Intermittent bleeds on sequential HRT

[TeenagersAngst]

I’ve been on HRT for 18 months, taking progesterone days 15 to 26 (and oestrogen every day). I usually bleed starting day 28 which I would track as day 1 of my new cycle.

Last month my period was about a week late and I wasn’t sure what to do with regard to cycle dates. The internet told me to ignore whether I bleed or not and just keep resetting my cycle at day 28 (two days after I stop progesterone).

This month I’m late again and understand it could be that I’m closer to menopause than before. Is the advice to ignore the date you bleed correct and just continue taking HRT according to a 28 day cycle?

I am new to HRT, but yes my understanding is you take the progesterone on the same days every month regardless of when your bleeding starts. So stick with your original cycle. Can i just ask- due to take my first progesterone tablets tonight and i’ve read some awful stories on here about side affects. Have you had any issues with it?

Thanks @AnxietyCam good to know I’m on the right track.

Ive has no side effects whatsoever since starting HRT. I’m
not sure it’s managing all of my symptoms but no obvious side effects. Hopefully you’ll be fine!

@TeenagersAngst forget about cycle days and take progesterone on the same date of the month each month if you started last month on the 20th start this month on the 20th and next month on the 20th etc. x

Thanks @Christine0708

If I’ve previously stuck to a 28 day cycle can I just change to a calendar monthly cycle straight away with no issues?

After you've been on sequential HRT for a while you can move to daily progesterone so it might be worth talking to your GP about that. I find it easier to take every day than remember it on certain days.

@AnxietyCamI had a terrible time with the Mirena coil for progesterone but Utrogestan capsules don't give me any side effects. I took it sequentially initially then moved to daily after about 18 months on the advice of my GP.

I am also on this type of HRT- you don't take it on the same dates each month as it is run on a 28 day cycle and there aren't 28 days in every month!

When you bleed/what date of the month it is etc does not count with this type of HRT. Once you start taking the HRT you run on a 28 day cycle that doesn't change depending on when you bleed- you stick to the cycle. As the actual dates for days 15-26 change every month- as our months aren't 28 days long- I work out which actual dates are days 15-26 and mark on the calendar for the next few months and I write it on the box. If you need clarification you could as at your next review. Hope this helps!

You take it on the same DATE each month @TeenagersAngst @madamegazelle1

It's frustrating that drs aren't explaining this properly. My consultant says for a monthly cycle you stick to the DATE. That means the cycle is 30 days. Those 2 days make no difference.

You cannot follow your own cycles. This is because they will change and you will miss some cycles the further into peri you go.

The reason for the 28 days is that this is an 'average' menstrual cycle. But in reality very few women have that.

@TeenagersAngst Your cycles are not late. It's normal to go several days after the last progesterone before bleeding starts. This is not YOUR cycle, it's a withdrawal bleed created by HRT.

My bleed usually starts 4 days after the last Utrogestan. (I'm post menopause so no natural cycle).

Occasionally it's been earlier by a few days. This is because Utrogestan is not very stable in how it's absorbed. If the amount in your system drops a little you may bleed early.

That's far too complicated and won't work once you miss cycles . You could go 3 -4 months or more with no cycle of your own.

I've explained why in my post.

I think @madamegazelle1is saying the same thing but just following a 28 day window rather than a calendar month. Is that right? Does it matter either way?

I did wonder that!
It's just far easier to use the same date each month.
Like the 1st etc.

The 2 days difference between 28 and 30 days make no difference to your womb lining. But it's easier to use the same date.

I follow a 28 day window as that is what the instructions say for the progesterone I get prescribed. Use on day 15-26 of 28 day cycle. My GP
also confirmed this when I said how annoying it was trying to work out days 15-26 each month. I have the same HRT as you- O every day and P for 12 days a month. That man made cycle is set in stone and I don’t deviate from it depending on when I bleed. If you seek clarity from your GP please come back and update!

Thanks both!

You’ve definitely cleared up my main confusion which was whether to factor the bleed dates into the whole shebang but I know now not to.

Many GPs just say do '2 weeks off and 2 weeks on' for Utrogestan.

That's 14 days whereas 12 days is enough ( the leaflet gives the option.)

When women use patches or tablets, there is no 'counting' because the patch or tablet has the correct hormones in.

Half the month it's just estrogen then half the month the patch/tablet has both.

They don't try to alter the 2nd half of the month to coincide with their cycles, they just complete the HRT cycle.

It's no different with Utrogestan.

Are there progesterone patches? I thought that was just for oestrogen.

There are no progesterone -only patches.
But you can get patches that are 14 days of estrogen only then 14 days of estrogen+progestogen. (not progesterone, which is micronised progesterone.)

https://www.menopausematters.co.uk/perimeno.php

Evorel and Femseven

Thanks, never heard of those.

I tried these patches before moving to gel and tablets. Lots of people get on really well with them and love them but I struggled with them staying in place and coming away round the edges- thought I had something in my jeans pocket but turned out to be a patch that had come off and crumpled up! Friends of mine get on really well with them