Starting HRT - so confused!

[Daffodils23]

I am 51 and have got a prescription for HRT- low does of estrogen and progesterone tablets. I have very irregular periods. Always have, but now they are very irregular.

When should I start taking HRT? Do I have to wait for period to start ( could be weeks, months or never!)

Also, if you take HRT forever does that mean you get periods/bleeding forever?

Does HRT delay menopause or does the menopause just kind of happen in the background?

I can't get appt to ask doctor these questions and can't find answers on Google!

Can't help as I have just started HRT but my periods have stopped.

Did you ever find an answer to this?
I'm interested as potentially in the same situation if I start HRT - I only have a period every 4 or 5 months now and suspect that I may not have another.

Actually a bit dismayed at the idea of going back to having regular bleeds if I start HRT, tbh. I've got pleasantly used to the idea of not having to worry about when it'll arrive, carrying supplies with me, buying them etc. I know that sometimes they'll prescribe a longer cycle like 3 months between bleeds on HRT for people who have quite irregular/infrequent periods now, but not sure if that is to start with or only once you're used to it and they've got the dose right.

So far as I know, if you start hrt without having had a period in the prev 12 months you start an hrt plan which gives no periods. Otherwise you can switch to the no period plan after 12 months of hrt (not sure if there’s a minimum age).
Menopausal progress continues in the background, but some of the associated issues are halted/reduced whilst taking hrt eg increasing cholesterol, reducing bone density, increased likelihood of dementia.

hmm, sounds like I'd have to wait the 12 months after starting then, as I've definitely had a couple of periods this past year, though not for 5 or 6 months now. But enough other changes since that I suspect I won't have another, though obviously I can't be sure.

Your answer should be in the paperwork in the box. Usually un helpfully buried in small print. I always checked as the doctor was wrong in my case.

I haven't started yet but I'll read the paperwork carefully and hope it's clear what to do in this sort of case once I do. Actually considering waiting til it's been 12 months before i start, so that I can go straight to the no-period type, now that I'm getting used to life without them!! And then no issues about when to start it, either. Means waiting another 5 or 6 months, though.

There are two ways of taking progesterone, continuous and half on half off, the second of which gives you a breakthrough bleed. You need some progesterone if you're taking estrogen and have a womb to stop the womb lining growing continuously which can increase your risk of endometrial cancer. However, it is the progesterone part of HRT which contributes to the small increase in breast cancer risk (estrogen alone reduces the risk of breast cancer). I think the logic of the half on half off is that you are taking less progesterone in total. From what I've read if you have irregular periods you can start the progesterone at any time and then start cycling every 28 days. This has the down side that you'll not know exactly when you were 12 months period free but does mean you immediately start to get the health benefits of HRT for your bones and hopefully relief of any symptoms you're struggling with.

Mirena coil has been a great option for me - it covers the progesterone needs with a low, localised dose that I can't forget to take and I've gone from short but regular cycles to being period free.

The downside also seems to be having to have regular bleeds again, when they have almost stopped. Have to decide if that's worth it, I guess, to start sooner. Need to read more about the risks. I didn't know it was the progesterone that caused the cancer risks.

Think I'd rather have continuous, but definitely not a coil.

I’ve read about some ladies having a 3 monthly bleed, maybe this is an option for starters with infrequent periods in the past 12 months?
Also I don’t think it’s more progesterone if you take it continually as it’s half the dose.

Continuous works out at 30 x 100mgs in a month compared to 12 x 200mgs a month.

@BotCrossedHun You could try the 3-month cycle but not a lot of GPs are aware of this option. There is a risk you may bleed anyway at odd times if your womb lining gets thick somewhere along the 12 weeks and sheds spontaneously.

On the other hand, using it continuously does come with the caveat that you can expect spotting for up to 6 months, if your own periods are not over.

@UnaOfStormhold Just one point- the research into continuous v sequential is not so much about the overall amount, but the fact that breasts avoid the daily stimulation of 2 hormones. They are getting estrogen only for half the month (or less on long cycles.)

One research paper theorised that in a sequential regime breast cells are also sloughed off, as in the womb, during a break, so any cells that are irregular may be controlled by this cycle.

(or less on long cycles.) I meant estrogen-only for more than 2 weeks.

so many things to balance! Increased risk of cancer then from continous, plus risk of random bleeds/spotting vs going back to regular bleeds. Hmm. Will see what my GP might know about it next time I go in. Could keep waiting til it's been a year without periods, but sounds like that would still keep the increased cancer risk of the continous form, even if it helped the other issues.

I have just collected a prescription for oestrogen patches and progesterone pills, I am aware I take the pills for 12 days of cycle but am so confused as to when I can start the patch, I've got some advice off here which is helpful but just want to be clear, my periods are regular but gotten much lighter and cycle now down to 21-23 days...can I start at any time and just create a new cycle with the hrt? I'm currently on day 11 of my "natural" cycle but if I start the patches today do I just go 15 days...then do the 12 days with progesterone and let it settle from there?? Its so confusing. TIA 😊

Just start when you like, I suggest working out when day 15 falls (which is the start of progesterone) as I got caught out and it meant that I was always pre-bleed or bleeding on school holidays/weekends away/bank holidays as these always fall at the end and beginning of the month.

Eg. October half term is the end of the month, May half term is the end of the month.

So I'd plan it with the most convenience for you!

And yes you then let it settle from there. Mine synced up immediately, I never had any further bleeding out of the cycle.

Ahh thank you, I thought that was the case but just reading it all there's so much information it's hard to decipher! Thanks 😊 xx

No you can start anytime, I already had a coil in for progesterone so just needed estrogen. My previously irregular periods evened out in the first few months and now appear to have stopped. It doesn't delay menopause, that carries on in the background.