Longer cycle hrt

[Menobenno]

Hi, can anyone please share their hrt routine for a longer cycle? I'm experiencing what I believe are peri symptoms but my cycles are pretty regular at 32 days, which is something I'm not up for fighting since it makes no sense to do so.

Do you need to check on which day ovulation occurs (if it does, ha) so you know when to switch to progesterone?
What products do you use? Does your dr monitor you in any way?

Thanks in advance for any info!

Are you asking if you can use HRT on a cycle longer than 4 weeks?

HRT is a monthly cycle where the bleed usually starts 2-4 days after the last dose of progesterone, so in effect that is a 32 day cycle by the time the withdrawal bleed starts. So daily estrogen and then 12 or 14 days of progesterone.

You can't work around your own ovulation because in peri it stops happening every month and then not at all (obviously)

HRT creates an HRT cycle.

Does this help?

Hi thanks for your response. I thought that standard hrt meant adjusting your natural cycle of in my case 32 days to fit a one-size-fits-all 28 day cycle have I misunderstood?

Also sorry but why is it that ovulation can't be worked to? I get that it doesn't happen every month anymore but it is still due to happen at the same time isn't it, and so can be an indicator of when your body is expecting to receive the progesterone from its breakdown (insert science bit here).

Bumping this - anyone not sticking to 28 days and adjusting things to suit their natural cycle? Surely I can't be the only one considering this! Can't find much online...

Hi thanks for your response. I thought that standard hrt meant adjusting your natural cycle of in my case 32 days to fit a one-size-fits-all 28 day cycle have I misunderstood?

It's not 28 days because many consultants say use progesterone for 12 days each month which is going to be 30 or 31 days.

but it is still due to happen at the same time isn't it,

No, because in peri you will have cycles without ovulation sometimes (even though you bleed ) and you will miss cycles.

You'll miss one, then 3, then 8, and so on, and this can last for years. You'd find it impossible to always identify ovulation and you'll go many weeks or months without a natural period.

Have you missed any yet? One of the main 'symptoms' of peri is irregular periods.

The reason for using progesterone is to stop the womb lining being too thick (hyperplasia) and possibly undergoing changes that becoming cancerous, in the long term.

If, in peri, you waited for 6 months (using only estrogen) before using progesterone, you'd be risking hyperplasia.

Just take progesterone for 12 days per month and you will have a cycle similar to your own.

Thanks @JinglingSpringbells I still don't quite get it but I'll take what you've said on board to further my research.

I've had some months with barely a drop, some with at least one really heavy day. But regular aside from when i was unwell.
Haven't yet figured out which one means egg and which means no egg. I would guess the other hormones are still doing their thing on their schedules since I'm still regular. A poster on another thread mentioned they were regular until they just stopped. I just have flare ups of hair loss and joint aches and extra bad PMT some months after never having had any real health issues ever. This started in the last year. Started taking iron supplements a few days ago to see if this will help this latest bout... apparently low oestrogen can cause low iron...

Looking at a chart of what hormones are supposed to be up/down and when is something I'd like to boost with a bit of hrt help. So if I ovulate at say day 16 then that's when I take progesterone until say day 30 or 31 which is when the oestrogen and progesterone drop off then wait one or two days and hopefully bleed then. That would mean 14 days of progesterone after at least 16 of oestrogen?

I just want to do what everyone else does but extend it a little, proportionally!

Not expecting answers (though great if anyone has any input) just having a little ramble of my thoughts so far.

@Menobenno If you were using patches or a pack of tablets the issue wouldn't arise.

They come as a standard monthly pack. Women on those don't try to juggle the patches or the tablets around their cycles.

Using gel and Utrogestan is the same principle- stick with standard dose of daily estrogen and 12 days of progesterone each month.

You're over thinking it.

Do you understand how when you miss a period you can't wait for the next sign of ovulation to start progesterone?

You could be waiting months and meanwhile your womb lining is building up.

And you would still 'only' have bleed on day 31/32 using the standard HRT way.

@JinglingSpringbells unfortunately the issue does seem to arise when women dutifully and trustingly take the medicine as prescribed yet their own hormones are more powerful than the supplementary ones and they're getting into all sorts of hormonal bother.

As already mentioned, I would be looking to start the progesterone part at the time I were to naturally have an upsurge in progesterone, i.e. day 16, whether I ovulate or not.

Why are you so against this?

Why are you so against this?

I'm not against this. I'm explaining the reasons why it's the prescribed dose.

As already mentioned, I would be looking to start the progesterone part at the time I were to naturally have an upsurge in progesterone, i.e. day 16, whether I ovulate or not.

You don't have an upsurge of progesterone if you don't ovulate, which is maybe what you mean?

Women post menopause (for example) have no progesterone at all but have to use it as part of HRT to avoid hyperplasia.

The principle of trying to coincide your own (variable) cycle with HRT isn't how HRT works. It resets a new cycle.

If you aren't happy with this, talk to your GP or see a specialist privately for more advice.

Hi Menobenno, I understand what you're saying and have experienced the same. I guess it depends on when people have started their HRT journey. Some of us may have years of regular ovulation before we start having anovulatory cycles. I have 'mittleschmerz' each month so know when I'm ovulating. My own cycle still overrides the HRT cycle but then I'm only 40 which is comparatively young-ish I guess.

As already mentioned, I would be looking to start the progesterone part at the time I were to naturally have an upsurge in progesterone, i.e. day 16, whether I ovulate or not.

You can do this because as long as you use 12 days (or 14 days if you're prone to heavy bleeding) per month, you will be completing a cycle.

Many consultants suggest starting progesterone on the same day each month like the 1st or the 15th. So that's each calendar month (not 4 weeks.)

What will be impossible would be to try to track ovulation if your periods are not regular (which they won't be in time ) and 'adapt' HRT around that.

Is it a big deal to have a 30 day cycle rather than 32?
Usually, cycles become shorter in peri anyway- mine went from an average of 30+ days down to low 20s and even 17 days in the end before they stopped.

Is it a big deal? Well 2, 4, 6 days out... it's not what my body wants. Why would it be anything other than matching to my natural cycles if I still have them? Why would one's natural cycles not be the starting point to work from? Granted things may change down the line. Is it because it suits medics for women to be neat and predictable so will ignore any information to the contrary and/or see them as anomalies?

'Many consultants suggest starting progesterone on the same day each month like the 1st or the 15th' sounds patronising and/or an option for the more disorganised amongst us.

@DazedandConfusedat39 thank you for seeing where I'm coming from, thought I was going mad there for a moment. Same age :)

I think as long as you take at least 12 days of progesterone each 'cycle' it doesn't really matter what day exactly you start on. If you're ovulating each month and can ascertain when that is and can be bothered to track it then I'd take your progesterone then and just match your cycle. I think we're in a minority to be on HRT so young hence why there's nothing online about it really.

How old are you at the moment @Menobenno and what type of HRT have you been given?

If HRT is for your symptoms, to help them, shortening a cycle by a couple of days shouldn't be a problem.

I tried really hard to answer your first post, which was can anyone create a different cycle, is it done etc.

What you're describing is not 'long cycle HRT'.
Long cycle is extending the estrogen-only part for more than 2 weeks- much longer. So it would be a 6, 8 or 10 week cycle.

Tridestra was an HRT tablet that was available (no longer) and was a 12-week cycle (estrogen only for 10 weeks.)

These long cycles can be done with consultants when women are intolerant to progesterone but usually comes with the proviso of ultrasound scans, every few months or annually (and usually privately not the NHS.)

I'll leave a link here to the BMS report on progesterone in HRT which may help explain the rationale behind it.

If you want to go 'off piste' and create longer cycles, you'd need to see a private specialist as GPs won't sanction it.

If you just want to take progesterone 2 days later each month but still follow a monthly cycle, just do that.

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

That's long but thank you I will read it. Off a skiing I go! Hopefully, when in a few months I go ask to get the drugs. Appreciate your input ❤