Gepretix every day but still having bleeds?

[thaneofglamour]

I have been tinkered about with on so many versions of HRT now that I (and my body) are a bit confused. There were two issues - allergies to patches and gel and intolerance of pill forms of HRT especially the progesterone bit.

We eventually seem to have settled on:

Estradot 50mg patches. Still intensely itchy but a smaller area at least.
Gepretix 100mg nightly. Suggested instead of the on off regime to help my tolerance. (GP suggested a 3 day break but specialist nurse said to take every day)

This has helped with my two main symptoms which were night sweats and nose bleeds and terrible ovarian pains have subsided.

However, given I am now taking progesterone daily, I am a bit surprised that I have had two bleeds - one 42 days after the previous one (which had been just before I started this regime) and now one 25 days later. Both bleeds were like a (for me) normal period - maybe not as horrifically heavy . To clarify, I have never at any point had a prolonged length of time without periods before starting HRT (am 53).

I was told 'you might still bleed but you probably won't '.

I'm just a bit confused. Is it just that 100 mg is actually quite a low amount ?

I think 100mg of progesterone is the norm; however I didn’t get on with Gepetrix. Had Utrogestan 100mg for over 6 months then when there was a shortage got given the Gepetrix and immediately started bleeding again (after a few early bleeds had settled on the Utrogestan).

Oh, interesting. Gepretix was just what I was given. Never had Utrogestan.

To clarify, I have never at any point had a prolonged length of time without periods before starting HRT (am 53).

This is the reason.

It still surprises me that so many GPs are not explaining how HRT is supposed to be taken when they prescribe differently.

200mgs x 12 days a month is for women who still have natural periods, even if they are irregular.

Daily (100mgs) is for women who are post menopause. This is 12 months with no period, or over age 54 when 80% of women have no ovarian activity.

Using a continuous sort (Utrogestan daily) often results in bleeding. This is because the lower dose doesn't control the growth of the womb lining in women who still have ovarian activity ( their own estrogen is higher.)

So instead of a regular withdrawal bleed (on the 12 day sort) your lining will shed when it wants to. This will settle down eventually as you are further into menopause but it could take a year or more.

I'm surprised you've been told to take it daily if you are intolerant- how is that better than 12 days per cycle? Presumably as it's a lower dose.

Just to add Gepretix is a 'new' brand that's cheaper for the NHS to supply. Most women were/ are on Utrogestan- exactly the same but a branded sort.

They are 100% the same product. They are just different names. A while back someone posted the ingredients from both patient leaflets and there is no difference at all.

Gepretix is cheaper so provided by the NHS now sometimes.
I have my HRT privately and when the pharmacy tried to give me Gepretix (without asking me) I questioned it and they swapped it (because they had actually charged me for Utrogestan.)

To be fair my named GP is a specialist and quite good but I have never met her. She just sends messages every so often. My GP appointments otherwise are 5 minutes and it's not long enough to explain anything.

The daily 100 mg does seems a bit counterintuitive but I guess it's the same slow release theory as a coil? Anyway, it's certainly better than the pills which had me in agony. And I can't use Evorel because of allergies.

I don't actually know if I have ovarian activity. Been messing about with so many different types of HRT for two years now that it's really hard to know! A pelvic scan did suggest they were small!

I have a slightly thickened womb lining so maybe the bleeding is good? I imagine it needs a bit of shedding. This may be a biological fact I have made up.

You say this, and I know that Gepretix is just generic, but I actually experienced more bleeding when I took it.

Then it was your own hormones and nothing to do with a different name.
It's just not possible.
I posted the ingredients info from the online leaflets and they are 100% identical.
They wouldn't be allowed to substitute with something that was different.
Gepretix isn't generic. It's still a brand. If it was generic it would be called 'micronised progesterone' .

If you are on HRT and don't had regular withdrawal bleeds, your lining will be thicker than someone post menopausal or well-established on a no-bleed type.
The lining gets thicker then thinner over a cycle, on sequential (or if someone is on continuous too soon and has ovarian activity.)

The 100mgs daily dose isn't 'slow release' it's just a lower dose, but daily, and therefore any side effects are less in some women. I guess that's what you mean.

I'm still tweaking progesterone and find I tolerate 100 mcg much better than 200 mcg plus my body seems to like the 100 mcg progesterone (residual anxiety and hip pain reduce/disappear on it). I'm trying to build up to 200mcg again this month i did it in month 1 but in month 2 had a significant negative reaction). But it's looking to me like I may want to look at the 25 day/100 mcg regime which still gives a withdrawal bleed.

I'm approaching 55 but was still reasonably regular pre HRT at the end of May.

Maybe go to the regime the Doctor recommended to give that withdrawal bleed and see if that helps?

But I am having bleeds on a 28 day regime so I'm not sure why that would help? Quite a lot of people are saying missing only three days seems a bit odd and might not give a withdrawal bleed. It's kind of the lack of certainty I don't like. I'm a routine driven person!

HRT is way more complicated than I expected!

I think the theory is that stopping the P "forces" a withdrawal bleed as the level drops off (as our bodies do normally). Then you wouldn't have gone 42 days without a bleed.

It is complicated.

I don't know what you mean by 'missing only three days'.

You've said you were using it daily.

Going back to basics.
Too many drs (and nurses) are giving contradictory advice. That's why you're confused.

I've been on HRT for 16 years with a menopause specialist. I've tried various cycle lengths /days of Utrogestan but always with complete explanations of why.

The regime for women with periods still, or under 54, is 12 days per month. Many specialists advise keeping to the same day each month (like the 1st) which sets a 30 day cycle.

14 days is 'an option' for women who have a heavy bleed as more utrogestan can reduce it a bit.

For women using combined continuous (100mgs daily) the leaflet says 25 days out of 28 but this has been replaced in practice by daily 100mgs.
This brings it into line with all other combined continuous types (patches or pills) where estrogen +progesterone are daily.

The 3 day break was a sort of 'insurance' for women who might want a short bleed.

Bleeds at odd times happen when women start combined continuous too soon and aren't post meno.

The 'missing three days' was a reference to the PP's comment who suggested doing it. I did for the first month ( and had no bleed!) and then changed to 28 : 2 bleeds since, one after 43 days and one after 24.

I have a gynae referral in September so perhaps they'll sort it all out!

Why, then, have people been having issues with different bottles of estradiol/Oestrogel even manufactured by the same company? I believe the ingredients listed on those are identical. Genuine question as you seem pretty clued up on this.

I have no answers to the Oestrogel question. The thread ran and ran but it's all gone quiet now. The only thing that I've noticed is that the new style pump gradually delivers less as it's getting close to empty, whereas the old bottles just 'ran out' . I never noticed anything different, other than that.

The cheaper version of micronised progesterone is just that. It's cheaper for the NHS.

What happened to me was that I had Utrogestan on my prescription. I paid for it (and it's quite expensive) but before I left the pharmacy I checked what they'd given me.

I said that wasn't my prescription and without any explanation they promptly swapped it for Utrogestan.

Having looked online at the cost, Gepretix is cheaper (by around 10p per tablet) but they had charged me the cost of Utrogestan, so that's why they immediately swapped it.

It's also a supply issue. You may know that utrogestan was in very short supply and rationed. One criticism was that there was only one supplier (who couldn't fulfil demand.) That's why another pharma company has stepped in to supply it.

It would be a scandal if it was ineffective as women would be at risk of hyperplasia.

Thank you, @JinglingSpringbells That’s all really helpful.