Oestrogel + Utrogestan, no bleed

[Peaceonearthplease]

I am coming into my third month of using Oestrogel (2 pumps daily) + Utrogestan (200mg vaginally day 15-27). However, I am not having a bleed after coming off the Utrogestan.Concerned that my uterus may become too thick and getting confused about how to count the days of my cycle. I am due a well woman check up in April (breast, uterus scan, Consultation with gynae etc). Ok to wait until then or do I need to investigate different HRT treatments earlier?

I don't think you should worry. Some women don't have a bleed- think the % is around 20%.

The other thing is you are using the Utro vaginally; a study showed that this is very effective- more than the oral route- and in the study they only used 100mgs (or suggested it was enough when used vaginally.)

You should have a regular cycle (bleed or no bleed) anyway if you are using it days 15-27, regardless of if you bleed or not. Are you waiting for a bleed to decide which is day 15? The easiest way is to use if on Day 15 of the month, regardless, or some women do 1st of every month. I use it long cycle, every 6 to 7 weeks, so count 6 weeks from the day I took it one month to 6 weeks forward.

If there was any lining to come away it probably would.

Thanks Polly. A couple of extra questions...
If I am in the 20% who do not bleed during sequi HRT, what is happening to my uterus lining? I thought my daily dose of oestrogen would stimulate this, what’s happening down there instead?

You should have a regular cycle (bleed or no bleed) anyway if you are using it days 15-27, regardless of if you bleed or not. could you clarify this please? what do you mean by a regular cycle if I am no longer ovulating or bleeding each month?

Are you waiting for a bleed to decide which is day 15? Yes, exactly. So because the bleed is not happening, I don’t know which date to count from. But moving forward, I’ll use the 1st of each month

if I am in the 20% who do not bleed during sequi HRT, what is happening to my uterus lining? I thought my daily dose of oestrogen would stimulate this, what’s happening down there instead

My understanding is that any progestogen /progesterone reduces the effect of estrogen- that's the whole point of using it. So if you think of estrogen like adding hot water to a bath, using Utrogestan is like adding cold water so it's not hot any more. It stops the lining building up - it changes the way the cells respond to estrogen. So for the days you take it, the lining is not growing. When you stop taking it, the lining breaks down. If the Utro has done a really tip top job, there is no lining to come away because it's kept it thin.

You don't follow your own cycle when you use HRT if you have irregular cycles; you use the HRT to create a cycle. So for example, if I start my Utro on Jan 1st, I'd go for 6 weeks and would start the next Utro course on 14 Feb. (as an example.) I don't count from when a bleed started.

You count from Utrogestan to Utrogestan, not bleed to bleed.

Thanks Polly. That is very helpful info. But guess what... I’ve started a bleed ! So, would you suggest that I count day 1 of the bleed as 1st cycle day or use Utro days as my guide? This is only my third month on this type of HRT so I guess my body is adjusting.

It depends on how often you are having natural periods. If they are more ore less monthly you should fit the utro cycle with those so you'd take it on day 15. If your cycles have gone awol, then you should re-set them with HRT so in other words start on a certain day each month (like the 1st or the 15th). If you are in peri you may still get 2 periods in a month- your own and the withdrawal bleed. No way round this.