Help! Bit confused by progesterone schedule

[LoudestCat14]

Even though my GP diligently explained it, I'm getting into a right muddle with my schedule and am hoping the wise heads of Mumsnet can clarify something. I began taking Oestrogel on Fri 28 May, then on day 15 began taking 2 x 100mg of progesterone. My last day of the 12-day schedule is Tuesday. After that, when do I start taking it again??? In two weeks or a month?

Honestly, maths has never been my strong point!

Hi, I’m a GP and I’ve recently done a lot of training updates on hrt prescribing due to the high levels of calls we’ve been getting about it after the Davina show! I’m presuming you’re on a sequential hrt regime (ie you’ve had periods at some point in the past 12months, and the plan is you’ll continue to have regular bleeds after starting hrt) with utrogestan?

What I tend to advise - and this is on the advice of consultant gynaecologists with hrt interest I’ve see present on various webinars- is taking the progesterone component for days 1-14 of the calendar month to make it easier to remember. You should usually then get a bleed a few days after stopping the progesterone, though this might be a bit erratic initially and take a few months to settle into a predictable bleeding pattern.

The gynae specialists I’ve spoken to disagree with what the BNF (doctors drug reference book) advises, which is 200mg once daily on day 15-26 of each 28 day oestrogen cycle (sequential hrt), or 100mg once daily on day 1-25 of a 28 day cycle (continuous hrt, so women past the menopause ie no period in the last 12 months), as it makes it overly and unnecessarily complicated. They basically advise 200mg days 1-14 for sequential, 100mg every day for continuous.

The 12 vs 14 days things - traditionally it’s been prescribed as 12 days, but most women find 14 easier to remember as it’s 2 weeks on, 2 weeks off, but you can do it in whichever way suits you best : days 1-12 of the month, days 1-14 of the month, day 15-26 of every 28 days. The reason the progesterone is used is to protect the lining of your womb from the oestrogen component of the hrt, and it’s licensed for 12 days out of a 28 day cycle, but saying that very few women have a bang-on 28 day cycle usually slightly longer, so a couple of extra days of progesterone aren’t going to do you any harm and may well provide a tiny extra bit of protection.

So coming back to your question (apologies for the background waffling above!), you would be due to restart the progesterone again 2 weeks after you stopped, so two weeks on, two weeks off. Obviously this means the actual dates you start and stop will be slightly different every month, so if you wanted to make it easier for yourself you could start the next lot slightly earlier on the 1st July - no risk to you doing this other than the chance of bringing on another bleed sooner than usual when you stop it again - and continue on like this, taking it day 1-12 of each month. I hope this helps! Xx

I've just started the same regime. My GP said just start taking the progesterone on the 1st of each month and that the extra day of a 31 day month won't make any difference.

Incidentally, she said to take it for 14 days, but the leaflet inside says to take it for 12 days. I did a bit of online research and come to the conclusion that 12 days was ok.

I didn't have any spotting or other bleeding until a couple of days after finishing the 12 days of progesterone. Then I had light bleeding for a day, 2-3 days of very heavy and then back to very light for a day or so.

@GoToSleepLittleBear Great to see you on the forum.

My meno gynae consultant has trained other drs and spoken at the BMS annual conferences. I've used HRT (from them) for many years.

Their advice is that for women who might be sensitive to the side effects of Utrogestan, it can be used vaginally and it also helps absorption as it goes straight to the cervix/womb.

Also, for some women, 10 days per cycle may be enough although this is off-label and tends to be ok for women who can access a private scan now and then to check the uterine lining. 14 days isn't always seen as necessary and as long as there is a good bleed each cycle, that's usually agreed to be safe.

Thank you SO much GoToSleepLittleBear for such a considered and detailed response, I really appreciate it as I totally get what I need to do now! I shall restart on the 1st as that will make it easier to remember. * MagpiePi My GP said to stick to 12 days, so that's what I'll do.

@LoudestCat14 you’re very welcome! I’m fairly newly qualified and really enjoying everything menopause-related so far so I love any chance to share my knowledge far and wide🤣 one thing I have to correct though - when I said you should be restarting the progesterone after 2 weeks I was still thinking about women who take 14 days of progesterone rather than the 12 that you’ve been prescribed, so for you on that regime it would actually be 16 days till you had to restart it - ie not taking it on the last two days of the current cycle (days 27 and 28) then not taking it on days 1-14 of the next cycle, starting again on the next day 15. But it think that sounds so confusing and tricky to keep track of, I thing you’re definitely doing the right thing switching to calendar days!

@JinglingHellsBells yes I just recently prescribed pv utrogestan for the first time, and straight away got a call from the local pharmacist to ask me to correct the script back to oral! And she was surprised when I told her it was on purpose so clearly it’s not been used much in my area before, but great to have it as an option. Thanks, that’s interesting about the 10 day option in certain circumstances, I hadn’t come across that before so I’ll get reading up on it.

@GoToSleepLittleBear You will know the medical ethics and rules better than I do, but the variations from the licensed doses seem to be okayed by private consultants, who are taking personal responsibility for it, which inside NHS prescribing may not be possible.

My own consultant (who has been a key speaker at BMS annual conferences for years) has me on a different cycle to the usual 4 weeks + 12 days Utrogestan. But this is monitored and I pay for scans, which aren't offered under the NHS. I am happy to discuss in more detail by PM if that helps, but I suspect that in the NHS your hands are tied re. dosage.

GoToSleepLittleBear Sorry, I'm a bit confused again! So you think it's fine for me to just start in July on the 1st, take for 12 consecutive days, then wait either 18 days until the 1st of August? Even though I'm only stopping my first 12-day dose tomorrow, on the 22nd? That doesn't seem much of a gap.

I actually started this first dose on the 11th, so I'm thinking I might just stick to starting on that day every month. It's actually easy to remember because my DC's birthday is the 11th.

@LoudestCat14 I'm butting in as I've used this regime for years.

So, from what you have said, you started Utrogestan on 11 June. (15 days after the 28 May.)

So your next dose of Utrogestan ought to be the 11th July.

As @GoToSleepLittleBear says, it's easier to follow a calendar month and not worry too much about the 28-day thing. It really doesn't matter if the month has 28, 30 or 31 days. Women's natural cycles never follow an exact pattern anyway, to the day, and all HRT is doing is creating a new 'HRT' cycle.

If you can remember to start on the 11th of every month from now on, all well and good. If you tend to forget dates, some drs advise women to choose an easier day such as the 1st of every month.

It's absolutely fine to re-set this HRT cycle either slightly earlier or slightly later to suit your own preference.

Thank you JinglingHellsBells, you've made it really clear now about calendar month vs the 28-day schedule. I think I'll stick to the 11th as my starting – I'm very good at remembering dates (even more so now the brain fog is slowly lifting!) so it shouldn't be a problem. I'll set a reminder on my phone too.

Also jumping on this thread as I'm a bit confused with the schedule and want to check that I'm following it correctly .

I picked up my prescription earlier today - Oestrogel and Utrogestan. I would like to start using it immediately (obviously!) so I'll start with Oestrogel for 2 weeks, today being day 1, and then take Utrogestan in 2 weeks time, on day 15, for 12 (or 14?) days. So does that sound ok? Just a case of reminding myself with diary note of when to start taking the Utrogestan? And it doesn't matter if I take for 12 or 14 days? I also started my period yesterday if that makes any difference.

Final question - any advice on whether to put gel on in the morning or evening? I am thinking evening as straight into bed, sometimes I don't shower until later on in the morning, after I've been to the gym. The Utrogestan says on empty stomach so also just before bed.

Really keen to start HRT but keep coming up with questions. Thank you for any answers / tips.

Sorry for causing more confusion @LoudestCat14, I’m clearly not well practised enough at explaining this sort of thing over text, it’s much easier face-to-face/over the phone! Your plan of sticking to the same starting date each month is a great one, and as daft as it sounds not an idea that had occurred to me before - I’d usually suggest 2w on/2w off or starting the 1st of each month, but it didn’t occur to me to suggest sticking to a regular monthly starting date which WASN’T the 1st of the month, so thanks to you and @JinglingHellsBells for pointing this out to me!

What I was trying convey (not that it reallly matters now as you’ve got a plan, but just in case anyone else comes across this looking for advice and also finds my last message confusing!) was the potential problem with doing the 15-26 dosing as part of the 28 day hrt cycle, because of how it changes the dates you’ll be starting the progesterone from month to month, because the months are longer than 28 days.

Eg, you starting oestrogel 28th May = day 1 of your first hrt cycle, then you start progesterone on 11th June = day 15, finishing on 22nd June = day 26. You then go back to just oestrogel again, and the next two days 23rd and 24th June are day 27 and 28 of your first cycle.

Then you come to 25th June = day 1 of your second cycle. (This is what I was meaning when I said it would be 16 days till you were due to restart progesterone, as you’ll only be having oestrogen on day 27 and 28 of the last cycle, and days 1-14 of the next cycle =16 days in total). Now 9th July = day 15 on which to restart progesterone, continuing to 20th July = day 26, then 21st/22nd you’re back to oestrogel only again for the last two days of this cycle.

Now 23rd July =day 1 of cycle 3, which means day 15 = 6th August...and so on.

So really the outcome I’m trying to explain is that doing it this way, each month your day 15 will move earlier dates-wise by two or three days, which maybe isn’t always easy to keep track of with everything else going on in life and definitely has more potential for confusion compared to doing it your way of sticking to starting it on a set date each month.

Gosh it’s so much easier to explain what I mean when chatting! But I hope this clarifies what I meant for anyone looking in.

Hi @shopsalot, yes you’re fine to put the oestrogel on whatever time of day suits you. If women are on high doses ie 4-6 pumps daily we usually advise they split the dose morning and bedtime, otherwise they can be standing around for ages waiting for it to dry in. You probably know this already but don’t rub it in, just gently smear it on (to shoulders, outer arms, or inner thighs) and wait for it to air dry, can take up to 20mins if on a few pumps. Also, the advice is then to avoid skin contact with anyone else (particularly male) for the next hour to avoid absorption by partner.

12 vs 14 days of utrogestan - whichever your GP has prescribed you is fine. For women still having periods then if it suits them we often advise taking the utrogestan in the final two weeks of the hrt cycle ie from days 15 - 26/28, the reason being that you would expect the bleed shortly after stopping the utrogestan so it would fit in with the current timing of your natural cycle. So actually you’ve timed it perfectly - starting day 1 of your hrt cycle almost bang on day 1 of your menstrual cycle (ie first day of your period) - so you’ll do 2w of oestrogen only, then 12 or 14d of added progesterone, then hopefully have your next bleed at the usual time for you. But don’t panic if it starts a few days before you finish the utrogestan, or not for another 4-5d after you stop, it’s common to get some irregular bleeding initially and it can take a good few months to settle into a predictable bleeding pattern.

Going forward you can either stick with starting your 12 days of progesterone on the same date every month (most straightforward for women taking 12d - see my reply above for the explanation of changing dates each month if you stick rigidly to days 15-26 in each 28d cycle), or if your prescription is for 14d you can also start on the same date each month, or just go 2w on, 2w off.

It’s whatever suits the individual women really, what current menstual cycles she’s having and what she thinks she’ll remember. For women whose periods are irregular/infrequent we just say start whenever suits you/whenever your most likely to be able to remember eg the 1st of every month, rather than trying to fit in around periods. Any subsequent irregularity in bleeding should usually settle over the first 3-6m.

You probably know this already but don’t rub it in, just gently smear it on (to shoulders, outer arms, or inner thighs) and wait for it to air dry, can take up to 20mins if on a few pumps.

I did not know this! I'm on my second month of HRT and have been rubbing the gel in rather than smearing it. Does that mean I've been wasting my time? Oh well, sticky thighs for me as of tomorrow...

Since the mid 90’s I’ve always prescribed progesterone for the first 12 days of a calendar month - easy to remember and reduces error / forgetfulness in taking - take it the same way myself

You probably know this already but don’t rub it in, just gently smear it on (to shoulders, outer arms, or inner thighs) and wait for it to air dry, can take up to 20mins if on a few pumps.

@GoToSleepLittleBear This is not what is shown on a video on the website of Dr Louise Newson. I don't have the link to hand but am sure you can find it and another poster left the link on a different thread last week.

Basically, you do rub it in. Not so much that it disappears completely, but a good few up and down strokes. (I've used it for over 12 years.) I did a 'survey' on myself after this chat here and reckon I rub/ smear for around 6 strokes up and down, shoulder to elbow.

It's not practical to say it can take 20 mins to dry. Mine takes about a minute for half a pump on each arm, morning then evening.

@GoToSleepLittleBear I take continuous progesterone with a 3 day break every month since August. I did have a period in April 2020 and previously to that one in October 2019 and a couple in the summer of 2019. I'm 50. Should I be taking cyclical? I think my GP prescribed continuous because I said I didn't want regular periods and I'm happy with that.

@Missillusioned It's really a matter of choice.
The reason drs say use it cyclically is because otherwise, in peri, your own periods can sometimes break through as well as the withdrawal bleed. For women whose periods are very infrequent, then using it cyclically to continuously is up to you.

When I first used HRT I was very late peri and my consultant put me on a 3-month cycle, where I had a bleed every 3 months. (This can be done with a type of HRT called Tridestra OR - in my case- using estrogel and a separate progesterone. This was by a consultant, who trains other drs.)

I have stayed on cyclical ever since as it suits me in some ways as I don't get on with daily progesterone.

So it's your choice.

@JinglingHellsBells you’re absolutely right, Louise Newson does advise rubbing it in, but I gather she’s a bit of an outlier in this amongst menopause specialists who tend to advise pat/smear. Most of our recent teaching has been from Leila Frodsham and various colleague/specialists she has invited, and they specifically mentioned that Louise Newson does this differently to them, and to the product instructions. They speak incredibly highly of her and are always referring us back to her resources but I think there is definitely a bit of debate about this. I suspect the product information relates to how it was tested, and the “smooth it on and leave it to dry” method was what got consistent absorption. Clearly rubbing it in doesn’t make it less effective but I wonder if that’s what it comes down to. At higher doses like 6-8 pumps (which is off license but some women do use) then it definitely can take up to 20mins to dry due to the volume of gel being used, particularly if in a cold house, which I agree is just not practical. Leila Frodsham is quite an advocate for lenzetto spray which is slowly coming out across the country, as it doesn’t have this issue,

@GoToSleepLittleBear I guess what matters is that it's what works for each woman. Obviously, symptom-relief is the objective, (unless there are other reasons for its use such as osteoporosis where a DEXA scan will be part of the treatment evaluation.) If it's resolving symptoms, then it's working. (I can't imagine what it's like trying to use 6-8 pumps which is a huge amount!)

I've been under the care of an excellent meno gynae for many years (Louise Newson regards him as one of the best) which is where my info is coming from and he offers training to other drs.

@GoToSleepLittleBear thanks for the advice. I was wondering why the prescription said 14 days but leaflet inside said 12 days. Starting the progesterone on the same day each month makes perfect sense.

I may be switching to the Mirena coil in a couple of months - just waiting for an appointment - so I assume that will be simpler. Although I did read on the BBC News app yesterday about how painful it is for some women (Naga Munchetty) so maybe I'll stick to the tablets!

Hi, can anyone help. I'm totally confused and I feel a little silly that I can't get my head around this HRT. After struggling with symptoms for about 2.5 years I've decided to go on HRT. My doctor has prescribed me Estradot 50 MCG/24 hours patches with the instructions 'Apply 1 patch twice weekly'. This seems straight enough - I can put one on tonight (Monday) and another on Thursday night and continue this week in week out. However I am confused about the Utrogestan 100mg tablets that I have been prescribed. The directions are 'One at night for 12 days in each month-could take day 16 to day 28 of month'. As my periods are irregular I have no idea where I am in my menstrual cycle. If I apply an Estradot patch tonight (9th August) should I also start taking an Utrogestan tablet tonight also and for the next 12 days and then stop and start again on 9th September? Or should I wait and start taking the Utrogestan tablet on 1st September? I cant get through to my doctor but i am desperate to start HRT but I'm scared of doing something wrong that is detrimental to my health. Any advice would be greatly appreciated.

@GoToSleepLittleBear have you heard anything about the problematic oestrogel packaging / product effectiveness?

https://www.instagram.com/p/CUP8kiEMZre/?utmmedium=copyy_link

@GoToSleepLittleBear I've been told to take 2 tablets from day 12-26 does this sound ok?

I'm good with counting the days of my cycle & would prefer to work to my natural schedule as it were...

[quote JinglingHellsBells]@LoudestCat14 I'm butting in as I've used this regime for years.

So, from what you have said, you started Utrogestan on 11 June. (15 days after the 28 May.)

So your next dose of Utrogestan ought to be the 11th July.

As @GoToSleepLittleBear says, it's easier to follow a calendar month and not worry too much about the 28-day thing. It really doesn't matter if the month has 28, 30 or 31 days. Women's natural cycles never follow an exact pattern anyway, to the day, and all HRT is doing is creating a new 'HRT' cycle.

If you can remember to start on the 11th of every month from now on, all well and good. If you tend to forget dates, some drs advise women to choose an easier day such as the 1st of every month.

It's absolutely fine to re-set this HRT cycle either slightly earlier or slightly later to suit your own preference.[/quote]
@JinglingHellsBells am planning to count from day 1 of my cycle as the start of the month (taking oestrogen every day) then from day 12-26 take the Progesterone - does that sound ok?

Have found this link which explains progesterone very clearly:

https://www.chelwest.nhs.uk/services/womens-health-services/gynaecology-services/menopause-and-pms-clinics/links/ProgestogenandProgesteroneRegimensinHRT130518AGREED.pdf