HRT and periods starting before progesterone is finished - is this normal?

[maeb]

I've been on HRT (Oestrogel and Utrogstan (progesterone) 16days off/12 days on) for several years without any issues. I have regular periods/bleeds normally starting 1-3 days after finishing the Utrogestan and very, very occasionally it will start before I've finished. Bleeds are just like my periods, 2-3 days, mostly light with every 3rd/4th one being heavier and more crampy.

However, for the last 3, it has started earlier, on around day 8 of the Utrogestan and is a bit heavier, lasts for 6-7 days and more painful The bleed is a little more 'watery' than usual and a bit heavier. Is this okay or should I speak to doctor?

I'm otherwise a healthy weight, exercise regularly and eat well (apart from the odd pack of gummies😏)

I can't find any information online either.

I'm asking as here first I'm dreading filling in the online form for the doctors. I much prefer speaking in person.

I think you should make an appointment to check with a doctor. Might be nothing, but the watery nature of it might indicate there's something else going on.

The usual medical advice (from the British Menopause Society in their guidance on progesterone /HRT) is that women who have heavier or odd bleeding increase their Utrogestan. So that would be from 12 days to 14 days.

Your GP could send you for a scan. But to be honest unless you can time this to the end of a cycle (when you have bled) when the lining is thinnest, it won't show much.

There are a lot of research papers which show that for women on HRT any change in bleeding is almost always something benign (compared to post meno women who bleed).

One question is if you are still in peri.
If so, is it possible that you are ovulating and your womb lining is thicker because of that?

I don't know, and my case is a bit different, but I've had the same question. I am still in peri and only on utrogestan (days 14-26 of my cycle). I would say that about a third of my bleeds start at day 23-26 regardless of utrogestan, and I was not expecting that.

Thanks for that info Jingling and to the other replies. That's a bit reassuring.

I don't know if I'm still in peri or not and apart from coming off HRT am not sure how I could tell.

I've booked an appt with a female* doctor so hopefully she will be able to reassure me and/or send for tests.

*Friend saw male doctor at same surgery to ask about menopause and he said 'sorry but I don't specialise in women's issues' - he's a GP and females are HALF the population!🙄

How many pumps of gel do you use?

200mgs Utrogestan for 12 days is fine for 2 pumps of gel, but if it's more gel then you would probably need 14 days.

TBH (and I'm not a dr- just thinking what mine could perhaps suggest) would be to try 14 days for 3 months and see if that helps, and perhaps a scan.

I use 3 pumps of gel and 200mg Utrogestan and have done for 7 years. Thanks for your advice, I do appreciate it.
I'll look into it more before I see doc in fortnight.

I posted a separate thread on here a while back- maybe 6 weeks ago?
It was the BMS guide to progesterone in HRT.

It was a guide for drs but it's very readable and it's where I found the info I mentioned above- about increasing the dose.

They specifically mention that on higher doses (3 or 4 pumps of gel) women ay need more Utrogestan and suggested 300mgs for the 12/ 14 days to control bleeding.

if you do a search or scroll back down the forum here you might find it.

Thanks again Jingling, I really do appreciate your opinion.

I've just found the BMS guide you posted, along with other threads you've commented on that that I'll read through before I see the doctor.

I started peri at 38 and I'm determined to stay on HRT for as long as poss (if no complications obv).

I had similar and my dr said I’m probably about 6months from meno and that will upset the balances. however if it happened again she’d send me for a scan. But that it was probably nothing to worry about but to keep an eye on it