Oestrogel & Utrogestan- how do you know if you’ve hit menopause

[Alexastoplistening]

Any thoughts on how you know if your periods have stopped while on HRT? I’m on sequential 0estrogel (2 pumps daily) and Utrogestan (2x100mg capsules 14 days). For 2 years on this regime I bled every month. But in the last 6 months I’ve bled once.
Many of these threads say ‘not bleeding’ is common. But I WAS bleeding…and now I’m not. How do you know if the lack of bleeding IS menopause…and how do you know when to change to combi instead of sequential?

do I need to increase my oestrogel to induce a bleed…or is that making my womb lining dangerously thicker without the bleed. Very worried about all this…and my GP just says ‘try a different product’. I just have no idea how you know if you’re going through actual menopause…or if I’m putting myself in danger by carrying on without a bleed after having bled on the same regime for two years

I am on the same regime as you but now have Everol 100 patches. So I have twice the amount of oestrogen as you.
the utrogestan you take stops the lining build up.
i have no idea if I have now hit meno as I still bleed every month- though often quite lightly.
I have thought about the combi option but I hate what progesterone does to me when I have to take it so would rather have 2 weeks off but still have to bleed tbh.

Thank you…I think I’m worried that the bleeding has stopped after 2 years of being regular…and just envisaged a massive womb lining sitting there asking for trouble. Do you know if increasing oestrogen increases the likelihood of a bleed? I seem to have shed 2 stone in 6 months without dieting, and my hair is really falling out…so a bit worried about both of those things but haven’t increased oestrogel as no other physical symptoms 🥴

I think you should ask for a blood hormone/ thyroid test. If you have no other symptoms I wouldn’t up the dose. The weight/ hair loss is unlikely to be hormonal. So bloods would be a good idea.
consider really upping your protein intake. My hair was falling out excessively for years. I happened to start taking protein shakes for weight lifting. The hair fall went back to pre peri levels.
older women really do need extra protein. Aim for about 1g protein per lb body weight or 2g per kilo.🙂

Thanks so much @BigButtons

You don't know for sure is the simple answer. It's usually recommended that women can try to switch to the continuous regime after a couple of years on sequential. But the BMS also state that it depends on how regular your periods were before you started HRT & also age is a factor (as the average age for post meno is 51). There is also no harm in taking continuous HRT even if still in peri-menopause... it's just that the sequential regime is recommended as it is more likely to produce a more predictable monthly bleed if not post-menopause. If you are getting fewer bleeds on the sequential regime, then it's most likely that your own hormones are settling down to more consistent lower levels & it's time to switch to continuous. If you aren't producing much oestrogen of your own & as you aren't taking a high dose of gel, the recommended progesterone dose will be counterbalancing the oestrogen amount to keep your lining thin & hence you may not get a bleed. If you are worried, then you can always ask for an ultrasound scan to assess the lining, but it is not uncommon for periods to start to decline on the sequential regime over time. x

Btw, if you have noticed your hair is shredding, this could indicate the lowering of your own hormone levels. Also lower iron levels (under 40-60), thyroid, diet & stress can all affect hair loss x

You know (I assume) that the bleed on that regime is a withdrawal bleed and not your own periods ? @Alexastoplistening

Not bleeding on sequential is not usual. Only 1:4 women don't bleed regularly.

There is no point doing blood tests when on HRT. I was checking this up online recently and it confirmed what my own consultant has told me (On the gel/ Utrogestan regime for over 12 years.)

I am many years post menopause (at least 15) and my blood loss on this regime is quite a lot even though my own natural hormones will be very low.

Blood serum levels vary by the hour, according to when you used the gel, how it's applied, etc.

If you are losing weight for no reason, see your GP for a check up of your bowels etc and also your thyroid. You could also ask for a uterine scan to see if the lining is thick.

The other thing that PPs have mentioned is that the amount of blood loss can be linked to the dose of gel and your own estrogen level. As you are older now, your own levels will have fallen.

Thank you. Really good advice here x

You know…I’m embarrassed to say I didn’t know the bleed was a withdrawal bleed and not my own period. Because I was regular every 28 days when starting HRT, I just assumed the bleed was still my own…so thank you for enlightening me. I will make a GP appointment

I had the same question a couple months ago. I recently changed to Combi from sequential but am on tablets. My bleeds on sequential were definitely withdrawal bleeds for a year - I could tell I hadn’t ovulated been ovulating for a while. I asked to switch over to combi because I started craving the “other” hormone towards the end of the 14 day period… ie towards the end of the 14 days progesterone I had a v dry vagina etc. it’s taken me a month to get used to combi as the dose I’m on is lower but it seems settled now and my body feels “right” again…

@Alexastoplistening when I first started HRT I would still get my own periods which often meant I had 2 bleeds a month.