Is it normal for cycles to be out of sync when starting HRT

[LLJETO]

Hi,

Is it normal for your cycle to be out of sync when you first start HRT and is it likely to settle? My cycles have been as follows:

•Started oestrogel 26th Jan (just when I picked it up)
•Period 2nd Feb - normal for pre HRT cycle
•Progesterone 9th Feb - 20th Feb inclusive (2 weeks after starting oestrogel as I thought that was the right time to take it).
•Next period started 25th Feb (23 days after last period which was my ‘usual’ cycle in recent years) - lasted 18 days, but was mostly light and spotting after the first few days. This is not unusual for me. Every few periods I get one that lasts a long time but it’s like it takes ages to get going and ages to stop. Not heavy - just as if everything’s slow to come out. Menopause nurse not concerned.
•Progesterone 9th - 20th March inclusive
•Progesterone started 9th April - ongoing
Period started yesterday, 13th April. Approx 6.5 weeks since the start of my last one. Again, not unusual. When I’ve had one of these longer periods previously, there is usually a bigger gap between that and the next period..6/7 weeks is about right.

So all of this is ‘normal’ for me but I’m obviously not syncing with the HRT cycle. Am I doing it right or should I change in some way?

Thank you!

Yes this is perfectly normal and common. Cycles becoming increasingly irregular is a hallmark of perimenopause, and standard MHT with micronised progesterone is not strong enough to override your own cycle, although it is capable of inducing withdrawal bleeding.

You are trying to get an increasingly erratic endogenous menstrual cycle to overlap with the fixed 28 day schedule out of the box that the 1960s male-authored gynaecology textbook thought a) all women had and b) all women wanted.

Number of women asked = zero.

So sometimes these will line up perfectly, like the hands on a broken clock. Many times they won't.

This is not a problem medically but can negatively affect bleeding related quality of life and there are multiple bleed free options that can be discussed with your provider if you prefer.

Your own cycle should settle down into an HRT cycle.
It may take a few months but it should happen. You're only 3 months into this.

One of the aims of HRT is to set a regular cycle, which will override your own cycles where you are not always ovulating each month.

Where you said this

•Started oestrogel 26th Jan (just when I picked it up)
•Period 2nd Feb - normal for pre HRT cycle
•Progesterone 9th Feb - 20th Feb inclusive (2 weeks after starting oestrogel as I thought that was the right time to take it).

Maybe your GP was a little remiss here?

The best advice if you have regular periods is to wait for the next cycle before starting HRT. It just makes it easier to coordinate the progesterone part.

If you are well into peri with very few cycles, it's okay to start it anytime.

It would possibly have been better to wait until 14 days AFTER your own period started.

Day 1 of your cycle was Feb 2nd, micronised progsterone from 16th Feb for 12 or 14 days.

You started progesterone when you were still having a period (you were on Day 7 approx of your normal cycle) so it's harder for the HRT to override that.

What you could do is now wait until 14 days after a period and start progesterone then.

You're getting a heavier period because you're not ovulating and none of your own progesterone is produced. So the womb lining builds up .
HRT should override this but you maybe have to reset it.

Thanks Jingling. That makes total sense! I’ve definitely misunderstood and done it as starting prog 2 weeks after the start of my oestrogen!

I’m currently on day 2 of my current period cycle, although I had some spotting at the weekend (also normal for me prior) so maybe it’s day 4 if you include that. I’m also on day 5 (6 if I include the one I’ll be taking tonight) of the prog cycle..I decided to do 9th - 20th every month, just because that’s when I started and thought I’d keep it the same.

Do you think I should stop the prog for now and then start it again on day 14 of this period cycle for 12 days from then? And if so, would count today as day 2 or day 4 based on the weekend spotting?

Thanks again!

Edited - my period isn’t heavier..just longer. As in I feel like it’s the same amount of blood just it’s taken longer to come away if that makes sense?

It's really hard to say but at some point you need to try to align your own cycle and HRT, otherwise there is a risk you will always be 'behind' or ahead.

IF you carry on as you are, (taking 12 days of progesterone at the start of your cycle you MAY find it overrides your own period or it may not.)

You should count the bleed as from the day you start spotting as this is when the lining is breaking down.

If you stop now, 6 days into taking progesterone you may get a withdrawal bleed of some sort anyway.

Why don't you stop the gel and the progesterone, wait for your next period and start again then? Gel on Day 1 and progesterone on Day 15?

Thanks again! I could do that although I’m not sure I want to go without my beloved oestrogen!😂 It is probably the best way of doing it though so I will try it.

If you don’t mind answering one more question…as you suggest, I’ll wait until the next period to do the gel and then on day 15 will start the progesterone. Then how will it work on the cycle after that if it ends up being 23 days between them as is normal for me? Would I still take the progesterone from day 15 onwards on that second cycle? Or if it ends up being a longer cycle, it’s it always day 15 from the start of my period, even if they’re sporadic? Hope that makes sense?

Once you get into the new pattern, keep to the same DATE as you're doing now each month. Ignore earlier bleeds if they happen.

I don't want to overcomplicate things for you even more, but you could carry on with estrogen only until you have a natural period if they are monthly, more or less, but as you've already had 6 days of progesterone you may have a withdrawl bleed which would complicate it all.

Thanks again. It’s very much appreciated.