Estrogel +14 day progesterone - no period

[estrogone]

I was prescribed Estrogel (1 pump) + progesterone tablets for the second half of my cycle.

The GP said I would have a period after the 14 days of progesterone and that it was important to regulate the lining of my uterus to lower long term risk of endometrial cancer.

I haven't had a period. Is this normal or should I go back to the doctor.

Last natural period was 6 months ago and started on HRT in April due to hideous hot flushes.

15% of people don't have a withdrawal bleed after the progesterone part. I never do. Mentioned it to my gp but she couldn't have been less interested.

Thank you! Did you stay on the sequential HRT or go to a combined style where you take progesterone every day?

Hi Ive had pump and tablet for het for 4years now I have a bleed and very scared

I've had pump and tablets for hrt but after 4years I have a bleed I'm so scared I'm 59

Do you mean you have not had a period after 4 years on a sequential HRT (where progesterone is only taken for half the month)?

@estrogone It's true that some women don't have a bleed. This is because the womb lining isn't being stimulated enough to grow by the amount of estrogen.

It may well happen though in your future HRT cycles, so you can't make a call on the first month. Wait and see what happens from now on.

However, my consultant says they would not be happy if a woman never ever had a withdrawal bleed on sequential and would want to take a look with a scan to check everything.

Don't start thinking yet about changing to a no bleed type- there are reasons why you may not be ready for that- too young, still having your own cycle, etc.

@Dingle66 You might be better starting your own thread on that as it's different to the OP and you need to give more details.

No had pump and tablets for the whole 4years and take every day

Thanks. I am 3 months into the treatment. My GP referred me for an ultrasound when she prescribed the initial meds, but I can't afford it privately and still on a waiting list.

It's been six months since my last period, so probably should go back to the GP.

Are okay- you're only on 1 pump of gel. It's quite likely you're not bleeding as that is a very low dose and will be offset by the progesterone.

Why are you waiting for a scan?

It's not required before using hrt.

My GP wanted it for a baseline. I am in Australia so might be different here.

HRT prescribing is very different in different countries.

Women in the UK only have a scan (on the NHS) if there are problems.

I think the reason you aren't bleeding is that the estrogen dose is very low.
2 pumps is the 'norm' and that's what a withdrawal bleed is based on.

2 weeks on just one pump and 2 weeks on progesterone means the lining is probably too thin to shed.

Were you told to use just 1 pump? And is it working for you?

I've stayed on sequential HRT. I do still have periods though (somewhere between every 40 and 90 days) and I suppose that might be why they're less worried in my case.

Yes, the GP was quite specific about one pump and it's working like a charm. The hot flushes are completely under control.

I am having one pump every day, not just for two weeks of the month though.

Thank you for your advice. I really appreciate it.

I am on sequential HRT. I have a bleed every month but it bears no relation to the progesterone I’m taking in terms of its timing. I understand that this is normal and periods don’t always line up. And I have just had an internal ultrasound (for other reasons not the timings of my bleeds) and my womb lining in fine, well within range. I am on 4 pumps of oestrogel.

@estrogone

I know you're using gel daily.

What I meant was that once you start taking the progesterone, it stops the womb lining growing. So your womb lining is only being stimulated for 2 weeks and then the progesterone changes that. As you're only using 1 pump the lining will be very thin anyway, and there isn't anything to shed at the end of the cycle.

@MyLov Normally, after a few months, HRT will reset the cycle and override your own natural cycle.

It's worth knowing that for women on a high dose of gel the advice if there is erratic bleeding is to increase the progesterone. 300mgs instead of 200 on a cycle, or 200mgs daily instead of 100mg. This is covered in the BMS guidance on progesterone.https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf Page 6.

It doesn't sound as if you have erratic bleeding, in between cycles, but if you're still early peri the HRT may have not yet reset your cycle.

Thank you. Really appreciate the info. 😊