When to adjust HRT

[AgenceGrateau]

I've got an appointment with my GP tomorrow but I'm not sure what I need.

I've been on HRT for 15 months. Before starting my cycle was irregular. When I first started HRT my cycles became much more regular every 26 days or so and all other symptoms levelled off. Over the last 6 months they're very irregular again. Ranging from 17 to 41 days with no middle ground - very long or very short.
Other symptoms are well controlled (though I am perhaps a bit brain-foggy again.).

I'm on three pumps of oestrogel and two progesterone for the latter two weeks of my cycle (though I've no clue what is or isn't the last two weeks now!)
Do I need to decrease oestrogen? Increase it? Move from cyclical to sequential HRT? Does this sound like a normal result of menopause progressing?
My GP wasn't happy about me going on to HRT (thinks Davina is a pain in the bum) so I've had to battle for everything, want to make sure I'm informed as possible.
Thanks!

Ranging from 17 to 41 days with no middle ground - very long or very short.

This does sound odd.
If you're using cyclical (also called 'sequential' ) you'd usually have a withdrawal bleed around 3 days after the last progesterone capsule.

How old are you?

It' s possible if you're young (under 50) your own periods are not being controlled by the amount of progesterone because you're likely to have your own estrogen circulating too.

Are you taking Utrogestan correctly? You mentioned taking it for the last 2 weeks of 'your' cycle. You're probably doing it correctly, but obviously it's an HRT-created cycle, not your own. Many menopause specialists say take it on the same day each month - any day but maybe the 1st or the 15th- and stick to that every month. Whatever you do, don't try to git it around your own irregular cycles.

The other thing is that the BMS suggests that women using 3 or 4 pumps of gel may need 300mgs x12 days a month to avoid irregular or heavy bleeding.

So maybe that's what you need to do?

Hi thanks for replying!
I'm 42 and take progesterone from CD14. I take two capsules per evening for 2 weeks regardless of my cycle and 3 pumps of oestrogel per day.

I had wondered about testosterone and whether that's a factor (I have zero libido) but I weight train and my muscle mass is fine so not sure if it rules that out?

Interesting about needing more progesterone though, I wasn't sure if I'd need to lower the oestrogen or if my own body was producing enough progesterone to make this irregular bleeding happen of its own accord?

I wish I could advise you more but without knowing all the details it's hard @AgenceGrateau

You're pretty young to be using HRT so I'm assuming you've an early menopause or peri symptoms?

Are you using hrt for symptoms like flushes, moods etc or something else?

From what you've said, the HRT isn't creating a new HRT cycle and your own periods are still there at different time intervals.

A lot depends on if these irregular bleeds bother you . If you want HRT to control your cycles, you could consider the Mirena coil which usually stops all bleeding. Or, you could try increasing the Utrogestan to 300mgs. Or you could change to different products like a patch containing Norethisterone. This is a much more powerful progestogen and would probably stop the bleeding. But it's not body-identical.

It's not 'normal' (you asked!) because HRT usually creates its own cycle with a regular bleeding pattern. Your periods are doing what they would if you weren't on hrt- becoming irregular.

So you've either just go to accept that you're getting HRT to control your symptoms, but as you're very much in peri, you're going to have erratic bleeds or you change to a different progestogen or increase the Utrogestan.

If your GP is not supportive, ask to be referred to a menopause clinic, or if you can afford it, refer yourself to a private consultant.

As you're so young and have been using hrt since you were just over 40, you need a dr who knows what's what!