Progesterone and “periods”

[mrsconradfisher]

Apologies if this comes out a bit muddled…I’m not quite sure how to word what I need to know!

Im nearly 49 and have been on HRT for about 3 years. I take Oestrogel and then progesterone in the second half of the month for 14 days. I actually use this vaginally rather than orally as it gives me far less side effects.

My question is, before I started on HRT my periods were very very spaced out, I’d probably go 10-12 weeks then have a very light period then 8-10 weeks and have another one.

As I understand it when you have finished having periods completely (so none for 12 months) you should take the progesterone every day? But when I finish the 2 weeks of progesterone now I have a “period bleed” even though it’s not a proper period. And I’ve read up on it and I understand that is supposed to happen otherwise the lining of your womb would get too thick. But how am I supposed to know whether or not I’d still be having normal periods when I’m having an artificial one every month anyway? And yes I could ask the nurse when I have my review but I completely forget last time so thought I’d ask on here!

You don’t know. I’ve been on sequential HRT (the same method as you) for about 4 years now so as I’m 54 I’m changing to continuous but I’m not really sure that my periods would have stopped yet so may get some bleeding for a few months. I’ve left it this long to change as I read a lot that you can move after a year on HRT but as many of us start it younger than women used to then there’s more chance your periods wouldn’t have finished yet. I’ve also read that you shouldn’t stay on sequential for more than 5 years. But there are some women who stay on it longer, it’s not easy to find clear information!

You can't know.
The only way would be to stop all HRT for months and see if you have your own periods.

Sorry this isn't helpful, I know.
The medical stats say 80% of women have no periods after age 54.

I’ve also read that you shouldn’t stay on sequential for more than 5 years.

This isn't the case at all.

I've used sequential for over 15 years with a consultant and a friend does likewise - almost 20 years.

There is a slightly higher risk of endometrial cancer (but a very low risk and the same as women not on HRT) but that has to be offset against the slightly higher risk of breast cancer on continuous.

Thanks both, that’s really helpful.
My next question is, do I really have to take the progesterone for the 2 weeks every month and then have this “fake” period? Could I do it every other month for example?
My periods were always very light, never really had period pains and only ever lasted a few days. These “fake” periods are actually not very pleasant! I’m getting bad period pains, flow is quite heavy and lasts a whole week. Seems crazy that I’m near menopause yet getting period pains. I don’t bleed or have pain any other time so it’s definitely the progesterone causing it.

As far as I know you need progesterone every month as it protects your uterus. Unless you’ve had a hysterectomy you have to take prog if you’re using oestrogen.

I have found that the HRT withdrawal bleeds are much heavier than when I had periods. My last period was in February last year, I started on HRT in May on the sequential dosage.

The withdrawal bleeds seem be very heavy for one day and are almost entirely over after this day. But the heavy day involves changing tampons a lot more often than my old periods.

I have also started taking iron tablets because of the heavier bleeding and I was losing more hair than usual. The hair loss has gone back to 'normal' now after about a month on the iron tablets which I will continue taking indefinitely.

HRT has improved my overall situation but the withdrawal bleeds are not pleasant, as you say!

With medical supervision you can have a longer cycle (ie alternate months) but you would be expected to have scans to check the womb lining at least once a year and these are rarely offered on the NHS (unless you are extremely intolerant to progesterone.) This is in the British Menopause Society guidance on progesterone.

The withdrawal bleeds are heavier than you own periods because the estrogen you're using is more than your own estrogen was. You could try using just 1 pump and see if that helps.

I have been able to do longer cycles but that's with a private consultant and it's carefully monitored.

If you were to do it the bleed after 2 months may be heavier than after 1 month (twice as much lining). The best thing is to try reducing the estrogen and if you feel fine on less, the bleeding may be less.

Brilliant, thank you. I did wonder if it was the amount of oestrogen causing it. The “periods”are bearable but Day 1 is pretty bad, I’m a TA so it’s just quite tricky to keep getting to the toilet. I will try slightly less gel this month to see if that helps.

I completely understand.

One tip is to use period pants alongside normal pads/ tampons which will avoid leaks.

Failing this, you may be able to try continuous on the basis that the withdrawal bleeds are too heavy OR you can increase the progesterone to 300mgs (rather than 200) OR consider a mirena coil.

I thought that the amount of oestrogen you take on HRT puts you back up to your pre-menopause level, as having too much brings its own side effects; which is why everyone needs a different dose.
I had a mirena soon after starting HRT so haven’t had a period in 4 or 5 years. I get the occasional day of pmt followed by some spotting which is roughly cyclical, so I assume that would mean I would still be having periods if not for the coil.
Would you consider getting a coil?

Interesting. I’ve just been told to use 2 pumps of gel which seems to be the standard dose, maybe I do need less?

No I definitely don’t want a coil. I tend to react quite badly to hormones in general, I struggled on the pill many years ago so I don’t really want something that I can’t easily stop.
Tbh the HRT regime I’m on has worked incredibly well, it’s stopped me feeling like a ball of anxiety and has allowed me to actually sleep. I put off trying it for ages as I was so worried. It’s just the 1/2 days a month when I feel like shit! The pains are like labour pains which is quite difficult to explain when I’m trying to teach 5/6 year olds!!
I will try maybe 1 1/2 pumps of gel and see how that goes. I can cope with the “periods”, it was more that I wondered if there was anyway around it. Honestly the stuff us women have to go through!

The guidance is to start on the lowest dose possible which will relieve symptoms.

That means you can start on 1 pump, give it a few weeks, and see how you feel.

My personal experience was 1 pump sorted everything (day time flushes on the hour!) but not waking at night and night sweats, so I upped to 2.
My consultant advised starting on half a pump and working upwards.

It always seems that most GPs aren't explanatory enough in their guidance.
The leaflet in the pack says 2 pumps but that is a medium dose and the same as a 50mcg patch.

…whereas I started on 2 pumps and quite quickly worked up to 4. I switched to 100mcg patches years ago and they suit me fine. My gp recently suggested that I should drop down to 75 as she said 100 is a ‘big dose’. I tried and within a couple of days had night sweats, aching joints and felt really miserable.
I think my point is, we all have a dose that is suitable and reducing it isn’t necessarily a good thing.