increase.

However, I have been wondering if my dose needs a bit of an upwards tweak again as the horrible feelings of anxiety/low mood/overwhelm/feeling upset have been creeping back in of late and I’ve been struggling to function from an emotional standpoint in the last few weeks.

This has happened twice along my HRT journey and was resolved with a dose increase, but the benefits don’t seem to last longer than a couple of months. I suspect this could keep happening as my Oestrogen drops off as I get closer to menopause but will eventually plateau?

I have an appointment with a private menopause specialist next month to discuss if Testosterone could be beneficial (I booked the appointment back when I was feeling ok) but I think she’ll probably put this on hold if my Oestrogen isn’t optimal. Is it normal for women who go through an early menopause to need higher doses of Oestrogen? (I’m 41)

[sheila99]

You're still only on a medium dose. I had a late menopause (no symptoms til 56 and not certain I'm meno now at 62). I've had to increase twice because of returning symptoms and am now on 100 so I don't think your situation is unusual. After you stop ovulating the ovaries still do 'something' for some time so you still get fluctuations though it's possible that without the added oestrogen there wouldn't have been enough of a build up for a bleed. I still get non hrt induced bleeds.

[Claire MM]

Just to say I believe it is normal for women going through early menopause to require higher doses of estrogen although it will depend how well you are absorbing etc, also you don't have to have optimal estrogen to add testosterone. Speaking from my experience. Having low estrogen and very low testosterone went hand in hand. I had low E and zero T - absolutely none. Interestingly i read around and apparently your body will steal from your testosterone reserves to make estrogen if estrogen is low, which is maybe why in an ideal world your estrogen would be optimised and then you could see on a blood test what the testosterone was doing but adding in testosterone if it's low can make a big difference to quite a lot of things, I would not be afraid to try it or to try increasing estrogen given the lack of a bleed, these are just my thoughts x

[0114tw]

So I am piggybacking on your post; I hope you don’t mind because it seems kind of relevant. I recently posted on MM to ask about whether I should move onto continuous HRT as I’ve not had a period for 7 months. Then today I got a period and it feels really surprising. It’s not post utrogestan. So I’m wondering, is it my cycle, is it drug induced, is it ‘who knows’, and does it matter? When do we need to ‘worry’ about these things?

[Emzib0b]

You're still only on a medium dose. I had a late menopause (no symptoms til 56 and not certain I'm meno now at 62). I've had to increase twice because of returning symptoms and am now on 100 so I don't think your situation is unusual. After you stop ovulating the ovaries still do 'something' for some time so you still get fluctuations though it's possible that without the added oestrogen there wouldn't have been enough of a build up for a bleed. I still get non hrt induced bleeds.

Just to say I believe it is normal for women going through early menopause to require higher doses of estrogen although it will depend how well you are absorbing etc, also you don't have to have optimal estrogen to add testosterone. Speaking from my experience. Having low estrogen and very low testosterone went hand in hand. I had low E and zero T - absolutely none. Interestingly i read around and apparently your body will steal from your testosterone reserves to make estrogen if estrogen is low, which is maybe why in an ideal world your estrogen would be optimised and then you could see on a blood test what the testosterone was doing but adding in testosterone if it's low can make a big difference to quite a lot of things, I would not be afraid to try it or to try increasing estrogen given the lack of a bleed, these are just my thoughts x

Sorry it’s taken a while to reply. This emotional stuff is sheer hell. I just wanted to thank you both for your insights, experiences and advice. My appointment is on Wednesday and it can’t come quickly enough!