Going from 2 pumps to 3 - should I increase Progesterone too?

[moderationincludingmoderation]

41 years old - in confirmed Peri - 8 months into HRT (2 pumps gel, 200mg Progesterone for 12 days) and it’s been really helpful. Still having periods, and some spotting, that only just seem to be falling into a pattern/cycle. I was seen for a scan by Gynae because of this too double check lining thickness etc and all was ok.
Started to have some symptoms return so GP said I can go up to 3 pumps if I like. But she didnt say to increase Progesterone. I’ve seen on other threads that some have increased to 14 days of Progesterone, esp if they spot / still bleed heavily.
Thoughts? Shall I increase my progesterone to counter the extra pump?
Does anyone do 13 days? Why is it always 12 or 14?

I went up to a 75 patch and still keep my progesterone for 12 days at 2 tablets. I wasn't told to increase it. I've continued to have withdrawal bleeds - I would say I bleed a little more now my oestrogen has been increased.

I only got told to go up to 3 utrogestan when I increased to 4 pumps so I assume you'll be fine. (I had to reduce down again as I found 3 utrogestan too difficult but that's another story!)

thanks for the reply. Out of interest, does your bleed always come after the progesterone?
Mine usually starts before i finish the progesterone but seems to be shifting closer to the end of the 12 days bit by bit

ah ok, good to know.
when you say ‘3 utrogestan’ do you mean taking 3 x 100mg ? I’ve never heard of that.. I thought it was max 200mg a day but some
do it for 14 days rather than 12.

I was told to do three pumps, and 1 utrogestan a day. I don’t get periods.

Yes 300 x 100mg and I take them day 15 to 26 of my cycle so part of a cyclical hrt regime.

That’s really interesting - I’d never heard of anyone taking 300mg.
Ok thank you so much

@moderationincludingmoderation The British Menopause Society has a report/guide on progesterone and HRT.https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

I wish it could be a pinned link because it's useful and I've left the link several times.

The guidance is that for women on high doses ( 4 pumps or 100mcg patches) they consider increasing micronised progesterone. This is partly because it's slightly 'weaker' than the older, synthetic progestin in patches and pills.

@KatParr is following this guide which says 300mg rather than 200mg for 12 or 14 days is sometimes needed.

It's not mandatory but if there are any signs of a thick lining (such as spotting) then increasing it is the first step (and maybe a scan too.)

For 3 pumps, the same applies- any bleeding not expected you may need more progesterone.

Yes, bleeding usually occurs a day after I finish the progesterone or thereabouts,...

Before I upped to 75g patch I had a few odd months when I didn't bleed which was weird even though the progesterone was the same (I had all the symptoms!). As soon as I upped to 75mg the bleeds have been regular.

@JinglingSpringbells as always, thanks so much for the clear and concise information!
I will have a good read through.
I’m probably going to try a mirena soon so I guess that will eliminate this query!