When to start taking HRT

[Lund]

I've been prescribed Evorel patches and Utrogestan - the Utrogestan to be taken on days 14-28 of 28 day cycle. I no longer have a 28 day cycle - it is very irregular and i'm currently on day 20. Do I need to wait until I get to day 14 again to start taking it? - this could be some time, given that my last cycle was 50 days! Can i start the patches straight away even if not taking the Progesterone for a while longer?

Didn’t your GP advise you? Or the pharmacist who dispensed the prescription for HRT?

Surely you should be asking someone qualified about this?

I think I'd email the surgery or ask for a call back. My surgery would happily clarify something like that.

I use a period app to keep track of the days. Count the first day of patches as day 1. With my uterogestan I take it on day 15-26. I ignore what my cycle does and stick to the prescription instructions.
It took my cycle 6 months to sync with the routine - my period would start random times- but I still stuck to those timings.

It's a shame your GP wasn't more helpful!

With irregular periods, you can use HRT to reset a cycle (it may not happen for the first few cycles however) .

There is no absolutely right and wrong way to do this when your periods are irregular.

As long as you have a course of progesterone each calendar month, that's fine.

You can start the estrogen now and wait 2 weeks till the Utrogestan. Or you can start both now. eg if you started today, the 9th, you'd take the next 12 days of Utrogestan on the 9th Sept.

Ignore your own cycle and set a new one. Your body with 'catch up' eventually with that pattern.

Presumably if they didn't tell the OP the first time, they aren't likely to now? This question of how to take it comes up time after time on this forum. Many Gps seem unable to work it out!

Thanks JinglingHellsBells, that's really helpful. My GP did explain about starting on Day 14 which I thought was fine - it was only when I came away and did the maths that I realised that could be more than a month away! And I could get back to them to clarify but I've a feeling it would be one of those conversations that goes round in circles and they stick to the hardline of 'Day 14' and I try to explain that is a long time to wait. It's good to know it's not so important with an irreugular cycle. I've been peri-menopausal for quite some time and had been putting of this appointment for ages so I'd like to start as soon as possible. Would be good to get back to a regular pattern. Thank you!

Just on the 'set a new cycle' point...

I started taking HRT in December after my henceforth regular cycle stopped abruptly in October and the insomnia was so bad.

I was nearly 52, so not surprised that my periods stopped, but hadn't expected them to go from a 28 day cycle to nothing.

For the first few months, I took Utrogestan days 1-12 then bled. All fine. For the past couple of months, I've started bleeding on day 7 or 8 of taking Utrogestan. I always take it at night, but wonder if there's been more than 24 hours sometimes. I've carried on taking the Utrogestan for the full 12 days though.

I'm going to contact my GP about this, but thought I'd also check with the wisdom of MN - is this normal/okay or something to be concerned about?

TIA

@christinarossetti39 A couple of things....

Missing 2 cycles doesn't mean your periods have stopped (for good.)

This is often how it goes- miss a couple, then back to normal for a few months, then miss another few, or cycles get closer together or further apart.

I always take it at night, but wonder if there's been more than 24 hours sometimes

Do you mean you skip a night? Or it's only an hour or so difference?

Skipping a whole day can cause early bleeding, in some women, especially as Utrogestan is poorly absorbed sometimes.

But my guess is that it's your own cycle that's come back and the utrogestan isn't controlling it enough.

One way to get more absorption is to either take it with food (so, close to a snack or a meal as this doubles the amount getting into the blood stream) or using the capsule vaginally, which gives a higher absorption.

I doubt your GP will know anything more unless they are specifically HRT trained through a BMS course.

Thanks JinglingHellsBells.

I didn't think that my periods had suddenly stopped and that was it when I went on HRT - more that they had stopped for a couple of months (which coincided with my third covid jab although no effect to my cycle with the previous two) and I couldn't cope with the acute insomnia.

That's interesting what you say about taking utrogestan with food - the instructions on the box are to take it on an empty stomach, either a hour before eating or two hours afterwards. I don't skip a night, but sometimes take it at 9pm then maybe 11pm the next night

Just had another cycle with bleeding on day 7-9 of cycle (taking utrogestan days 1-12). I took it for the remaining days but no bleeding when I stopped.