Bleeding starting on day 3 of Utrogestan

[Awkwardmedicalquestions]

Can anyone give me some pointers about what to discuss with my doctor at an HRT review please?

I’m 57, and have been using HRT since 2018 when I was 51. Started on Evorel Sequi before moving to Evorel Conti (75) and Utrogestan (2 tablets orally days 15-28 of my cycle) in 2020, introduced Testogel nearly 2 years ago, and started Ovestin in January this year. I now seem to have balanced all of my symptoms apart from when my period arrives.

Since taking Utrogestan, my period always arrived early. Usually around the 10th day of taking it but over the last 3 cycles, it has got earlier: two months at day 6, this month at day 3. It has also lasted longer with no regular progression eg spotting, heavy flow, nothing, brown spotting, medium flow with clots, nothing, bright red spotting. I continue to take the Utrogestan as prescribed all the way through.

I last had an ultrasound in 2021, and a smear last year.

Could the introduction of Ovestin have triggered this change or should I ask the doctor to look at the oestrogen/progesterone balance?

@Awkwardmedicalquestions Have you got mixed up with the names of what you're using?

You say you're using Evorel conti (so combined continuous with estrogen+Norethisterone in each patch)?

Evorel conti only comes as a 50mcg patch.

And if you were using a conti type, you don't need Utrogestan as well because there is Norethisterone in Evorel conti patches.

Oops 🫢 I definitely was on Evorel Sequi 50 patches with Utrogestan when I swapped from Evorel Conti (because I've still got a copy of that prescription) but I hadn't appreciated that I'm now on Evorel 75.

I'll see if I can edit the post.

The Evorel you are now on is estrogen only.

You probably need 300mcgs of Utrogestan .

This is now advised for women on higher doses of estrogen.
That's anything above 50mcgs.

You're probably bleeding because the dose of Utrogestan isn't controlling the build up of the lining.

The way this works from now is that your dr has the choice of sending you for a scan now, increasing Utrogestan and seeing if the bleeding settles down and maybe sending you for a scan after 3 cycles (ish) on the higher dose.

Thanks @JinglingSpringbells. I had wondered if the balance was wrong as, for a while after the Evorel Conti 50 didn’t seem to be controlling all symptoms, I’d been prescribed Evorel 100 patches and which were then reduced to the 75 as I’d read that the level of progesterone might be a bit too much for the amount of oestrogen I was taking.

The last time my GP and I spoke, she did talk about trying to move me back onto the Conti as my periods were more naturally likely to have stopped now. The joys of the menopause 🙄😕

You don’t have to be change to cont just take the Utrog continuously instead of sequnal.