Periods and sequential HRT

[Picksomethingatrandom]

I cannot find a clear answer anywhere on this!

I am on sequential HRT for severe psychological perimenopause effects. Now aged 50...
My cycle seems to be getting longer and longer, now around 40 days. I thought the HRT would keep me in a regular cycle, bleeds roughly every 28 days, in time with the progesterone element.

Do periods/bleeds eventually stop, even when taking HRT?

on sequential, used on a monthly basis, the bleed ought to occur around 3-4 days after the last dose of progesterone.

what type are you using and what dose?

The only reason for this odd bleeding is your own hormones are overriding the HRT.

Are you on tablets/ patches/ gel- dose? And what sort of progesterone?

Are you sure your dr has given you sequential?

I am on Oestrogel or Sandrena, depending on availability. And Utrogestan 14 of 28 days. Currently on day 40 since last bleed.

Dose - 3 sachets of Sandrena or 4 pumps of

Hit post too soon...
Or 4 pumps of Oestrogel...
And 200 mg utrogestan.

Absorption of utrogestan can be very variable in women and you need to make sure your womb lining isn't building up - speak to whoever prescribed it to you. You may need more (a nurse said to me they could prescribe 300mg now though if you're not absorbing it that may not help), a different delivery mechanism e.g. vaginally or to consider a Mirena.

If you aren't bleeding at the expected time that's not a huge issue unless you don't bleed at all. BUT the breakthrough bleeding could be down to little absorption of utrogestan as PP says and you are also using a high dose of gel- twice the starting dose.

You could ask for a scan to check the womb lining but it's hard to arrange the right time through the nhs, because ideally it needs to be done just after a bleed to check the lining is thin then (when it ought to be.)

You will always get a bleed on sequential so no, it won't stop as it's not a real period. it's created by the utrogestan to make sure the lining doesn't get too thick.

when you are post meno, you can swap to a no-bleed sort using progesterone daily.

Thanks. I am on a high dose as I was still having night sweats and mood swings. But, I think the night sweats may be unrelated, and have just had blood tests to rule out other causes.

I've been querying longer cycles on sequential and been told that you can start to miss some - as body naturally heads into meno.

Which can be an indication that continuous would be appropriate?

My Gp said women usually move on to continuous after a year on hrt anyway.

@WarriorN Cycles shouldn't change when using sequential HRT. It's not connected to age, it's connected to the balance of the estrogen - progestin in the HRT.

Too much estrogen can mean some breakthrough bleeding (rather than a regular monthly withdrawal bleed.)

Usually, if someone is bleeding outside the predictable monthly withdrawal bleed, it's because they have a lot of their own estrogen as well as the HRT estrogen and the dose of progestin doesn't control it.

On the other hand (!) too much progestin can make the womb lining very thin so there is nothing to shed, at the end of a month.

The regular withdrawal bleed rarely changes no matter how old someone gets. I'm still on sequential out of choice, more than 15 years post meno, and the bleeds are usually very predictable to within a day or two each time.

I'm wondering if using progesterone vaginally is working too well in my case then?

My oestrogen was tested and was flagged as 'borderline low' when on 50 patches (it was day 3 of period.)

Why and when do you go onto continuous?

I'm having a monthly bleed but it's a good 7-10 days after I stop the progesterone.

Had become v v light before went up to 75 patch. Yet to see how this month's goes.

that is possible...low estrogen can = no bleed.

Going onto continuous is a choice but most GPs don't seem to understand that. It's there so women avoid the bleeds.

sequential has a slightly higher risk of uterine cancer but a lower risk of breast cancer.

Breast cancer risk
1 lowest with estrogen only (lower than for women not using any hrt)
2 higher with sequential
3 highest with continuous

I have stuck with sequential.

Guidance is continuous at age 54 ( 80% of women post meno then) or 12 months after the last natural period. Using it before either of those can cause spotting as the smaller (daily) dose of progesterone doesn't control bleeding enough.

Ok thanks - has that been based on orally? Is there any difference when taken vaginally?

@WarriorN I don't think that research and data has been done.

The data that was used for the most recent report- in the Lancet- barely included women using micronised progesterone (it was a tiny number, like 58!) out of hundreds of thousands on other types.

This is why almost all data on risks of BC are confusing and unclear, as they only include the synthetic progestins.

The BMS has compiled a statement on the risks of Utrogestan and they say that for up to 5 years' use it does not increase the risks of BC. Longer studies and analysis is needed.

There is data from Europe on its risks and safety, which does show little risk compared to other types of progestin, but it doesn't differentiate between oral or vaginal.

I may get a Mirena again. Just to try and keep levels stable through each month. I also looked back to the notes my HRT doctor gave me. She said to go back to 2 sachets of Sandrena if the sweats continued, which I will do. And get the extra blood tests done. I am waiting on the results, but I am pretty sure nothing will show up, as I think the sweats are anxiety related. And this anxiety has a specific cause rather than being perimenopause related.

Thank you for the info and clarification Jingling.

I hope that works for you OP. Did mirena help with hormonal ups and downs? I struggle with the dip around my period.

Gp said it wouldn't do that but that was a long time ago.

Hi everyone , I'm very new to Mumsnet and HRT but I'm hoping someone can help 🙂
I've just started using patches with 200mg progesterone to be taken 14 on and 14 off. I'm also on the mini pill which has been great as no periods . I'm just concerned that now I'm adding estrogen will I now start to have a period during my 14 day break from progesterone.