Skipping my progesterone to prevent period

[user1485182339]

I only recently started on HRT so it hasn't been long enough to fully understand how my body will react to changes. I need to go on a complicated field trip this week but should be starting my progesterone pills today, so will have a fairly heavy bleed which will really be incredibly inconvenient. I want to hold off with the progesterone until next week and hope my withdrawal bleed stays away for those few days but my GP can't find me an appointment before I go so I can ask them. What do you think? Is it likely to be okay?

I thought taking progesterone stopped periods? So I'm not an expert but the coil and the mini pill are all progesterone based and stop bleeding?

The progesterone is there to offset the womb cancer risk of the estrogen, so I would not be skipping any doses.

Don't you have a withdrawal bleed when you're on oestrogen alone, so a day or two after you stop taking the progesterone?

There is a brilliant group on Facebook if you are on there. The menopause support network. Ask on there if you are on Facebook. Think they may also have a website as approval has to be approved and wasn't instant.

Hmm. That's interesting. I have my withdrawal after I start on progesterone. And then bleed most of the time until I stopy dose again. The GP seemed to think this is normal enough. So I thought if I delay starting it, my bleed would be delayed.
Onnabug yes, that is true too. I would not skip it as such. Just delay for a few days.

Notlottie thank you. I don't do Facebook anymore but perhaps it is a good reason to get an account again.

Hmm. That's interesting. I have my withdrawal after I start on progesterone. And then bleed most of the time until I stopy dose again. The GP seemed to think this is normal enough. So I thought if I delay starting it, my bleed would be delayed.
Onnabug yes, that is true too. I would not skip it as such. Just delay for a few days.

There were some autocorrects in there. Should be I bleed most of the time until I stop the progesterone dose again and just take the oestrogen.

Are you doing 2 weeks on, 2 weeks off with the progesterone? If so, usually the bleed starts on finishing the 2 weeks on progesterone and you're on oestrogen alone - but you're saying you bleed when you're taking progesterone instead?

The Progesterone is take to counteract Hyperplasia, caused by the oestrogen. Not everyone bleeds on it. I don't-at all. But that's just me. It will still stop the hyperplasia-which can lead to endometrial cancer in some women.

Pleaseletme. I think if I had the coil I would stop bleeding completely. I may ask for it in future as I have to do away field based work a lot.

taken-not 'take'.

Normally the bleed starts a few days after stopping the progesterone element? Seems odd if it triggers it for you.

If you are younger or your own periods hadnt actually stopped well before starting on HRT then you may find you are actually just having your own cycles still in amongst the HRT and it’s going to take a while to get settled into more of a pattern.

I slightly extend my non progesterone days to fit with my own cycle which has always been 33-35 days long. If I stuck to the 28 day HRT I think it would cause me all sorts of hassle. My periods are starting to get less and the ovulation part less obvious so I’ll move to more of a typical 28 day pattern over time.

anyway it’s hard to say then if delaying will make any difference given it seems against what is usual with the progesterone but I don’t see it would hurt just to delay a few days so long as you are essentially still taking the progesterone in full.

some people take much less progesterone as they don’t like the symptoms it gives but it does start to get unsafe if you aren’t careful.

Sorry cross posted, I see you've now clarified that. In that case, I don't have any experience of that scenario and not sure what to suggest.

Oh that's interesting that some people don't bleed at all too even on the pills.

Askingfor. That's useful about you extending it to fit in with your cycle. I think that is what I was hoping to hear. I get the impression everything is individual and tweaking it here and there is okay.

@user1485182339 You can delay taking it.

NICE updates gives the option of using HRT on a monthly or 3-monthly cycle. I posted this last week for someone asking a similar thing. If you are really worried I can find it again for you but TBH I've just logged in here before breakfast!

There is in fact a tablet form of HRT Tridestra which is a 3-month form (10 weeks of estrogen only then 14 days of progesterone.)

I have been on a longer estroge-only cycle for years under a consultant.
When I first started, I used a 3-month cycle, with gel and Norethisterone.

@Onnabugeisha It takes months if not years for hyperplasia to develop and even after 1 year of only estrogen, only 20% women would have hyperplasia.

To give a specific answer @user1485182339 just delay the progesterone till you come back, use it for 12 days and the bleed should come about 3 days after you stop taking it.

Your GP is unlikely to know as it's a recent update in NICE.

@user1485182339 @Onnabugeisha @despondentatwork

cks.nice.org.uk/topics/menopause/prescribing-information/hormone-replacement-therapy-hrt/ REVISED SEPT 20222

Regimen
The hormone replacement therapy (HRT) regimen used depends on whether the woman is perimenopausal, postmenopausal, the route of adminstration, and the woman's wishes.

Combined HRT can be prescribed as a:
Monthly cyclical regimen — oestrogen is taken daily and progestogen is given at the end of the cycle for 10–14 days, depending on the type of progestogen. The suggested dose of progestogen given in a continuous combined HRT regimen is a minimum of 0.5 mg/day of norethisterone or 2.5 mg/day of medroxyprogesterone acetate.

For low-dose sequential regimens norethisterone a minimum of 1mg/day given for 10 days a month, oral micronised progesterone 200 mg/day for 12 days a month, medroxyprogesterone acetate 10 mg/day for 10–14 days a month or dydrogesterone 10 mg/day for 14 days a month are suitable options.

Three-monthly cyclical regimen — oestrogen is taken daily and progestogen is given for 14 days every 13 weeks.

Continuous combined regimen — oestrogen and progestogen are taken daily.
For perimenopausal women, monthly or 3-monthly cyclical regimens may be used.

A 3-monthly regimen may be more suitable for women with infrequent periods or who are intolerant to progestogens. See the section on adverse effects for more information.

A monthly regimen produces monthly bleeding whilst a 3-monthly regimen produces a bleed every 3 months.

A continuous combined regimen is not suitable for use in the perimenopause or within 12 months of the last menstrual period.

Note: the absence of bleeding whilst taking a cyclical regimen reflects an atrophic endometrium.

Exclude pregnancy in perimenopausal women or women with premature ovarian insufficiency.

Check compliance with therapy if the progestogen component is taken separately.

If HRT was initiated in the perimenopause, consideration should be given to switching from monthly or 3-monthly cyclical regimens to continuous combined regimens after the woman becomes postmenopausal.

For postmenopausal women, monthly or 3-monthly cyclical regimens, or a continuous combined regimen may be used.

A continuous combined regimen may be preferred as it does not produce withdrawal bleeding.

When I first started HRT it took a while for my cycle to settle into what should happen. I now bleed after the progesterone part of the cycle, when I start the new estrogen only bit. But I used to bleed during the progesterone bit - my body's natural cycle was fighting with the regime being imposed on it. So, if you are new to HRT this might be what's happening.
I think you have to stick with it and not mess with the timings or it might take longer to settle down.

That's not what the OP is asking though.
She wants to delay the withdrawal bleed. It won't make any difference to subsequent withdrawal bleeds if one is delayed a week.

It might make it longer until her body settles to the regime though. If she's going to be doing regular field work it would be helpful to know exactly when she's going to bleed.

@JinglingSpringbells
@Onnabugeisha It takes months if not years for hyperplasia to develop and even after 1 year of only estrogen, only 20% women would have hyperplasia.

Imagine saying this about smoking and lung cancer….

Sorry I don't understand your point.

It's a medical statistic.

Are you saying that you don't believe a medical stat?

Oh, I believe the stat, I’m just gobsmacked you are being so dismissive.

@Onnabugeisha

Hormone replacement therapy and the endometrium FREE
K M Feeley1, M Wells2
Professor Wells [email protected]
Abstract

Modern hormone replacement therapy (HRT) regimens contain oestrogen and progestogen, given either in a cyclical or continuous combined manner. Most endometrial biopsies from women on sequential HRT show weak secretory features. Approximately 15% show proliferative activity, although this figure may be less if more than nine days of progestogen is given in each cycle. A small proportion will show an inactive or atrophic endometrium. Up to 50% of biopsies from women on continuous combined HRT contain minimal endometrial tissue for histopathological analysis: this correlates well with an atrophic endometrium with no appreciable pathology. Of the 50% with more substantial material, approximately one half will show endometrial atrophy, and one half will show weak secretory features. Proliferative, menstrual, and pseudodecidual changes are rare. Approximately 20% of women given unopposed oestrogen for one year develop endometrial hyperplasia. The relative risk of endometrial carcinoma is two to three. This is dramatically reduced by the addition of progestogen to the regimen, but cyclical progestogen as part of a sequential HRT regimen does not completely eliminate the risk of carcinoma. The prevalence of endometrial hyperplasia associated with sequential HRT is 5.4%, and that of atypical hyperplasia (endometrial intraepithelial neoplasia) is 0.7%. Continuous combined HRT is not associated with the development of hyperplasia or carcinoma, and may normalise the endometrium of women who have developed complex hyperplasia on sequential HRT. The probability of a histopathologist finding clinically relevant pathology in an endometrial biopsy specimen of a patient on HRT is low and is more likely to be a manifestation of pre-existing disease.
dx.doi.org/10.1136/jcp.54.6.435