On HRT but No withdrawal bleed for 2 months?

[ILoveRevels]

I'm 52 and started HRT (oestrogel & Utrogestan) in September 2021 - all good and symptoms (tiredness, poor memory, rage, palpitations, nausea etc) all improved after increasing to 3 pumps per day.

I take 14 days Utrogestan (2 weeks on, 2 weeks off) as prescribed by my GP. I did query this at a review as PIL says 12 days and I've read on this forum that 12 days is enough - she said 12 was the minimum safe number of days and she preferred to prescribe 14. I continued with 14 as it generally meant the bleed happened over the weekend which I find convenient.

I was changed to Lenzetto spray in August this year due to supply issues with the gel. GP prescribed 2 sprays as she said Lenzetto was stronger so I needed less (I now know this isn't the case). After starting the spray my next withdrawal bleed began early (day 11 of Utrogestan) and was much heavier and longer than usual. I put this down to a combination of changing HRT type and having had a shock (sudden bereavement).

After having an early & heavy withdrawal bleed in August I was worried it would happen again when the funeral was due to take place in September so I delayed starting Utrogestan for 2 weeks (having read a thread on here about delaying a bleed). I thought the next withdrawal bleed might be heavier but it never got beyond some light spotting.

And this month's bleed hasn't happened at all! Finished Utrogestan last Tuesday and nothing. My breasts feel slightly tender but no period pain type feelings or spotting.

In the meantime I changed back to Oestrogel 2 weeks ago as peri symptoms returned quite quickly on Lenzetto. Moved to 3 sprays while waiting for GP appointment to get prescription changed back to gel which improved things a bit but overall Lenzetto dose just felt inconsistent. I was on Lenzetto for 10 weeks.

I'm worried about the almost non-existent withdrawal bleed in Sept and the missing October one. Did I cause this with delaying the progesterone? Is it the changing of HRT type?Could of be that I didn't absorb sufficient oestrogen while on Lenzetto for my uterus to need to shed? Is it because I take progesterone for 14 days?

Thank you for reading and any thoughts appreciated.

Around 20% of women have no bleed at all even on sequential hrt.

However, from what you have said, the estrogen dose was lower with the spray which will most likely account for no bleed, especially as you are using 14 days of utrogestan.

The PIL is correct- the 14 days is an option for women who bleed too much on 12 days.

Your GP is wrong because there is guidance online for GP HRT training which actually says the minimum progesterone is 10 days in 84 days! That's 10 days in 3 months.

There is a tablet form of HRT- Tridestra- that uses that regime. It's mainly used for women still with periods who are fine with an occasional bleed once every 3rd month. I was on that regime (not Tridestra) for a long time, under a consultant.

I wouldn't worry too much because once you get back into the swing of it all, the regular bleeds may come back.

The info I mentioned....

www.gp-training.net/tutorials-clinical/gynaecology/hrt/

Long cycle HRT
The only licensed preparation is Tridestra using 20 mg medroxyprogesterone acetate for 14 days each 3 month cycle. It produces four withdrawal bleeds per year and may cause initial irregular bleeding but this tends to settle.

Endometrial hyperplasia has been reported when lower doses of progestogens are used for 10 days, every 84 days.

^(in other words, less than 10 days per 84 days)

On the menopause training I did last week a lot of people said they preferred the 14 day prescription simply because it is easier to manage. 2 weeks of tablets/half a packet and always ending on the same day. Not having odd leftover tablets from each packet.
Nothing to do with the actual medication, purely for ease of management.

I'm on 14 days of Utrogestan, but the packets contain 30 tablets, so I do end up with a pack two left in it 😂

@JinglingHellsBells Thank you for your reply and reassurance that the lack of bleed may be because the oestrogen was too low in the spray. It certainly felt that way - I went from feeling like myself to feeling exhausted, jittery and nauseous in a couple of weeks. It escaped shame as the spray was convenient to use. I was just concerned in case I'd caused a problem when I delayed taking Utrogestan.

I think I will change to 12 days Utrogestan next time I take it. I like and trust my GP which is why I took her advice. Been seeing her for 20 years and overall she's been great. She has an interest in womens health and recommended the Menopause Doctor website for more info. She also prescribed Vagifem after noticing vaginal changes when she did my smear.

As @RagzRebooted said it was convenience of the schedule I liked with the 14 day cycle eg knowing the bleed would take place over a weekend as the loo at work is not the best! Always leftover tablets though as @we BatshitCrazyWoman said - I find it easiest to count out the correct number and put them together in one box so I don't get in a muddle.

People who are on HRT or drs giving out the advice?

This is the advice of Dr Newson who wrote the training manual for GPs, I expect.

Many women find the Utrogestan days very hard to tolerate so the least that drs ought to do is explain it's a choice between 12 and 14.

It's not hard to chose the 1st of each month and count 12 days.

@RagzRebooted As PP says there are 30 tablets per pack, so there are always leftovers.

The 30 in a pack is packaged for women using it daily - so that's a month's supply.

@ILoveRevels Reading across some meno forums, and my own experience, there are far more variations on this than many GPs are aware of.

Long cycle use ( anywhere from 5 to 6 weeks of estrogen-only) or only 10 days per monthly cycle are both being used by women.

I can choose my own cycle length, (under medical supervision) within certain limitations, to give flexibility over when the bleed occurs.

Hi,
I wonder if I could get some advice😱
I’ve recently started taking progesterone 14 days on 14 days off along side 1 spray of Lenzetto (I started in January, but this is my first month of the new progesterone regime). My symptoms have eased (the main one being chronic itching!). The issue I’m having now is irregular bleeding, which I’ve never had…… since taking the 14 day regime, I’m all over the place! Spotting & having a period either before taking the progesterone or while taking it. Is this normal? I’m thinking I may need to increase my spray to 2 sprays?
I can’t get an appointment to speak to my GP & am feeling overwhelmed with Google!
I take it I just carry on taking the tablets for 14 days on & off regardless of the spotting/period arriving?
Thank you, I would appreciate hearing about others in a similar situation & a bit of reassurance that things will settle. 🙏