Changing time of HRT

[Barcs]

Hi all - any advice? Can’t get hold of GP for two weeks and prescription arranged via email. Just starting HRT - taken first dose ever of oestradiol (09:45 today) but am thinking of switching to the evening. Any ideas if this is OK if I leave it to evening of following day? Also have utrogestan - doc has advised 12th -18th of each month but this is 15 days (ie longer than the advised 12-14) and I have read (NICE guidelines) you can take it on days 1-14 calendar month. Would like to do this and start on 1st June. Periods are v irregular so can’t align to any sort of cycle so I would have thought first 14 days of calendar month would be OK. Does anyone have any thoughts?

Bit unclear what your dr said..

12-18th is 7 days worth. Is there a typo in your post? :)

I am not aware Nice has guidance on the dosage but can assure you it's 12 days which is on the leaflet in the pack- you can read it.

It's been 12 days for years.

Why are you wanting to switch when you use the gel? Assume it is gel? Although 'taken' suggests it is oral- a tablet?

It doesn't matter when you use it- any time of day or evening. If you go for longer than 24 hours, once it's an established pattern, you may get slight breakthrough bleeding if there is a long gap ( ie more than 48 hrs) between the doses.

Yes, you can easily wait till the 1 June.

Many women (usually under private consultants) are advised to have estrogen-only for a whole month so they can judge the dose and tweak it, without having it affected by ay side effects of progesterone.

I have checked Nice out of curiosity and it's 12 days ( says days 15-26.)

Obviously for women without regular periods, starting mid cycle is meaningless, so you can start any time. Usually, it's best to start on the 1st of a month - easy to remember - or the 15th (same reason) even if neither is relevant to your own cycle, as HRT will reset the withdrawal bleed.

Does anyone know if you can take the progestrone 14 days on 14 days off? I read this on Louise Newsome's website, so not sure if it's 'official' or not, seems easier to keep track of.
OP, I use one pump of gel in the morning and one in the evening, I find it easier to spread that way, and it doesn't seem to cause any issues.

@Purpleavocado You can take 14 days if you want to, but most women seem to want to use as little as possible (me!) due to side effects. I use it vaginally, on my consultant's advice, but still get some side effects and after 12 days I've had enough!

Thanks so much JinglingHellsBells - that is really helpful. Yes, hormone head did a typo - dates on my utrogestan packet were 12th to 26th of the month, which I think I will ignore - as you say - pointless without a regular cycle. I’ll do 1st of the month for 12 days. And I’m using Lenzetto Oestrodial spray - did two sprays as directed this morning but now am thinking - a bit late in the day - probably best to do the whole hormone thing in the evening as my morning schedules vary from very early starts to very late.

Re: progesterone, also says this on the BMS (British Menopause Society) site: thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf#page13
“Based on current evidence, progestogen intake in non-hysterectomised women taking sequential HRT is recommended for 12–14 days a month. If the last menstrual period occurred less than one year (or less than two years in women with POI/early menopause) prior to starting HRT, a sequential combined regimen should be started [i.e. continuous estrogen with progestogen for 12–14 days per month].2 This can be taken on days 15-26 of the cycle or for practicality it can be taken on days 1-12 of each calendar month.”

**Just wanted to check that using a calendar month is OK advice as it seems to vary.

Go by the BMS advice above. I've used HRT for almost 14 years. My consultant is very experienced - has been a main speaker at the BMS annual conferences and also trains other drs. He says calendar months are fine (and in fact I have a variation on that but it's 'personally tailored' so won't suggest you do it.)

Only way I remember to take progesterone is by doing it on the first of the month otherwise I've no idea what's going on as I seem to have a period every 3 months or so.

Thanks Everyone - that has been really helpful. Value your advice!