Sequential HRT with regular periods

[IDriveMySupernova]

I’ve been prescribed continuous oestrogel and 14 days of utrogestan 200mg.

I’m still having regular periods with a cycle of 32 days.

I’m a bit confused about when I should be taking the utrogestan. For example, my period has only just finished on Day 6 of my cycle. My last utrogestan was 4th September, so does that mean I’m supposed to start taking it again on 18th September? It feels off as it will only be Day 10 of my cycle.

Am I supposed to ignore my cycle and just stick to this utrogestan every 14 days, for 14 days regime?

Also, my GP has told me to up the oestrogen from 2 pumps to 4 pumps while I’m taking the utrogestan as I also have PMDD. This has been quite helpful at alleviating the symptoms so far, but then I’m left with a gap of 4 days before my period actually starts, where I don’t know if I should be continuing with 4 pumps or going back down to 2? It feels counterintuitive to go back to 2 pumps at the worst stage of the cycle.

I’m trying to book an appointment to discuss it but it’s difficult to get one atm, so in the meantime I’m wondering if this makes sense to anyone!

You ignore your cycle and stick to a 28 day regime with the 14 day progesterone.

Not sure on the boosted gel, I'd check with your GP on that.

On a thread with jingle bells- I tried matching my cycle as I’d just originally picked a day and it just felt off. So I stopped and matched my cycle and it works better for me.

It might make sense for you to start the utrogestan on the 18th as that’s what you’ve begun.

You are supposed to create a new HRT cycle.

Women who use patches or packs of tablets don't have this 'when to start' problem. The use the patches as they come on the pack, or the tablets in the strip. They don't start counting which to use around their own cycle.

So gel and Utrogestan is no different.

You can't follow your own cycle because eventually it will be very irregular, either very short, or months without a period.

Most specialists will advise you to choose one day each month and stick to that.

So whatever day you began Utrogestan in August (must be around the 20th) then start again on 20th Sept, then 20 October etc.

Also, the dose is 12 days. 14 days is an option for women who find 12 days doesn't control the bleeding. The patient leaflet in the box says 12 days.

GPs have started telling women to do 14 because they think it's easier for them to remember 2 weeks on, 2 weeks off, but it's not a medical decision.

You don't have to use 4 pumps. If you find your mood dips during the Utrogestan phase, you could try upping the gel to 3 pumps, but it's best to wait and see rather than assume.

Thanks for your help everyone.

@JinglingSpringbells So whatever day you began Utrogestan in August (must be around the 20th) then start again on 20th Sept, then 20 October etc.

If I take it on the same date of each month, that will mean I’m going more than 14 days without it though. Is this ok to do? It would certainly make it easier to remember when to start it.

Yes that’s what I do. The same day every month.

I take mine on the first of every month for 12 days regardless of month length. Makes it so easy to remember.
My bleeding comes when it wants though despite me sticking to this regime. Two days before day 12, four days after, ten days after, none for three months.

It's absolutely fine to have a few more days than 28.
What's always a bit annoying with this type of HRT is that most GPs lack enough knowledge to really inform women of how to use it.

The regime is based on the theoretical idea that a menstrual cycle is 28 days.
In reality, hardly any woman has that. 28 days is an average, so HRT is based on that.

As long as you use 12 days per calendar month that is fine. It is also fine to start it a day or two earlier or later if you want to avoid the withdrawal bleed coming on a day when it's not convenient.

For info, there is a type of HRT called Tridestra, which is a 3-month cycle, with progesterone for 2 weeks out of every 12. (Just to put it into perspective.)

Thanks so much @JinglingSpringbells, you’ve been a huge help!