Am on HRT but periods all over the place is that normal?

[FusionChefGeoff]

I know this might be a really stupid question but I assumed that once I was medically managing the hormones (up to 4 pumps oestrogel with progesterone tablets for 12 days every month) then my cycle would be predictable?? And it was for over a year. But then last month I had a tiny bit of spotting at the right time but nothing like a normal period. And now I've just come on quite heavily before I've event started the progesterone and I usually come on after the 12 days - so that makes this period 2 weeks early..?

Any reassurance that this is totally normal??

I think it’s pretty normal for HRT to make your periods all over the place but it’s always worth seeing your GP about unexpected bleeding just to get some reassurance. Have you not been recommended the coil to best manage bleeding? It means you wouldn’t have to take the progesterone tablets, they made me bleed really heavily x

You should probably be on a higher dose of Utrogestan as you're on a high dose of gel . 4 pumps is high as it's 3mgs a day.)

The British Menopause Society has a paper on this (I've linked to it here several times if you search BMS/HRT/progesterone guidance.)

They advise that for high doses of estrogen many women need to use 300mgs of Utrogestan and for 14 days rather than 12.

You're most likely getting break through bleeds as the lining is shedding early because it's thick.

Maybe try this higher dose for a month or two and see your GP if it doesn't improve.

I did mention increasing progesterone when she increased the oestrogen but she said no need?

I really don't fancy the coil due to hearing horror stories about difficulties getting appointments / agreement to removing it! I was on the contraceptive injections back in the day and they did not agree with me but I had to suck it up until it wore off so I'm very nervous about anything that's long lasting

I'm on three pumps a day with 12 days utrogestan for two years now.
Sometimes I bled three days before I finished the utrogestan, sometimes three days after, sometimes twelve days after, I haven't bled at all now for three months! Am 53 next week and wondering if this is normal.

@FusionChefGeoff This is what you could take to your GP. Issued April 2023

thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

Page 3
Progestogen doses within HRT regimens

The dose of the progestogen should be proportionate to the dose of estrogen.
While no data is currently available on the endometrial effects of high doses of estrogen and the optimal dose of oral or vaginal progestogen in this context, women who require high dose estrogen intake should consider having their progestogen dose increased to ensure adequate endometrial protection (e.g. micronised progesterone 300 mg for 12 days a month instead of 200 mg in cyclical HRT regimens or 200 mg daily on a continuous basis instead of 100 mg in continuous combined HRT regimens).

I don't think that is normal and I think they need to look more closely at the balance between your high oestrogen and basic progesterone, also your age (are you quite young?).

@FusionChefGeoff I was on 4 pumps of Estrogel and meno consultant was shocked that GP hadn’t increased my Utrogestan to 200mg every day (I’m on continuous HRT). What @JinglingSpringbells said ⬆️.
Finally had my first Mirena fitted in September aged 58 to try and control the bleeding and I think it may be working.

@TheYearOfSmallThings for menopause purposes (and not much else unfortunately!) I am quite young yes at 45...

I'll see if I can get a review call to discuss and see if increasing the progesterone is something she'd be happy for me to do as I am concerned my oestrogen dose has gone up pretty fast and is now very high so I want to make sure I'm 'protected'