Bleed starting too early on HRT .

[SirVixofVixHall]

I am on transdermal HRT, Oestrogel every day, and ten days of progesterone capsules, i have been varying the oral ones with the vaginal ones.
I have noticed if I only take the oral ones that I start spotting on day 7/8 of the progesterone. If I use mainly vaginal I don’t bleed until two or three days after I finish the progesterone.
This cycle I have started spotting today on day six, I have taken four oral doses and one vaginal last night. Is this common, or should I worry ?
I have been varying the way I take it as the oral ones make me feel sick, and the vaginal ones irritate my vagina.

I don't think you should worry, but it depends on how you feel.

Interestingly, I'm trying a similar regime.

I'd avoided vaginal use for years even though my consultant said it was a good way to use it, because I was worried about irritation.

I'm trying to stick with vaginal because more is absorbed that way . (There is a research paper that showed 100mgs vag gave same effect as 200mgs orally.)

I find 200mgs vag. gives me very much worse side effects, mainly feeling hot and sleeping badly. (Like before HRT!)

I am doing as many vag nights as I can stand then trying orally in between.

If you take the tablets orally, food increases the absorption so a small snack just before my help the early bleeding?

Yes I sleep differently on the 200 vaginally, i get nightmares on the progesterone anyway, and I feel a bit dopey and tired on it, but then sleepless on that particular dose. I had read somewhere else that the 100 capsule is enough vaginally, but as my Doc has given me the 200 ones i have been using those.
So you only use a 100 capsule when using it vaginally ?
I think I definitely get a higher dose on the vaginal capsules as it takes longer for me to bleed, but I don’t understand why I start bleeding on the oral ones before the end of the course, as I thought it was the drop that triggered bleeding.
It is only ten days at a stretch but I far prefer being just on the oestrogen. I get a bit tearful on the progesterone, a bit like PMT used to feel.

No I use 200mgs each day of using it but I'm experimenting with 100 vaginally and 100 oral (on same night.)

I get SO hot on 200mgs vaginally.

Absorption orally can be hit and miss- some is lost in digestion so that's why you bleed. I've had bleeding as soon as day 8 when using totally orally but usually it was around day 10, which made it very hard to plan anything (being unpredictable) as I can get quite bad cramp for the first few hours.

This month is the earliest I have had bleeding but it is normally about two thirds of the way through an oral course, today is slightly earlier. Only faint spotting, but then I bleed more heavily as soon as I stop, rather than a gap of a couple of days.
I notice the odd brief hot flush on the progesterone but I haven’t paid attention as to which way I am taking it when it happens.
I am seeing my Hormone doc soon so I will also talk it over with him, but I wondered if others had the same issue.
I agree it is hard to plan !

How many pumps of oestogel do you use? I’ve been having 2 x am 2 x pm, and find with urtrogestan I bleed almost as soon as I start taking it. I take it ok days 1-12 (was 14 but then I’d stopped bleeding so thought 12 days would be ok)
I do find I have PMT before my period too. Bizarrely I’ve just had a hormone blood test & my ‘levels are high so I’m probably perimenopausal’ 😳 Well isn’t that why I’m on HRT?

One pump in the morning, one in the evening. It is reassuring that is isn’t just me who bleeds on the Ultogestan.

@Oxfordblue that sounds really odd and is more likely to be your own cycle if you are peri.

When are you using it? I don't understand your comment that you reduced from 14 to 12 days (as if this was connected?)

You ought to bleed after a course of progestogen. If you are using 4 pumps of gel, it sounds more as if you have (perhaps) a thick lining that is coming away regardless of progestogen, especially if your own estrogen is still quite high.

was your FSH high or your estrogen?

Thanks for your reply.
I started HRT about 18mths ago, changing to the gel oestrogel & days 1-14 on Utrogestan, about 15 mths ago. I thought it was normal to bleed by day 1, certainly by day 10. So I reduced taking the Utrogestan to 12 days (that’s what the literature states iirc & I’d always finished my bleed) Had a review over the phone with the consultant nurse & she expressed concern, stating I should bleed AFTER the 12/14 so she requested i have a hormone level blood test & a pelvic scan. My gp did the blood test & said my ‘levels were highly & I was probably perimenopausal’ I said I’m actually on HRT. We then had a convo about the pelvic scan, so I’m not sure what’s going on.
Because I was freaked out by the Menopause nurse, I reduced my 4 daily pumps to 2. This is about 10 days maybe. Earlier in the week I thought I might just stop it all because it’s been suggested my cycle might be still be in force.
(I went on HRT about 2 mths after my last period, they’d be odd for quite a few mths & then literally everything dried up 😳 & I started having full on hot flushes, throughout the day & least 2-3 x a night. The HRT stopped the hot flushes & gave me back discharge - what a relief!)

Can't understand bleeding on Day 1.
Is this not your normal monthly period that happens to coincide with using Utrogestan? That's all I can think of.

The science of it is that using progestogens stops the lining growing all the time you are using estrogen. When progestogen is withdrawn (after the 12 days) the lining breaks down and you bleed.

Blood tests are a bit meaningless unless you know what they tested for.

Maybe it is. I don’t know. The clinic ordered the hormone level tests so maybe I had a blip of being peri, with the hot flushes etc & then decided to have periods again?

I don't understand the hormone tests because if you are / were using 4 pumps of gel, the tests are going to be affected by that!
You certainly won't get an accurate level of your OWN estrogen and the FSH level is not really here nor there, in peri.

How long have you bled on Day 1? How many cycles?

It isn't possible it's the Utrogestan. As I said, it stops the lining growing ( the scientific term is it's anti -proliferative.)

It mimics a natural cycle, where we get a period once the progesterone has dropped at the end of a cycle.

Either the bleed is your natural period or you have used such a high level of estrogen, your lining is shedding without any use of progesterone.

Hmm. How come I start spotting before the end of the Ultrogestan course then, if I take it orally ? I am loathe to only take it vaginally as after three or four days it really irritates.

Sorry I thought I'd asnwered this down the thread.

Orally, the amount that is absorbed can vary hugely from day to day. It goes via the liver- 'first by-pass' they call it, like any drugs taken.
This means what although the dose is 200mgs, only half of that might reach the uterus because a lot can be lost in digestion.

The endometrium responds ( starts to bleed) to a fall in levels of progesterone. So if by day 8 or whatever, the level has fallen off from how it was a few days before, you will start spotting.

The use of it vaginally means that more is absorbed and the levels stay more constant.

That's my understanding anyway.

I also mentioned before that taking it orally with food, increases the bio-availability (the amount in the blood stream.)

That means you can help it be absorbed more by taking it when there is some food in your stomach. The instructions say 'take on any empty stomach' but this is primarily to stop some of the side effects (as you will be absorbing more.)

Oh I see, sorry to be so dim. I didn’t grasp that the daily fluctuation in levels was the issue. I assumed that they factor in absorption and so the 200 dose is designed to give an appropriate daily dose even though much is not absorbed. So probably around 100, given that 100 vaginally may be fine, I thought that dose was consistent, but perhaps not high enough to keep bleeding at bay, if that makes sense ? I know that I get a higher level using the 200 vaginal capsules, as it takes so much longer for the level to drop.
Now I understand what you said it makes perfect sense ! Sorry !

Are there any benefits to absorbing more ( with vaginal delivery ) , or does that up the risks ?
I feel zonked and nauseous whatever I do, but more zonked out on the 200 vaginal capsule, although less nausea.

I feel just the same as you!
I feel worse using it vaginally - very hot at night and slightly sore 'below' some days though not that much.
Using orally I feel far more dozy and sometimes slightly queasy for an hour or so in the morning.

However, I'm on long cycle (using it only every few weeks not every month) so for me, I'm willing to put up with the side effects in so much as it might be safer for me, being on long cycle.

I don't think there are increased risks using more- it's a pretty safe drug and it given in large doses (600mgs) for fertility treatment.

My doc did mention that after a while I might be able to use it less frequently than once a month. At the moment it is ten days each month, but I do hate it ! I am taking it at the moment and I feel so sluggish.

Ive sent you a PM by the way (but it's a question, not for the forum.)

Thank you, I have replied.