Periods become very irregular after starting hrt

[Tyresmanc]

I'm using 2 squirts of Oestrogel in the morning and Utrogestan for 14 days for about 5 months. My periods have disappeared. I'm not pregnant. Yes I've taken tests.

I haven't been as regular as I shoud have been with the medication esp Utrogestan which I took for 28 days / 1 tablet for a few months. I'm now taking it properly.

Could me not taking the hrt properly have caused periods to become so irregular. I've had a few breakthrough bleeds from Utrogestan and a couple of periods a few months apart but that's it.

Please help

I'm not sure if it's relevant but I have more pmt period type pains / heavy feeling since starting hrt too almost like feeling my period was about to start sometimes.

Here

I spoke to a menopause consultant who told me to wait 4 months. My symptoms are apparently not that unusual but just on the high end.

There are many ways to take Utrogestan.

I started out with a daily tablet and felt dreadful. The specialist then switched me to 14 days on and 14 days off. Still felt dreadful. She then tried it vaginally. Still felt dreadful....

It really doesn’t suit some women at all. Yes to the irregular bleeding and pains. It’s not you taking it “wrong” at the start. It’s about finding the regime that suits you. If you’ve stuck with it 5 months already I’d ask for a change of HRT

Are you in peri or post menopause @Tyresmanc?

There are 2 ways to use Utrogestan depending if you own periods have stopped or not.

If you were not having your own periods any more when you started Utrogestan, the dose is usually 1 capsule daily. You won't get a withdrawal bleed on that but you might get some spotting for up to 6 months.

If however you are in peri and having your own periods when you started using it, the dose is 12 days per month, starting on the same day each month (like the 1st or the 15th.)

After the 12th capsule you would normally have a withdrawal bleed 2-3 days later.

Not all women do though- 25% don't.

Your own periods will stop of course once you are post menopause. so when you say your periods have stopped or become irregular, do you mean the withdrawal bleeds are not happening at the same time each cycle?

If you are taking it on a monthly cycle, you should expect a bleed a few days after the last capsule. But not all women do.

Hope this helps.

and the dose if you are using it for 12 days each month is 2 capsules, not one. Is that how you've been using it?

@JinglingHellsBells

and the dose if you are using it for 12 days each month is 2 capsules, not one. Is that how you've been using it?

My specialist had me on one capsule for 12 days although she said use for 14 as it was easier to remember!

There seems to be a considerable variation in the way this drug is prescribed

@jinglehellsbells Thanks for the help! I was still having monthly periods until I started hrt.

I made a mistake for the first few months with Utrogestan and took 1 pill a day for 28 days, then I forgot for a bit because I'd been originally told to take them when my period started and for the last 6 weeks I've been taking 2 pills a day for 14 days. I had a withdrawal bleed last month but no period.

I will take them from the first of the month from now on for 12 days.

@Elphame I've not come across that before.
The dose as per leaflet is 100mgs daily, or 200mgs for 12 days.
Using 100mgs daily (orally) for 12 days is not enough to keep the womb lining thin. There is some research showing that 100mgs vaginally is okay.

For women on a cycle, it's 200mgs for 12 days. If your periods are regular (still) Utrogestan can be taken mid-cycle to tie in with your own hormones. Otherwise, it's started on a set day each cycle and this will create a new HRT cycle with a bleed at the end, (like to Pill.)

GPs can't deviate from the licensed dose.
Consultants who are private are not bound by the licensing rules and can prescribe a more tailored regime but that's usually done on the basis that women can access private scans to check any odd bleeding.

PATIENT LEAFLET

4.1 Therapeutic indications
Utrogestan is indicated for adjunctive use with estrogen in post-menopausal women with an intact uterus, as hormone replacement therapy (HRT).

4.2 Posology and method of administration
Posology

In women receiving estrogen replacement therapy there is an increased risk of endometrial cancer which can be countered by progesterone administration.

The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on Day 15 of the cycle and ending on Day 26). Withdrawal bleeding may occur in the following week.

Alternatively 100 mg can be given at bedtime from Day 1 to Day 25 of each therapeutic cycle, withdrawal bleeding being less with this treatment schedule.

@TyresmaC You won't have a period as well as the withdrawal bleed. (Not usually anyway.) The HRT sets a cycle that (usually) overrides your own cycle.

@JinglingHellsBells

I'm under the care of a specialist NHS menopause clinic consultant.

Patient leaflets tend to be somewhat simplified information when it comes to dosage. There is clearly some wriggle room in dosage if your specialist thinks it's warranted. I was on a smaller dose for a few days longer each month .

Vaginal use doesn't appear in that leaflet either as it's not licensed for use that way in the UK. It doesn't stop it being suggested on here though.

Yes, that's right with vaginal use. It's a bit of an anomaly. In Europe and especially France, it's the main way to use it. There are lots of benefits in terms of fewer side effects and it also is shown to be absorbed better. (I've seen research papers linked to on Menopause Matters forum where someone dug around for the information.) My own consultant prefers it used that way, although it is a personal choice.

@jinglinghellsbells wow! I wasn't told that by the Newson clinic. Thank you for telling me. Makes a lot of sense!

Really useful to know about the vaginal use of Utrogestan too.

What happens if I'm using a diaphragm? Will it affect the absorption? I have a diaphragm that can't be removed for 6 hours after sex. And sorry to ask the question but would sperm interact with the medication?

@jinglinghellsbells sorry for another question but hrt doesn't stop ovulation does it? I didn't know think so but was then wondering why I wouldn't have a period after ovulation.

You can't really use it if you are using a diaphram as well because the idea is it's absorbed as much as possible by the cervix.
Also, you can't really use it at the same time as sex because it will be 'diluted'. You could use it if you allowed several hours between both (ie sex at night/ Utrogestan morning) but this won't work if you use a diaphram.

It doesn't affect ovulation. How old are you now? Are you ovulating?

Thanks for all that.

I'm 46 in May. I am presuming I was still ovulating last year as I still had regular periods?

Would it matter if I just took Utrogestan orally on the nights we have sex?

I think I missed this question

Your own periods will stop of course once you are post menopause. so when you say your periods have stopped or become irregular, do you mean the withdrawal bleeds are not happening at the same time each cycle?

I was having regular periods last year and think I was ovulating. Noticed the right type of discharge.

When I say irregular I meant I've only occasionally had a withdrawal bleed but this is likely because I was taking it wrong. I had expected that I'd still have periods too, which you have explained wouldn't happen. I didn't know that before.