sequential HRT, spotting and the minipill

[spiegelis]

Will book in with the GP but just thought I post here too.

I have been on cyclical HRT for almost 6 months. I take 200mg utrogetan for 14 days on/off. I am also on the minipill (cerazette) for contraception. I take 1.5 pumps gel daily.

I haven't had a period since starting HRT and had one late last year (they were very infrequent due to the minipill) but about 5.5 months into my HRT I started spotting when I did not have a period at all since starting HRT.

I do wonder if I take a lot of progesterone 14 on/off esp with the minipill on top and my relatively low gel dose (1.5 pumps control my otherwise unbearable flushes fine and all insomnia has been cured - these were my main symptoms). Would I be better switching to the coil? I am 47, one ovary left.

I'm a bit confused.
Are you saying you want/ don't want spotting or a bleed?
Or you don't want to use Utrogestan and the mini pill as well?

It is possible to use a higher dose of the mini pill (usually 3 pills a day) as the progestin part of HRT but your GP may not be aware and you'd need a specialist to tell them what to do.

I am just a bit unnerved that I started bleeding (albeit lighty) after not bleeding since starting HRT.

I read that too much progesterone/progestin can cause the endometrial lining to thin and cause spotting/bleeding and wondered if I am too heavy on the progesterone side given I only take 1.5 pumps gel.

Mirena would kill 2 birds with one stone Instead of taking utrogestan and the cerazette. Not sure I am making much sense.

did not know that the minipill can act as the progesterone part of HRT. Will ask about it. GP suggested initially the coil but there was a long wait for fitting appointments so I just went ahead with the cerazette and utrogestan.

I'm not sure on this but I'd have thought that the amount of progestin in the mini pill wasn't enough to keep the lining thin. It depends which mini pill you are on as some also inhibit ovulation, not just implantation.
It could be the opposite- that as you've settled into HRT the lining has thickened and is shedding, but not at a regular monthly interval.
Not all women bleed on the cyclical sort and some only bleed now and again.
Maybe see what happens over time? You may find the bleed becomes regular but if that's an issue, maybe the mirena would be better.

Thanks, @JinglingSpringbells . I am on Desogestrel 75mg plus utrogestan 200 mg 14 days on and off (but puzzled here, many seem to take it only 12 days 🤔) . I will see how I get on.

If you are on the minipill why are you having sequential HRT?

I'm on the minipill so have continuous HRT. Surely it's the messing about on and off Utrogestan that is causing your problems.

I thought continuous is for menopausal women? I am peri. I just went with what the GP prescribed.

Should I be on continuous if peri and on the minipill???

I was already on the minipill so hadn't had a period in years - so without coming off you can't say peri or menopausal (but most likely peri)

Just added in the Utrogestan on top of it. Honestly Mirena would be a better solution but again, it would be continuous oestrogen with that.

I can't see what your minipill is supposed to be doing TBH. Either you have sequential without it, or continuous with it. I wonder if your GP just got confused on the day.

I had irregular periods on the minipill and just had one a few months before going on HRT. They said I need it as contraceptive add on (or the coil to replace both the minipill and the utrogestan)..

Continuous is for women post menopause and if they aren't sure, they say over 54.

See link. www.menopausematters.co.uk/postmeno.php

Using continuous too soon can result in odd bleeding (so many posts her on that) and then women get sent for tests that are worrying but usually unnecessary.

@AnnaMagnani The OP is using the mini pill for contraception I assume.
HRT isn't contraception - but you'll know that.

Honestly Mirena would be a better solution but again, it would be continuous oestrogen with that.

Estrogen is daily whatever the progesterone is.

@spiegelis You can take just 12 days.
12 days is the actual amount as shown on the patient leaflet.
it was the 'brilliant' idea of one dr, to produce a guide to say that doing 14 days on and 14 days off was 'easier' but in terms of what's needed, it's not.
Only for women who bleed a lot and then 14 days may help that.

thanks @JinglingSpringbells . I will book in with the GP to discuss the whole shebang. I think I will switch to the coil. no more faffing with all those pills.