No bleed on sequential Utrogestan

[Helenahandkart]

I’ve been taking Utrogestan 14 days on 14 days off since about February.
Initially it made my bleeds very regular (27-29 days) which was great after several years of very irregular cycles.
In the last few months this has slipped (22/23/33 days) which is similar to what was happening before starting it. This month I’m up to 42 days with no bleed.
Does anyone know if this is problematic?
I know that the Utrogestan bleed isn’t a true period, but is it bad if it doesn’t happen at all?

I’m also feeling some PMS symptoms this month (mostly headaches and insatiable hunger) which I thought had been eradicated.
(There’s no chance I’m pregnant)

How old are you? What dose you take? 2 tablets? And what dose of estrogen?

Following as recently this is happening to me too. Aged 43.

I started utrogestan 200 mg vaginally 12 days per cycle in September (no estrogen prescribed yet). I am perimenopausal and 48.

I did not have a bleed after the first batch of 12 utrogestan, the bleeding started during the second batch: a 50 day cycle, the first time ever for me other than in pregnancy. My interpretation is that this cycle, the lining just did not build up enough to bleed (I had a couple of days of random spotting during the 50 days).

My bleeds have anyway been getting shorter, lighter, and closer together for about three years now; when I was regular, I used to bleed heavily and for 7 days, recently it's been lightly and for 2-3 days. I guess - hope - that my last proper period is not far.

So my understanding is that the Utrogestan bleed is not a period. That HRT overrides your cycle, so your ‘normal’ periods prior to HRT aren’t really relevant. But maybe I’ve misunderstood this.

My periods were light for many years before HRT, but then fell into a regular pattern with HRT. I’m not sure why this would change as I was under the impression that sequential HRT would cause me to continue bleeding even after my natural periods stop.

I’m 49, taking 2 x 100mg pills per night, and 2 pumps of Oestrogel.

So my understanding is that the Utrogestan bleed is not a period. That HRT overrides your cycle, so your ‘normal’ periods prior to HRT aren’t really relevant.

That is right. It's a withdrawal bleed and not connected to a normal period.

I’m 49, taking 2 x 100mg pills per night, and 2 pumps of Oestrogel

In your first post you said it was 14 days.
Which is it?

It's not really an issue not to bleed although if it carried on for many months, I think my consultant would be suggesting a scan to see if the lining was thick or thin.

It's possible that the dose of gel is not enough to make the lining thick, especially when you're doing the 14 days on Utrogestan and 14 days off.

This is not actually how many specialists prescribe it. They'd suggest less.

The dose (as per the leaflet) is 12 days per cycle. 14 days is 'reserved' for women who need more to reduce bleeding.

Although the product licence is based on a 28 day cycle, most women do not (naturally) have 28 day cycles ( before menopause.) 28 days is an average but the norm can be from 24 to 35 days.

Some specialists would suggest 12 days Utrogestan per calendar month.

The 14 days on and off is really a new 'guide' for GPs/women to follow easily. It didn't used to be like that - it was 12 days.

If you want to have a bleed, I'd suggest doing 12 days and within a month (so you're going 2 to 3 days longer than 28) starting on the same date each month.

Can I jump in and ask something? When do you bleed if you’re on Utrogestan? I’ve just started taking it - it’s day 10, CD 24. I’m going to stop taking it after day 12 - period due the next day according to previous cycles.

I don’t want to make my cycle longer if I can help it, have a holiday in just over two months and I don’t want my bleed to coincide. If cycle stays at 27 days that won’t be an issue.l - if I continue to start taking Utrogestan on day 20 for 12 days can I expect to start bleed the day after I stop taking it?

As I understand it, if you're not making enough womb lining then you won't have a bleed.

I'd speak to your Dr. You could drop to 12 days as suggested above - I find that easier, and potentially go up to 3 pumps.
@ThunderMonkey I sometimes manipulate my period by starting the tablets a week early or late. Normally I start on the 26th of the month and bleed within 9 to 12 days (its not always consistent). I could start a week later and then bleed a week later.

@JinglingSpringbells Sorry if I wasn’t clear. The dose is 2x100mg per night, for 14 days. Then 14 days off.

My GP told me to take 1 x 100mg tablet a day- no break. Its different advice to that given to my friends but its easier to keep track of and no bleed- hooray! But do wonder why my GPs advice was diffrerent to others! and if there are any pros and cons?

I’ve had consultations with four different doctors now, and each of them has told me to do things differently, without really explaining the rationale. It’s impossible to get an appointment with the same doctor each time, so I feel as though I’m a guinea pig and not being treated with any consistency. I save up all my queries for the next appointment, and then the new doctor gives me a new regime before I’ve had the opportunity to ask any questions about the last one.

@Runnerduck34 I was told to do that initially, but then changed to 14 on 14 off in order to make my cycle more regular I think. Or maybe because I was still having periods.

My normal cycle for 20 years pre HRT, was 22 or 23 days. With a couple of 35 days to keep me on my toes.

OP this is what happens to me too.53, 4 years on HRT. Bleeds very irregular, had one in March, one in August, one last week. No one seems concerned. My periods were also always very light pre-HRT.

I do exactly the same and still have a period every month...are you also using oestrogen?

Yep using oestrogen.
Have a bit of spotting every now and then but not a period.
Im 52 and been on HRT for a year and periods were becoming irregular when i went on it so maybe naturally finishing now?

There are two ways to take HRT

1 Sequential
2 Continuous

1 is for women in peri.
2 is for women who are post menopause (no period for a year of aged over 54.)

This medical site explains why.
https://www.menopausematters.co.uk/postmeno.php

When?

• Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).

• If sequential therapy started while still having periods, wait till age 54 years. At 54 years 80% of women will have cessation of ovarian function and are likely to settle on continuous combined (period-free) therapy.

• Change from sequential to continuous combined by finishing the current sequential pack and start new therapy at the end of the expected bleed.

POST MENOPAUSAL
Continuous combined therapies.
"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age.

The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin.

Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy.

The different 'advice' from GPs is often because they are not trained in HRT and confused.

If you start continuous too early, you will get break through bleeds (or your normal periods coming anyway).

Runnerduck34 interesting. I'm 47 and have been on oestrogen, progesterone and testosterone for a year.

I take all continuously which my consultant said was better with the symptoms that i had - horrendous moods dripping in sweat each night etc.....

JinglingSpringbells i haven't yet had any break through bleeds, and my doctor is actually a specialist private meno doctor so i assumed she was fully up to date on things. i will question her more at my next check up!

i haven't yet had any break through bleeds, and my doctor is actually a specialist private meno doctor so i assumed she was fully up to date on things. i will question her more at my next check up!

@soberfabulous You need to have a conversation along the lines of "My understanding is that the sort of HRT you have prescribed is for women post-menopause or aged 54+. Can you explain why I'm not on sequential? And I'm also having monthly bleeds, so the bleed-free type you have prescribed isn't working like that."

Also, bear in mind that many drs have jumped on the private 'meno specialist' bandwagon. Yours may be excellent, but any dr can call themselves a 'specialist' in menopause. Is she a consultant ? A gynaecologist with specialist menopause training?

@soberfabulous Reading the rest of your post- sometimes continuous is used as it can level-out the mood swings that women may get on sequential. However, the downside is that there can be erratic bleeding, not just regular normal periods, but other bleeding as you move further into late peri when your own cycle will be more irregular.

JinglingSpringbells yes she's a very experienced gynae with specialist meno training. i live overseas and she's one of two most sought after specialists in this area.