What fresh hell is this periods??

[MiddleAgedDread]

Started bleeding on Thursday, nothing particularly heavy as has become more my norm in the last year or so. Had very watery discharge when I wiped first thing yesterday morning and then nothing all day. Have woken up this morning with cramps and bleeding fresh red blood. I’m on HRT and finished my 2 weeks of progesterone on Friday but my cycle never syncs with the tablets as it’s meant to.

You possibly need your HRT tweaking- either lower dose of estrogen or more progesterone (depending on what you are using.)
If you're using more than 2 pumps of gel or higher than a 50mcg patch this could be one reason.
Have you never had a regular withdrawal bleed 3 days-ish after the last progesterone?

I do 3 pumps of gel every day (increased from 2 a few months ago due to joint and muscle aches n pains reappearing) and 14 days of progesterone tablets every 14 days @JinglingSpringbells my "cycle" since Dec 2024 has ranged from 19 days to 40 days! Bleeding rarely, if ever coincides with the end of the progresterone. It's a nightmare, never know when to expect it!
It seems to be falling into a bit of a pattern of a shorter cycle and 2 longer ones, since Dec last year i've had 40, 19, 24, 36, 21, 28, 31, 20, 35, 31, 23, 31.
I've never had bleeding stop and restart like this though.

The advice for what you've had is to up the progesterone to 300mgs x 14 days.
Try that?
The stop start is because there is more blood to come away.

If you feel able to use the progesterone vaginally, (I know 3 capsules is a lot) that may also control it more as more is absorbed that way.

OR take it WITH food. The instructions say take on an empty stomach BUT the reason for that is food can increase some side effects (I never found it did) but it also doubles the effectiveness.

I wasn't told to increase the progesterone, just the oestrogen gel. I take 2 tablets of progesterone, usually before I go to bed, or an hour or so beforehand. Same with the gel, I usually do that in an evening.

a) your GP may not know and b) you weren't told that for some women increasing the estrogen can cause more bleeding.

It's all here.

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

Based on Cochrane evidence, the suggested dose of progestogen given in a continuous combined HRT regimen would be a minimum of 0.5 mg/day of norethisterone or 2.5 mg/day of medroxyprogesterone acetate. For low-dose sequential regimens norethisterone a minimum of 1mg/day given for 10 days a month, oral micronised progesterone 200 mg/day for 12 days a month, medroxyprogesterone acetate 10 mg/day for 10–14 days a month or dydrogesterone 10 mg/day for 14 days a month would be suitable options.

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).

Thanks, I'll try and get a call booked with the nurse. It's stopped again today!