Can I start HRT even though not getting Mirena coil for a month

[CazziN]

Hi there,
I'm new here but what a godsend it is! I'm 46 and after suffering for a couple of years, I finally took the plunge and I'm about to start HRT (oestrogel) Thing is, my doctor can't fit the Mirena coil until Sept 11th which is 4 weeks away. I'm not bothered about contraception as I'll just use condoms until then, but would i being doing any damage if I started my HRT straight away without progesterone? My consultant prescribed me Utrogestan (to 'tide me over' for a month until Mirena) but I've read really negative things about it and would rather avoid if I can. But I really don't want to wait another 4 weeks to start HRT. Any ideas?? This whole change of life is so bloody confusing :(
Cheers,
C

Yes you can.
No issue.

Some women use a 3-monthly type of hrt which is estrogen only for 10 weeks.

Yes absolutely. And you get the joyful benefits of oestrogen before the progesterone hits 😁

Thanks for quick reply!

I'm hoping that given i was always fine on the combined pill, mood-wise (apart from a slight crankiness a couple of days before my period but nothing major), then I'll be ok once the progesterone hits. But given I've been feeling really low for over a year now (sadness, anxiety, rage - all in the space of a few hours) I don't really trust my own hormones/personality more, so god knows how I'll be once the progesterone hits. I shall report back! Thanks so much for the reply.

I'd use the utrogestan in the meantime, or have a chat with the doctor about using oestrogen only.
The progesterone stops the uterus lining from thickening. A month without it might be fine, but might not.

A month without is fine.

There are types of HRT available - one is Tridestra- which is a 3-month cycle, with estrogen only tablets for 10 weeks, then estrogen +progesterone for 14 days.

It is also in the NICE prescribing guidance that all women can use a 12 week cycle (as above) if they find they are intolerant to progestogen.

I don't know anything about tridestra but I still would not recommend not taking prescribed progesterone without discussing with doctor.
I am not an expert but most recent materials I have read recommend progesterone to stop the uterus lining thickening and also, control bleeding (if still having periods).
I know a month is not a long time but OP has not given any indication that they are progesterone intolerant.
I'd just take the utrogestan.

That is why I have posted about Tridestra.
And the NICE guidance.
NICE would not say it was an option if it was unsafe. if you want to search Nice HRT prescribing guidance Sept 2022, it's there.

When I first used HRT my consultant (who trains other drs) suggested a 3 month cycle and I was on that for around 6 years. I reduced it slightly as one downside of a long cycle is a heavy bleed.

Ah, thanks for the date (2022), I found it. I had been doing a bit of searching and had previously only found older guidelines.
That's interesting, it was not something I'd come across before.

I stand by my point though that I would encourage OP to speak to doctor before not taking her progesterone. The settling in time for the mirena can be tricky for some people, and could lead to bleeding (or could be absolutely fine, it was fine for me), so I don't think I'd personally take oestrogen alone for a month before having a coil without speaking to my GP/menopause advisor.

I appreciate you coming back with your informed answers though, I have learnt something today.

@SomersetBrie One factor to bear in mind, is that very few women in peri have 28 day cycles anyway. So in reality, most women are not having a period every month and can go months and months without one (so the lining builds up .)

That's why a 3 month cycle in peri (or post meno) is allowed.

Unless the OP is post menopause, she's likely to have a natural period anyway in the 4 weeks.

The risks that the BMS highlighted were to do with very large doses of estrogen being prescribed (sometimes 2- 3 x the max doses) and over long timescales.

Sorry, I probably didn't give enough information (first time here!) I'm peri rather than post menopause, and to the best of my knowledge, I have no issue with progesterone (I was always ok on the combined pill for c28 years....until the past couple of years when my periods started changing to every 21-23 days from 28). I've just read so much negative stuff about Utrogestan around mood, and as my mood is so low, I want to avoid it getting any lower. But I guess there will be lots of success stories too (people don't tend to share those as much!) Really appreciate everyone's answers - thank you. I'm thinking i will take it....I'll just be very mindful of how I feel and review if my mental state takes a nosedive...

I would give the Utrogestan a go as you may get on very well with it. Personally I love it as it has improved my insomnia no end. I’m also managing to lose weight on it and Oestrogel (I’m on 2 pumps a day). I’ve lost 23 pounds since increasing from one pump a day to two, 3 months ago.

I’m also dieting and exercising as it’s not that magic 😂