Perimenopause - bleeding starting before progesterone

[MoiraRoseIsMyQueen]

I’m 40 and I’ve been on HRT for peri symptoms since August (Evorel 50 & 200mg micronised progesterone - bloody wonderful and life-changing stuff quite frankly!) I wasn’t taking it correctly until about Christmas (waiting for my period rather than taking it on a regimented 28 day cycle), so this may be a factor if things haven’t fully settled yet, but I’m finding I’m starting to bleed either on the day I start progesterone or even a day or two before. I’m having a pretty typical period (lasting 7-10 days, with light days and then a heavy day at the end), so it’s more than a withdrawal bleed - but I’d assumed that the HRT would alter/override my cycle.

Any experience of whether this is ok? If not, does anyone have any recommendations I can take to my Dr to discuss?

I'm waiting for a Dr appointment for the same issue!

But asking here and elsewhere (medic friends although they're not in this area of expertise) the consensus is that women in 40s are still making lots of their own hormones so this happens. Remember it's a recent thing that we are even able to access HRT at this stage of perimenopause.

The consensus is also "just keep taking the ultrogestan on schedule" but I feel physically I can't do that. I'll see what my doctor says the route forwards is.

What has surprised me is that my path through perimenopause has not been a linear progression. I went from normal (for me) cycle, to big gaps, and now I've jumped right back to my normal cycle. Weird.

Following as I’m going through similar

No, a low dose of estradiol and micronised progesterone will not shut down your natural cycle.

As it is however capable of inducing withdrawal bleeds, many women find they end up with both as your cycle won't always line up.

Given your age have you considered the combined pill as a better option?

I take it continuously and don't bleed at all, no hormonal fluctuations and a nice stable daily dose.

I can’t take the combined pill unfortunately as I get hemiplegic migraines. But thank you for the advice!

Wondering if you’ve spoken to your Dr yet? I had a phone call today and seeing the Dr next week, she’s talking about sending me for an ultrasound. I’d love to speak to someone more specialist but don’t even know how to go about that, but I have a feeling I’m just going to be sent for a load of unnecessary tests and then badgered to go on the coil, which I’m desperate to avoid 😫

@MoiraRoseIsMyQueen It may take more than 2-3 months to reset your cycle. You only started using it properly in January from what you say.

Why don't you stop the estrogen for a week or two, wait until you have a period, then start the new HRT cycle so that you take progesterone around day 15 , if your own cycles are around 28-30 days?

I don't know what you were doing before (maybe the above?) but it's worth trying a reset.

Because you are so young it's possible that HRT isn't overriding your cycles.

Also, withdrawal bleeds can be as you are finding - heavy and lasting a week. That's not unusual.

My appointment is next week.

Every Dr seems to push the coil so I imagine it must be incentivised for them somehow? I also really don't want it.

I'm 41 and have been on HRT for over a year now; my cycles are still independent of the HRT cycle. I just get my normal period still and no withdrawal bleed. I'm on dyrdogesterone for the progesterone component which I luckily don't notice at all, so I've just accepted they will be out of synch until I'm older. The daily estrogen has lifted my mood and my periods aren't floodingly heavy so I'm happy. HRT isn't as strong as contraception so makes sense that our natural cycles override it (in younger women).

i had a phone call consultation yesterday for this with the pharmacist she swapped me from patches of progesterone to the tablets as it’s more tolerated apparently.

we will see in 15 days!!
I hate it, just start spotting from day 1 of progesterone so I dont use the vaginal estrogen, it also gives me migraines. she did suggest the coil and said there’s another hormonal one that stops your periods all together. So you don’t have the false period every month.

I had my phone call. The positives were the Dr wasn't worried about anything. But I did feel they kind of misunderstood my issue as simply not liking progesterone (and then made more suggestions of mirena coil) which isn't really the case. I'm going to try stronger evorel and hope it overides natural cycle.