Update on the duration of Progesterone

[Sageda]

Hello again. I got in touch with my dr who put me on Progesterone for 14 days and told him that ladies in this platform told me 12 days would be enough. Also l ve asked him why he wanted me to not use my estrogen patch for a week right after l finish progesterone.He says l don t have to give a week break and can continue the patches however this is affecting some patients and cause no bleeding because of the existence of estrogen so he recommends to give a break to secure a bleed.( btw for those who didn t read before l m on body identical hormones, the ones that give you a bleed). And regarding progesterone he told me that the ideal amount of time is 14 days as it prevents the tick lining of the uterus. He says with the 12 days or shorter uses, they found that some patients had spotting in mid cycle or that during ultrasound checks their lining was found thick. I just wanted to share this. I will go for 14 days now.

Good you have come back to update. Obviously you will do what you feel is best but this is not the advice of UK doctors.

His advice does contradict the prescribing regime with the actual product. That says 12 days. My consultant is happy with 10 days.

The fact you are being advised to have a week's break to give a bleed doesn't really make sense. It's when progesterone falls in your blood levels that a bleed begins.

The bleed is also dependent on the amount of estrogen used during each cycle. So for example, someone using 1 pump of estrogen gel every day would most likely have less blood loss than someone using a higher dose ( 2 or 3 pumps daily.) A higher dose patch would have the same outcome.

So, you are less likely to bleed much if you miss a week.

If Utrogestan works properly, all the lining should come away after 12 days.

Usually, doctors only suggest increasing the amount of progesterone above the guidance from the manufacturer IF there IS mid cycle spotting, not to prevent it.

However, you must do what you feel is right for you.

Just to add, it's likely that with only 3 weeks of estrogen plus 2 weeks of progesterone, you may have no bleed at all.

Around 20% of women on HRT do not bleed even those using the sequential types that allow for a bleed.

Thank you. Its interesting and worrying at the same time. Its 4 weeks of estrogen and 2 weeks of progesterone on the last two weeks of the month then bleed. What re the side effects or complications if l use it for 14 days?

By the way l just looked at the prescription for cyclic progesterone use and it says 12- 14 days every 28 days. So there is a mentioned 14 days there.

I appreciate it's 4 weeks o estrogen but you did say in your post that your dr had suggested leaving a week estrogen-free (to give a bleed?) which would mean only 3 weeks on it if you followed his advice.

There is no harm in doing 14 days. The only harm is that some women find they have side effects like mood swings, loss of energy and feeling not too great on Utrogestan so they keep the dose to the minimum.

I'm a little concerned your dr seems to be slightly confused- more Utrogestan will keep the lining thin, that's true. But reducing your estrogen to 3 weeks will also reduce the build up of the lining and wouldn't 'help you bleed' - just the opposite.

Thank you for your time @JinglingHellsBells. He said to give the break after the finish of Progesterone. So let s say during one month, l take estrogen each week that makes 4 weeks of estrogen and on the last two weeks l add progesterone. So 4 weeks estrogen plus 2 weeks progesterone ( same month) then give a week break. Then start estrogen again for 4 weeks. So 1 month of Hrt then a week break.

So 4 weeks estrogen plus 2 weeks progesterone ( same month) then give a week break.

So one week of no estrogen after every month?

That isn't how HRT is used and your dr is prescribing incorrectly.
We use estrogen daily with no break.

I appreciate you are not in the UK, but there are prescribing guidelines and advice from the International Menopause Society and he ought to follow these.

If you stop for a week you may get a return of symptoms. There is no point having a week without estrogen and I cannot understand why he asks you to do this.

Thank you for your concern. Yes that s right, one week of no estrogen after one month and then start the same routine of 4 weeks estrogen with progesterone the last two weeks of the cycle and 1 week of break and on it goes.
When l asked him about it yesterday he said l can continue the patches if l wanted to but for some women this may interfere with the bleeding they re supposed to get after progesterone. He said estrogen dominance can get in the way and that he wanted to make sure l got a bleed. Having said this before l was diagnoised with POF and lost my periods, they were regular but lasted max 3 days . All my life it was like this. I m curious to see if it will be the same now that l will get one artificial one.

Having less estrogen by missing several weeks of your patch in a year will give less bleeding, not more, because it's estrogen that builds up the lining.
It's the withdrawal of progesterone (after the last tablet each cycle) that causes the lining to break down and bleeding begin.

Your dr seems rather obsessed with bleeds for some reason. I wonder why?

There is a licensed HRT (Tridestra) which gives a bleed only once every 3rd month for women mainly in peri, and that is considered safe.

Sorry and with respect, but your dr seems rather confused.

No one is advised to miss a week unless there are reasons in your history we are unaware of.

No nothing unusual in my history, he just asked me before prescribing the type of HRT whether l want to have periods or not and l told him that l would want to choose the one that gives me an artificial period also because l still hope and want a pregnancy. l will keep my patch on after the end of progesterone. As l said when l asked him why he recommended no estrogen during period he replied it s because edtrogen dominance right aftet the drop of progesterone may effect the period hence stop it from happenning.