New HRT to start TODAY - Estradot (75mcg) & Lutigest (100mg) pessaries - how to use?

[54isanopendoor]

I'm 54. After much persuasion my GP gave me HRT (Evorel Sequi).
I took for 8m, effect wore down. I asked for higher strength. GP said not avail.
Gave me Estradot (75mcg) / 24 hrs & Lutigest 100mg vaginal pessaries.

Only Im not sure how / when to start them.
I was having monthly periods before I started the evorel aabout a year ago.
Then I stopped HRT about 4 m ago. Since then, no periods.

So, I'm not sure when to start the new regime. You'd think my GP could advise but I can never get hold of her. Any advice please?

I recently started HRT and searched high and low for this info. Generally the advice seems to be that you can start on any day that’s convenient. I still have periods so I decided to start on the first day of my cycle just because it made sense in my head, but I think if your periods have stopped, you can certainly start anytime. Good luck.

@Glasgow51
Thanks x

Does anyone know which i start 1st - the pessary or t'other ?

I've been given NO guidance at all ...

As you’re not having periods you can start any time, the patch x2 weekly eg Monday and Friday and Lutigest nightly. There’s a guide here and the relevant HRT table is at the bottom www.chelwest.nhs.uk/professionals/gp-advice-and-troubleshooting-guide-for-hrt-in-primary-care

Have a look at Jane Pangbourne's FB group, HRT truth collective, lots of useful info on there

thanks @Emsb2022
thanks @Glasgow51
thanks @over50andfab
I will try to look at those links thoroughly (deep in middle of teenage college crisis atm but I will cope with that better if I start my HRT I am sure - its circular!)

Meantime, it looks like patches twice a week & pessary nightly.
Is this for all 4 weeks of the 'month' though ?

I’ve screenshot the relevant bit. You’ll see Lutigest instructions are given to be taken continuously (every day) rather than sequentially (half the month). If there are no instructions given - usually on the sticker attached to the box if you want to confirm this is correct either ask the pharmacist or see your GP

@over50andfab
thank you so much x
Yes the Lutigest label says: one to be inserted at night' so clearly every day.
The Estradot label says: ' apply twice weekly' (box of 8, 3m supply) so I presume that is all month long too?
I would say I don't know why I'm being so dense about this but I do -
it's a mix of needing HRT, low iron & low B12 & low D. I'm a mess & cant focus...

Yes the patches are twice a week with no breaks. When I used them I changed them Monday and Friday evenings after a shower. I didn't really like attaching to the lower stomach so alternated between each buttock and upper thigh towards the back.

Getting any deficiencies corrected will also help. so many of us are low in vitamin D and we should all take it during the winter months. It also aids absorption of calcium just as vitamin C aids absorption of iron.

Keep on it, you'll get there!!

@over50andfab
thank you again xxx
(you've been SO much more helpful than my GP!) x

@over50andfab

sorry if tmi but, whilst dithering about which day to start my period arrived
(none since March but an exceptionally stressful time so sometimes stop then)

I take it I can put this down to a rogue 'last hurrah' by my body (!)
& start the HRT on Friday anyway ??

(sorry if tmi & sorry to bother you again) x

It might be a random last bleed or you might experience others too. Postmenopause is when you haven't had a period for 12 months and some women can bleed at month 11. As you say stress can also play a part in our periods - it's all connected to the immune system. Starting or changing HRT can cause bleeding too for some women - just to confuse things! - but this generally settles in the first few months.

You can still start HRT whenever you've planned to. From what I can see you were on sequential for 8 months then stopped it with no bleeds for 4 months. Guidelines are that after being on sequential for a year you can move to continuous which is what you're doing.

Hope it goes well for you.

@over50andfab thanks for the advice (nb appreciate you're not medical so will abide by MN usual rules re this but you've been WAY more helpful than my GP :)

I shall proceed on Friday :)

No problem - I volunteer in this area and try to signpost to guidelines or reliable resources if I can. I don't usually see Lutigest prescribed, it's usually Utrogestan, but this might be due to where you live and the wonderful lottery of drug formularies in different areas!

Guidelines are that after being on sequential for a year you can move to continuous which is what you're doing.

@over50andfab Is this a new guideline?

Menopause Matters website still says that continuous is used after 12 months with no natural period, OR if the woman is over 54.

My understanding was that a certain private dr was putting women on conti earlier than this, but it's not really an accepted guideline. The risk is there will be breakthrough bleeding, as natural hormones may override the smallish daily dose of conti progesterone.

From Menopause Matters
POST MENOPAUSAL -
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy.

No it's not a new guideline, though the recent random bleed might not mean the OP is postmenopausal, however she is 54 so I think your post is saying much the same thing.

Sequential HRT causes a withdrawal bleed so even if someone has stopped natural periods she will still have a monthly bleed when taking it. This is why after a year the OP can move to continuous HRT. Some women even post menopause might choose to continue sequential HRT with a monthly withdrawal bleed for various reasons.

"We know that periods have stopped and that you are postmenopausal by having had at least a year without periods, or by being aged 54 and over, by which time 80% of women have stopped having periods."
Source: Women's Health Concern which is the patient arm of the British Menopause Society. www.womens-health-concern.org/help-and-advice/factsheets/hrt-types-doses-and-regimens/

The inside flap on the Estradot box shows you which 2 days you change your patch. Essentially you change the patch every 3 and a half days. If you start a new patch on a Monday am, you change on a Thursday pm.

@over50andfab Yes I think we are saying the same thing.

At 54 she'd 'qualify' for a no-bleed type. But the appearance of a normal period when stopping sequential means she may not be post menopause.

I have chosen to continue with sequential many years post menopause, for various reasons.