HRT. Do periods just carry on forever?

[blinder]

I’ve been on HRT for a year now. My periods have settled back to pre-peri normality. Not heavy. Slight moodiness.
But, for those of you who have been on HRT for a while, do you still have periods or have they petered out now?

The thought of having periods in my nineties (assuming I make it that far!) is daunting!

Most women stop periods by 53/4. My Mum stopped at 55. No HRT. Then after 3 years when she was almost 59 they returned spontaneously. She thought it was cancer. GP confirmed bleeding was periods and told her she was lucky not to have got pregnant. Periods lasted about a year and she was 60 when had last one.

@Chocolatestain that’s genius. I’ve been forgetting to take my progesterone and worrying about it because of the cancer risk. I could just start on Day 1 of the month. Wow - that would make life so much easier.

Great link thank you @Apileofballyhoo!

Sorry to just jump in but a lot of you are raising questions so can I to?

I'm 42 and not had a period for 13 years because I take the pill continuously. How will I notice menopause? Will the pill (desogesterol) mask it happening? I don't have a clue. I really don't want to come off it because I get migraines if my hormone levels change. Plus who wants to have a period?!

@blinder I think we have JinglingHellsBells to thank for that tip. I’m pretty sure I read it on one of her posts. Apparently it’s the way a lot of specialists prescribe HRT.

I now just cut off a strip of 24 (12 doses) of Utrogestan tablets on the first of the month and leave them on the bathroom shelf next to my toothbrush so I remember to take them when I clean my teeth at night.

I knew none of this. Why isn't this stuff more widely known?

Am waiting to pick up my prescription for oestrogen patches (have just had a mirena ftted again). I think this would be type 2 so hopefully no bleeding....

I started HRT about 5 years ago. After a year, my consultant suggested I take it continuously.

No periods when I use Utrogestan continuously.

I really do despair at how little GPs communicate.

In my experience over the last 7 or 8 years when looking for advice and help from numerous nurses and doctors at my local practice, most know next to nothing about the menopause. It has been quite shocking really. Having been on the pill and not having had a period for over 10 years no one could tell me what to do, whether to stop taking it or what might happen. I decided to read a book to educate myself and then took myself off the pill. I was confronted with very long and heavy periods which came as quite a shock. HRT has really helped but I had to pay for a private specialist to get the dose right because my gp didn't have a clue. I was advised to try continuous progesterone (I'm 53) and I don't get bleeds on it. Anxiety, mood swings, anger, sleep and muscle aches are much better so wouldn't go back.

Someone mentioned that symptoms go after a few years and you can come off HRT. I don't understand this as the hormones don't come back, so is this true? If tye gp decides not to prescribe it for me anymore will I have to put up with feeling rubbish again?

@JinglingHellsBells I think the reason a lot of us don’t get info from our GPs (assuming they know, in the first place) is that, if like me, the GP appointment was over the phone and very brief. I make a note beforehand of the very essential questions I had and saved the others for my own research. I’ve also been lucky that I have friends that can afford to go private and had much longer appointments and shared the knowledge. Lots of people (including me) can’t afford that.

Ps and also was lucky to have this forum too especially you @JinglingHellsBells

Can I ask a question please? I'm on HRT for the past few months (initially 37.5mg Estrodot then 50mg, and 200mg Utrogestan 12 days a month) and got a withdrawal period the first couple of months but not for the past 3 months? I can't seem to find out if you're supposed to have one every month or if its just that most people do? My period had become irregular anyway in the year or so before starting HRT if thats relevant. It's next to impossible to speak to my gp (nearest appointment is a month away). I'm taking the Utrogestan orally to help with sleep, maybe I should be taking it vaginally instead? Any help appreciated!

I'm using evorel 50 patches continuously and taking provera 10mg tablets for the last 14 days of the cycle. I'm bleeding whilst taking the tablets. Does anyone known if it's ok to postpone the tablets for a week or so to prevent the bleed happening while on holiday?

I'm 63m and still on the period inducing type HRT. My period is only 2 days though, which I can live with. The covid vax wrecked that for a good many months however... flooding and pain for 4 or 5 month post AZ vax and again after Moderna booster.

@JinglingHellsBells
I hope you don't mind me asking something..,I'm 55 and have been taking continuous HRT for at least a couple of years. I'm still having "periods", pretty light and very irregular. Am I understanding correctly that this is my own cycle still? As I'm not on cyclic HRT? And so will it die out eventually?

I don't know why this is so confusing or why this information is so hard to find out. I suspect that GPs don't always have all the answers, so what hope have we got? 🤷🏻‍♀️

Hmmmm! Had your periods stopped when you started HRT? If not, your GP ought not to have put you onto continuous.

You do need to go and talk to your GP.
Any bleeding that lasts more than 6 months has to be investigated because after 6 months the estrogen+progestin in conti types should work and avoid a bleed. BUT if you are still not post meno that could explain the bleeds.

This should explain it all better than I have here!

www.menopausematters.co.uk/postmeno.php

Read the bullet points further down and also see the type of HRT you are on just to check it IS continuous/combined.

@JinglingHellsBells Thank you so much for the reply.
My GP changed my HRT from cyclic to continuous because I was still getting awful mood swings and the idea was to level out the progesterone so there'd be no "crash". It worked in that sense but I went from having a regular bleed to having sometimes 2 bleeds a month and sometimes just random bleeding. I'm still having irregular bleeding over 2 years later.

I can definitely go back and discuss it but I'm worried that she will suggest I stop HRT altogether, she pretty much suggested that the other day when I called to discuss alternatives to Estrogel, she started up with the well you've been on it 5 years, we don't even know if you need it any more blah blah. I indicated that I definitely was not planning to stop any time soon!

I’ve been on HRT over 5 years and am over 54 and have never been told about continuous form. Is the only advantage that there is no bleed? I would prefer to use transdermal oestrogen and I presume the No bleed continuous form is a tablet?

No, MVision. Continuous can be transdermal. I'm on Oestrogel myself.

what type and dose are you on @Caminante ? Patch? gel? Pills?

You certainly don't need to stop. I've been on it for around 14 years. I came off for a month a while back and felt awful - sleep issues. My consultant suggests a 'check' if women want to know how they feel not on it- ideally a 2-3 month break, then back onto it if they still have symptoms. That might be a talking point for your GP if they are stroppy.

However, at 5 years it's quite early days and if you feel well, there is no need to stop.

I find the whole thing about continuous and sequential and switching very confusing.

Many women who start HRT have erratic periods. They haven’t fully stopped, so they start with sequential. The HRT gives them a regular non-real period bleed. Fine. And then they don’t know when to switch. To know if their period has stopped, they’d need to come off HRT for months, to see if their erratic real periods ever returned…suffering the consequences if menopause whilst waiting. But we are always warned about not switching too early….54 is touted as the age when it’s safer. But many women start HRT far before this, and so suffer painful bleeds, PMT etc for a long period to 54, which for many will be long after their periods stop…but they don’t know they’ve stopped and don’t want to go continuous before it is ‘right’.

But the only downside if continuous I can see, is if someone has it before periods have fully needed, they might get a break through bleed/real period. I assume this is as well as the HRT induced bleed. Why is this a downside or problem to be avoided? If women keep getting it, they know their periods haven’t naturally needed and can return to sequential. Why is is bad to get a breakthrough bleed particularly? Does it matter? Does it have bad consequences beyond being slightly annoying? Instead women feel they must wait until 54 to be sure. I know some places say you can switch after 12 or even 6 months, but that info doesn’t seem widely out there, and 54 the magic number.

Why instead don’t they suggest that each year, women try a continuous phase for a couple of months and see what happens? Isn’t this a good indicator in itself if whether natural periods have needed or not? What downside is there of this?

So many women are on these threads saying they’ve been in sequential for several years and would like continuous but haven’t hit 54. For younger women starting who have erratic periods, there always seems to be an outcry if an start on continuous…but why….is it actually a really bad thing to get a breakthrough bleed. It’s always mentioned as the big reason not to have continuous if under 54 or not knowing for sure you’ve been period free for a year, but is it actually a big deal? Usually, the websites don’t go beyond mentioning a break through bleed but never say why this is a thing that must be avoided.

Sorry…final thought.

No doubt someone will say, it doesn’t really matter and you can try both and see which suits you. That’s fine, but the point is women generally do t want to be left to do trial and error and see what works for them. They lack the confidence to do this with prescribed items and fear doing the wrong thing which will harm them. With other prescribed drugs, choosing your own regime or changing dose could be very serious. So I think there needs to be more clarity about why and if sequential is actually vital or simply advised, and if the withdrawal bleed problem is a serious issue to avoid, or just a matter of inconvenience. Otherwise, women continue with regimes which they feel they must stick to, which might generate other problems…painful bleeds, PMT etc etc.

I think I need to go to med school or something. I still don't really get what's going on with my periods.

I was still having periods, although my cycle was getting quite erratic - from a bang on 28 days for my whole fertile life to anything from 14 to 60 days, when I stated HRT. Because of periods I am on sequential, with prog for 2 weeks every 28days. So I know I'm supposed to have a withdrawal bleed. But sometimes I'm bleeding at the start of switching to prog, sometimes mid way, sometimes when I'm actually only on oestrogen, and then another when I'm on prog. it's all very erratic still. I don't know if that should concern me? It certainly frustrates me.

I'm trying to work out what it means for my hormones. I think it's to do with my natural hormones sometimes working, and somehow my hrt 'cycle' has unsynchronised with my natural one? And I can't work out how to solve it.

I am completely confused by hrt.

I started it literally just a week before lockdown in 2020, aged almost 50. At the time my periods were erratic and unpredictable and spacing out after a year or two of 3 week cycles - but were, and have always been, very light.

I have patches - and progesterone, for 2 weeks.

I don't get bleeds. Or at least very rarely. Certainly no return to predictability. I had a very light bleed a couple of weeks back, my first in several months.

I don't know if the hrt isn't strong enough or if it's that I am not very good at remembering to take the progesterone every night for the relevant two weeks. I do find that I have less issue with dryness and low libido since starting hrt.

I did ask a different and very young GP about the lack of bleeds and she said that the aim of hrt was to stop periods and that's what we wanted...so I don't think she was the right person to ask really!

I still can't find out whether the lack of bleeds is a concern or not.
I am not worried about flooding - the occasional bleed I do have remains very light.

Like karma above, the occasional bleed I have is unrelated to the hrt "cycle". It's not like when I took the pill years ago, where the withdrawal bleed would start predictably 3 days into the no pills week.

@WombatChocolate You might be a bit confused over a few things.

But many women start HRT far before this, and so suffer painful bleeds, PMT etc for a long period to 54, which for many will be long after their periods stop…but they don’t know they’ve stopped and don’t want to go continuous before it is ‘right’

Do you mean women having their own natural periods or on HRT?
Some women have no bleeding on sequential HRT (about 20%.)
Some women have a light withdrawal bleed.
Some women have a heavier withdrawal bleed.

It's assumed that by 54, 80% of women are post meno. That's why continuous is suggested if they want it. (There is no absolute rule.)
If someone is not actually post meno then, yes, they might get a natural period, that is not controlled by continuous HRT. But most won't.

Your idea of trying it for 2-3 months.

The guidance is that it takes up to 6 months for conti to work and for no bleeding to occur. This is because it can take that long for the 2 hormones to work together to keep the lining thin.

Breakthrough bleeds

In younger women using continuous too soon, breakthrough bleeding (often continuous spotting or very light bleeds) is a nuisance but nothing more.

In older women who have used conti for some time and then have bleeds (after the first 6 months) it creates a scenario where they might be sent for investigations. It's always assumed post meno bleeding is possibly cancer till proved otherwise. (RCOG guidance). Obviously, HRT complicates this as most women who have bleeding on conti are fine and it's a hormonal blip. Some women on contil still have a lot of their own estrogen = bleeding- so the guidance says increase the progestins first to see if this helps.

It's all explained here www.menopausematters.co.uk/postmeno.php

The other reason for continuing with sequential is it's been shown to have a lower risk of breast cancer than continuous. (by about 1.3% in some studies.)
If someone is on HRT long term, this might be a consideration.

Sorry for the essay!