3 monthly cyclical HRT, regular periods? Starting day?

[namechange5575]

My GP has just prescribed me Evorel 50 and Utrogestan 100. He offered me the choice of a monthly or a three-monthly bleed with the Utrogestan, and I chose three monthly (bit of a no brainer, less bleeding, plus it's the progesterone that's causes pms type symptoms, right?) Anyway, research suggests that Utrogestan should be monthly if I'm still having regular periods. They have changed a lot over the last few years, but are still roughly every 25-33 days. What can I expect? Will my body still give me a period without taking the Utrogestan?

Also, the insert said to take them within 5 days of my period starting. Today is day 15 and I can feel my body is gearing up to ovulate, but I've started it anyway as I'm sick of the peri menopause symptoms, they are interfering with work and home life. Will this trigger or delay a period? Or extend one? Or could it cause more serious issues and I should take it off.

Thanks in advance to the very patient, knowledgeable and generous experts and experts-by-experience here

Okay here goes...

A 3-month cycle is not usual on that type of HRT. It's available with a tablet form of hrt called Tridestra. Other than that, it's not usual for a GP to prescribe long cycle.

There are women using longer-cycle HRT but it's usually off-licence through a consultant. Maybe query why he's suggested it that way? It's actually okay especially if you are still having your own periods, but what's likely to happen is you will have normal periods for 2 months, and then an HRT withdrawal bleed too at the end of the 3rd month.

The dose for a monthly cycle is 200mgs x 12 days (out of each month.)

Bit unsure if your GP knows this or thinks it's 100mgs?

You can start Utrogestan at any time of your cycle BUT it's best to a)keep to the same date each month - usually the 1st or the 15th. b) if you can tie it in with your own cycle now, so start mid-cycle when your own progesterone would kick-in, that's fine.

Sorry for the essay :) Feel free to ask more Qs or PM me.

@JinglingHellsBells Thanks so much for your response, I didn't reply immediately as I wanted to see what would happen with periods. I'll keep it on the board in case it helps someone else in future :)

So, I have continued to have periods at the usual time. I'm still having a normal cycle and ovulating, I'm sure; I had 30 and 31 days cycles over the last two months.

I've been using Evorel 50 patches and things are much much better, but I think there's room for improvement. I'm still having hot flushes and insomnia, and my joints have started to ache again. I'm planning to see the GP and ask for a higher dose patch I think - are there any down sides to that? I did have a much heavier period last time, getting through super plus tampons every hour (only for one day though).

I'm due to start taking the Utrogestin on day 15 of this cycle, which is 4th May, but I'm going to bring it forward to 1st May to try and help keep a regular date for doing so. You were right, I'm due to take 2x 100mg Utrogestin at night, so the dose is 200mg daily, prescribed for 14 days (although not 12 days like both you and the insert suggest Would it be advisable to keep to 12 days instead?).

Is there any advantage to taking progesterone if I am having regular periods? Should I bring it to my GPs attention, or just see if I can get away with the 3 monthly dose as long as I am having regular periods?

I really appreciate the work you do to help so many women out, you are a superstar

Happy to help if I can :)
I think it would be sensible to take 14 days on a long 3-month cycle.
Progesterone is used to change the lining of the womb from a 'growing' phase into a different type of phase, and when it's withdrawn ( ie you stop the tablets ) the result is a withdrawal bleed.

So as you are still having your own cycles it would be sensible to use it, because the patch is giving you estrogen possibly above your own natural levels. There is a tiny chance that the lining will become too thick without it, and there will be months in the future when you don't have a natural period.

A higher dose patch may help you but be aware that more estrogen usually= heavier blood loss each cycle.

Good luck!

@JinglingHellsBells Just an update - I'm going onto 75 Evorel as I'm still having symptoms. I read somewhere that consistent dosing of Ibuprofen can really reduce heavy flow, as well as pain for heavy periods, and on my one month trial last month it massively reduced the flow. It works by reducing prostaglandins. I only took it for 48 hours. I usually avoid Ibuprofen as it has irritated my stomach in the past, but I'll keep using it for this I think. It shouldn't increase the risk of anything should it? Reduced blood flow doesn't equal increased risk of endometrial thickness in this case does it?

www.cemcor.ubc.ca/resources/painful-periods