Advice needed on breakthrough bleeding on cyclical HRT

[newnamenellie]

I’m on my fifth month of Oestrogel and Utrogestan (taken vaginally for 12 days each month). So far, after a bit of tweaking, things have run fairly smoothly so I have had a breakthrough bleed a few days after finishing Utrogestan. This was the case for my last cycle although the breakthrough bleed only lasted a couple of days (previously it had been more like a proper period). I then started getting really tender breast a few days later (around day 7 of the HRT cycle).

I'm now on day 15 of the HRT cycle and due to start Utrogestan today, BUT I’ve started bleeding and it’s like a normal period in terms of flow, cramping etc…

Firstly, can anyone tell me what would cause this (which hormone is unbalanced? It obviously is linked to the light short bleed at the beginning of this cycle).

Secondly, should I take the Utrogestan today as planned or should I let this bleed finish and call today cycle day 1?

Period wise pre HRT, I was still getting regular periods although cycle length could vary.

I take 1.5 to 2 pumps of gel spread across morning and evening. If I take two pumps at the same time, I get awful palpitations so had to tweak that.

Really grateful for any advice 😊

Firstly, can anyone tell me what would cause this (which hormone is unbalanced? It obviously is linked to the light short bleed at the beginning of this cycle).

I'd not think of this as a hormone being unbalanced. It's more likely to be your own periods breaking through.

This can happen if you are not post menopause.

You can either wait till this bleed stops and start again in 2 weeks with Utrogestan, or carry on with Utrogestan as planned.

It won't make a massive difference either way because eventually, HRT will reset an HRT cycle and your own hormones won't override it as you get further into peri and then post meno.

Thanks @JinglingSpringbells - good advice as ever 😊

My only concern (based purely on other things I’ve read elsewhere!) is that if I don’t start the Utrogestan today, the bleeding will be prolonged.

I would rather count this as CD1 and start Utrogestan again in a couple of weeks. This is because I take it vaginally and that’s going to be tricky if I’m bleeding.

I’m still finding my feet with the right amount of gel to use and the fact that I’m essentially topping up my own oestrogen means that it can be a bit hit and miss. I’ve found that 2 pumps in one go is too much, and even 2 pumps over two applications (morning and night) may even be too much.

Out of interest, how can I resolve the issue of my own cycle breaking through. As I said, it all went to plan the first four months with the breakthrough bleed happening when it was supposed to. Not sure what’s gone wrong this month!!

My only concern (based purely on other things I’ve read elsewhere!) is that if I don’t start the Utrogestan today, the bleeding will be prolonged.

I'm not so sure about that.
When progesterone is stopped or withdrawn (as in HRT) the lining breaks down and sheds.
Why would the bleeding be more prolonged? Using any progesterone once you are already bleeding, doesn't make the bleeding stop because the lining is already shedding. (Happy to see anything you have found that says differently.)

It would only be more prolonged if you skipped a whole month or more and used estrogen-only for 8 weeks.

I would rather count this as CD1 and start Utrogestan again in a couple of weeks. This is because I take it vaginally and that’s going to be tricky if I’m bleeding.

You can't really use it that way when you're bleeding as it will just flow out (or most of it.)

Out of interest, how can I resolve the issue of my own cycle breaking through.

Hmmm! I doubt you can.
The dose of Utrogestan is meant to control the amount of estrogen in HRT.
If your own levels suddenly rise (when you ovulate) you've got your own + HRT estrogen. And that's too much for the progesterone to control. OR the timing of the progesterone doesn't coincide with a shorter cycle you might have had and the whole thing goes out of sync.

TBH I'd not worry about it too much. It's early days for HRT and it's only an issue if it happens time after time (when it becomes a nuisance, rather than dangerous.)

Thanks so much! Really appreciate the time you’ve taken to respond to my questions.

Im going to wait a couple of weeks and start again then with the Utrogestan. Makes most sense!

Sometimes I bleed several days before I've finished the utrogesten, sometimes 2-3 days after, sometimes several days after, once not at all. I stick to the same regime regardless.
52 and been on HRT 15 months.

@newnamenellie out of interest how are you taking the utrog? Are you starting it in the same calendar date each month? Or 2 weeks on 2 weeks off? X

@Christine0708 I’d been taking it on day 15 of the HRT cycle, 12 days on, 16 days off.

I’m counting the first day of this new bleed as day 1 and resetting the cycle, so will start Utrogestan again on day 15.