Bleed while taking Utrogestan, not after

[Ffffffs]

Any advice please?

I'm 47, still having regular periods. I started HRT 3 months ago, estrogen every day starting on day 1, then 2x Utrogestan from day 14. Initially I took it for 2 weeks but it seems 12 is better (?). And I realise it takes time to settle down but so far I've had a bleed in the second week of taking Utrogestan every time, and this month (4th round) it started on day 4.

Am I supposed to continue with the right number of Utrogestan pills, regardless of bleeding, or do I stop when I get my "period" and reset the count, so count that as day 1 and restart the Utrogestan 14 days later?

I felt a lot better to start with, then in Jan got covid and it seems to have knocked things out of whack, back to being cross and itchy!

Thanks!

I had this issue and raised it with a menopause specialist. Her advice was to do the reset ie stop the utrogestan when your period arrives and treat that as day 1 and restart the utrogestan on day 15.

This happens to me too - I started HRT when I was having regular periods. To start with my consultant suggested going completely without the Utrogestan as it seemed my cycle was overriding it. But then I had a month when I didn't get any bleed at all. So now I am just taking it for 12 days starting on the 1st of each month, but if I bleed before then I do what @ladygindiva suggests and re-set..

Great, thank you.

I hadn't realised that bleeding during the progesterone stage was an issue. I still have periods, I started Evorel sequi 4/5mths ago, I've just moved onto gel and tablets this month. But whilst on the patches I bled without fail on the second progrsterone patch of the cycle. (The irony being my periods have been irregular my whole adult life). I carried on with the third and fourth patch, should I not have?

Women taking cyclical HRT (ie. Oestrogen every day usually via a patch or gel, and progesterone for 12 days during the second half of the cycle) should expect to bleed towards the end of, or just after, the progesterone phase. Your menopause specialist should tell you to expect this - especially if you are still having regular periods.

Because you started HRT before your natural periods stopped (as I did) it can be difficult to establish exactly when you're through menopause, due to the potential for monthly bleeding, whether natural or withdrawal.

You're more likely, naturally, to expect monthly bleeding towards the end, or just after your cyclical HRT regime if you're still having periods. I don't know why doctors would tell you to reset by going back to Day 1 as bleeding is normal due to you being peri and not post menopausal.

If you're post menopausal and/or have just started a cyclical regime (ie, within 6 - months or so) breakthrough bleeding is normal and to be expected. Progesterone builds the lining of the uterus. It's natural that a bleed may occur towards the end of a cyclical regime.

I'm just reviving this thread briefly as I've had this same situation and as far as I can see, medical advice varies on how to deal with this.

As I understand it, the Utrogestan is there to cause you to have a monthly bleed, and prevent the womb lining from building up whilst on oestrogen. So if your period starts before that point, your body is doing the job anyway, so you can stop taking it and start again on day 15 of the next cycle.

However, other sources tell you to continue with the 15 days for hormone balancing purposes, as per this resource

www.cemcor.ubc.ca/resources/cyclic-progesterone-therapy

I've emailed my GP to see what they say, as there is no advice in the leaftlet that comes with my progesterone pill. I will update with new info as it comes in!

@FernCurl You carry on taking it, don't stop.

I had this issue before and my consultant advised that.

There are two reasons for this

1 A breakthrough bleed can sometimes mean the lining has got thick and is shedding early, so you need more progesterone, not less.

2 It means you never create a HRT cycle and your hrt is following your cycle, rather than you cycle being set by the HRT. Long term this won't work, because your own bleeds will end up all over the place in peri- they can come as often as once every 2 weeks, or once every 2-3 months.

ps the site you found is not really a conventional medical site and not a source to be relied on. it's also not a UK site and HRT prescribing and products are different in the US.

If you want to find reliable advice, look at The Women's Health Concern, or the British Menopause Society.

I don't know if you will find this helpful but here's what I'm doing. My own cycle kept overriding the hrt cycle and I was bleeding each month but never starting when the utrogestan was supposed to make me bleed. Additionally I was feeling pns symptoms for more than 2 qeeks so I knew the original regime wasn't suiting me. I didn't want to take more oestrogen/progesterone than necessary to 'fix' this, so: each calendar month I bleed, i count that as the 1st cycle day of the bleed and on the 15th cycle day to the 26th cycle day i take utrogestan.
The start date changes each month slightly but I'm happy as long as i take utrogestan and subsequently get a bleed each calendar month.
If my bleeding stops or goes completely awol, I'll pick a date and take the utrogestan on tge same date each month.

Hi all could I ask for your advice and experience on my very similar situation as I am confused now about whether t0 continue as is or make a change. I started HRT at the end of October so am midway through 3rd cycle. I am on Evorel patches - the lowest dose ones of 25mg and then the 12 days of 2x100mg of Utrogestan. I am working on a 28 day cycle so 25mg patches twice a week then 200mg of Utrogestan on days 15 - 26 for the 12 days. I am 51 and period were still present beforehand but I was definitely skipping and I hadn't had a natural period since early September.

The first cycle I stopped the Utrogestan on day 26 and then a pretty light bleeds came pretty much on schedule around day 28 and lasted for 3/4 days. Pretty much like a light period. At the end of the second cycle (day 28 on 23rd December) nothing happenned for a few days but then I started bleeding very, very lightly around day 2 of the third cycle, no clots. But I am still bleeding now which is day 11 of the third cycle. It has gradullay got much heavier and now its like a heavy period, with clots and shows no sign of slowing down or stopping. I am obviously due to start taking the Utrogestan again on Saturday for day 15.

Do I just carry on with the schedule regardless of the fact I am still bleeding way into the first part of the third cycle? Do I start taking the Utrogestan again according to the schedule on Saturday for day 15 of cycle 3?

Have I somehow got the balance of Estrogen and Progesterone out of whack I am wondering? Because I am on a low dose of Estrogen (25mg) is 2 x 100mg Utrogesterone too much? Should I switch to one tablet?

Complicating factor is I had covid (again) before Christmas during the middle of the Utrogestan part of cycle 2 so perhaps the bleeding could be to do with that? It did bring on some heavier periods ealier last year when I had it the first time when they had been starting to slow down previously.

What would you do?

If it were me, I would keep on this same regime a few more months as it takes awhile to settle and know where you are before making changes.

Just reactivating this as very relevant to me - early days of peri and been on HRT since last July. For the first 5 months, my bleed was in a pretty regular 28-day cycle and started within a day or so of stopping the utrogestan. In November however I started a bleed after 23 days and it's been skewed ever since, with my bleed starting while I'm still taking the utrogestan. And my PMT is suddenly terrible. Question for@neurospicygal - if you are midway through the 12 days of utrogestan when you start your bleed, do you just stop the utrogestan and start again on day 15 of the new cycle? And have you received any medical advice about resetting it in this way? Thanks!

I started hrt in july. Periods were 3w off, 1w on, 1w off, 3w on.

As soon as I started utrogestan, my periods regularized, starting on day 18 (day 4 of taking utrogestan) and it continues until day 26 (day 12 of utrogestan). Periods are heavier than before. My mood is also really low.

I've just had a review and moved onto evorel patches to see if not taking progesterone orally works better. GP not concerned that I bleed whilst on progesterone but said it was unusual.