HRT/no periods/utrogestan confusion!

[uponthe11thfloor]

Hi all,

Would love some advice as not sure what to do going forward...

Am nearly 47 and started getting peri-menopausal symptoms about 18 months ago (heavier periods, shorter cycles, anxiety, aching joints). Initially GP suggested I back on combined contraceptive pill as I'd always reacted well to being on it - however, my BP started going up, so I changed to HRT three months ago.

Am on two pumps of oestrogel and 200mg utrogestan for first 12 days of cycle.

I feel fine on it - but I haven't had a period since I've started which worries me a bit. I'm aware that this happens to some women, but aren't we 'supposed' to bleed so our uterine lining doesn't get too thick? Plus I'm sure my mum (sadly no longer with us, so I can't ask her to clarify!) went through menopause around the age I am now...if I'm on HRT how will I know where I'm truly 'at'? Finally, I am loving what the utrogestan does for my sleep in the weeks that I take it, but when I'm 'off' it my insomnia returns? Rather than take 200mg for 12 days, could I not just take 100mg every night to help with this?!

I'm a bit confused as to what is safe and what I should be doing, so I'd love any advice/thoughts on this!

Anyone?! I’ll speak to my GP but wondering if anyone here could offer any insight? Thanks so much xx

Marking my place!

I have a similar issue. I have to take it days 1-25. I’m currently day 25 with no sign of a period.

@Maltester71 - interesting. Had you gone more than a year without a period before starting HRT? Just wondering the logic behind being advised to take the progesterone for 25 days - it’s what I’d like to do for the sleep benefits!

I’m on the same regime as you OP but I have upped the gel to 3 pumps. I have just finished the utrogestan phase and am back to nighttime waking which is miserable. I’m interested to see what others say about the lack of periods as I am wondering the same. How are you feeling generally after 3months?

@uponthe11thfloor Not all women have a bleed on cyclical HRT- about 20% don't. This is because some women are poor absorbers of estrogen and it simply doesn't stimulate the uterine lining much when they are also using 12 days of progesterone. Other women absorb a lot and they have heavy bleeds.

Most women DO bleed and if cyclical is used long term (I've done it for over 12 years that way) a bleed will usually happen. It's not related in any way to how far you are naturally in menopause. So someone 15 or even 20 years post meno will still bleed on a cyclical regime.

The other point of when to swap to continuous progesterone. It's actually a choice- not black and white. I don't like continuous as I felt sedated on daily progesterone. Most GPs don't 'get this' as they aren't specialists (I've seen mine for years and they have far more knowledge.)

If you start continuous too soon you will probably have bleeding if your own hormones are there alongside the HRT. The daily dose of progesterone is not enough to control the estrogen stimulating the womb.

The guidance for continuous is one year with no period or aged over 54 (when 90% women are post meno.) You are still a bit on the young side!

Also, the 25 days now is old hat. Most specialists say use it daily on continuous - no 3 day break- to bring it in line with women on continuous patches or tablets (no breaks there.)

@rcat74 - sorry to hear that you wake in the night too! Miserable isn’t it? I definitely notice a difference in the 12 days I’m on utrogestan, although on the flip side I feel a bit heavier and bloated those days…generally I do feel ‘better’ on hrt than I did before, though the lack of periods is weirding me out a bit!

@JinglingHellsBells - so informative, thank you so much! Interesting that I might not be absorbing enough oestrogen to bleed - I had periods like clockwork on the pill. So it isn’t risky for the uterine lining and cancer risk? I’m also wondering what would happen/if it’s ok to take 100mg progesterone daily to help with sleep - I mistakenly only took 100mg at the very start (until I realised the dose should be doubled) and it still had a positive effect…

I had periods like clockwork on the pill

The Pill is not HRT- they are very different.
The Pill is a high dose of synthetic estrogen.
HRT is body identical estrogen (like your own) and made from yams.

The bleed on the Pill is a withdrawal bleed (it's not a period as the Pill stops ovulation.)
The bleed on HRT is a withdrawal bleed.

(I expect you know this anyway!)

You have only been on HRT for 3 months. You may well find that you do have bleeds soon. If your estrogen levels are low, (and 2 pumps may be too low for someone aged 47 as that is young(ish) to be on HRT), then the amount of Utrogestan you use may be 'cancelling out' the effects of estrogen on the lining.

The advice of my consultant would (probably!) be up your gel to 3 pumps if you still can't sleep. After 3 months on 2 pumps, you need to re-assess and maybe adjust.

That's the first step before trying a different regime like continuous.

You may find you bleed on 3 pumps.

If, as time goes on, you never bleed, talk to your GP who should arrange an ultrasound scan to see if your lining is normal.

I appreciate that most women using HRT are doing so on the NHS, but just for comparison, women who see drs privately often have annual scans just to check-(a kind of MOT.) Obviously this is paid for - it's not free. The NHS will only offer scans if things are going wrong, not as prevention. But do speak to your GP if you are worried.

Thank you so so much @JinglingHellsBells - you are a mine of information! It’s the progesterone that I find benefits my sleep I think - the weeks I don’t have it my insomnia returns….

Interesting about the bleeding and makes sense. One thing that confuses me though (I promise this is the last question!) is when you say 2 pumps might not be enough oestrogen because I’m relatively young. Surely the younger you are, the LESS oestrogen you would need, because your own levels of it would be higher than in a post-menopausal woman? Xx

Surely the younger you are, the LESS oestrogen you would need, because your own levels of it would be higher than in a post-menopausal woman?

There is no absolute answer to this one! But....

Usually a woman of 47 would have more estrogen than an older woman.

BUT (big 'but'!) if she is in peri meno and her own levels have dropped significantly, she will need more to get the level up to that of a 47 year old should have.

The average age of menopause is 51-52 (final period). So younger women on HRT generally need more than a woman in her late 50s (for example) who starts HRT because you are trying to replace what you would have naturally, before age 52.

It's really all trial and error. Myself, I wasn't in peri (with symptoms) till I was 52 and started HRT at 53. I've carried on with almost 2 pumps since then, although 1.5 pumps works ok. Any less, and my sleep goes to pot. I also get a very good (?) bleed on that.

You just have to experiment a bit. The fact you are still struggling to sleep and have not have a bleed suggests not enough estrogen, so I'd consider that before changing to a continuous regime, which is another can of worms!

Glad I found this thread. I, too, am missing periods/ withdrawal bleeds on the cyclical regime. I’m 49 and I’m on it 7 months now and my periods are irregular, either my cycles are too long or too short. I’m on a 75mg patch and progesterone tablets 200mg for 14 days on/ 14 days off.
I’m due a gp check up so will discuss it with her. I’m starting to think my oestrogen is too low also.

I’m on the coil and hrt patch 100mg estradot a week for the past year. I have very sore boobs and then a red bleed daily for about 5 days that would be light but still there. I didn’t have any bleeding for about a week and now today bleeding a blob of blood but my boob soreness has gone down thank god!
. Is this normal? I have an ultrasound in December but still wear a panty pad every day. Does anyone have a similar experience. Thank you

Hi. Old thread but very relevant to me. If there is no bleed on utrogestan, how do I know when to start the next cycle of utrogestan as there is no day one of my period. Hope this makes sense. Thanks