Is it normal to start bleeding a few days before the end of the progesterone phase on sequential HRT?

[Geminijust]

I'm on month 3 of sequential HRT (14 days 2 pumps oestrogel then 14 days 2 pumps oestrogel + 200mg progesterone). Month 1, period started on day 13 of progesterone, month 2 on day 12 and this month on day 11! Is this OK or should I only bleed after stopping progesterone, so a withdrawal bleed? I'm late peri (& late 50s) and prior to stsrting HRT was only having random light spotting (all checked out & fine apart from some fibroids that I've had for years) and now I'm back to full on monthly periods, so not thrilled and wonder if I might be better off on continuous (2 pumps oestrogel + 100mg progesterone daily). I do have an HRT review coming up but would be good to know what I should be asking GP.

Thanks!

There’s a common misconception that periods /bleeds will align with progesterone. They won’t.

You simply take your progesterone for the 14 days, and forget about when the bleed occurs. It may align reasonably well, but it may not.

However in your case in your late 50s it’s very unlikely you have your own cycle so I would question why you are on sequential HRT (it taking progesterone separately) and would discuss with your GP. It would seem more sensible and advisable to be on continuous combined HRT, where you won’t have a bleed. You do need some form of progesterone if you have a womb.

Yep, I've asked two GPs that same question but both said I should stay on sequential for at least 6 months as not post meno as was still having some bleeding/spotting, albeit eratic/very light.

I find it so odd how gps can give totally different advice. I'm on continuous, well 25/3, but a lot younger than you and still having periods, albeit infrequently. I can't see any justifiable reason why you have to remain on sequential when continuous may help.

Have you asked this before @Geminijust (no problem maybe it was someone similar.)

You have said you are late peri so you are still ovulating now and then.
If that is the case you can try sequential first although the guidance is try continuous over 54. It's not mandatory- there are women very much post menopause who prefer cyclical as it means they don't have side effects of daily progesterone.

The guidance for continuous is
over age 54 by which time 80% of women are post meno
12 months or more with no periods.

One tip if you want to increase the effects of progesterone is to take it with food. The reason for 'take on an empty stomach' is that food increases its efficacy and possibly side effects for some women. You may find you stop bleeding early that way.

Don't think so. I'm going to bring it up with the GP again. Tbh I don't think I'm ovulating and haven't done for a year or 2. I know I could just do it without asking as the prescription is the same but would rather not. I do know HRT can take a few months to settle down and I'm only month 3, but is it an issue to bleed early, even if you don't have a natural cycle? As I said, I've already been checked out quite recently and would rather not go through all that again!

In my experience yes - am on oral HRT and seems to take me by surprise every time (although same every time!) 😂🤦‍♀️

The guidance is there is no need for another scan (if that is what you had) within 6 months.

Maybe you need to give it longer?
3 months is nothing and it can take a while to settle down.

Your periods are actually following a monthly pattern, just not with the HRT.

HRT won't usually control the first cycle because if it was already underway (unless you started estrogen on Day 1 of the cycle and timed the progesterone to your own mid-cycle - day 15ish.)

When in your own cycle did you start progesterone?
Did you wait until you had a cycle, then started it roughly halfway?

(It's not always necessary to do it that way but it can help to set the HRT cycle.)

Same here. I sometimes spot slightly just before day 1 of the progesterone, and I usually start to bleed properly around day 7 ish.

That's the thing, I don't really have a cycle and haven't done for over a year. Pre-hrt I could go several months with no bleeding and then have phases of random, light spotting, not actual periods. According to blood tests (which I know aren't that accurate) I should be post meno. Now I'm back to monthly bleeds heavier than I've had for a few years, not great!

The HRT bleeds can be heavier than periods. Mine are.
The only way to control this is to reduce your estrogen patch (or use something like gel which is easier to reduce) or increase the progesterone.

Maybe your GP would agree to 300mgs Utrogestan for 14 days which is one option (in BMS guidance) for heavy or irregular bleeds.

How are you using the progesterone?
Are you sticking to the same date each month?
Or have you tried resetting a cycle by waiting for a bleed and taking it on day 14/15? Light spotting still counts as a 'period', even if it's not full on.

Blood tests aren't always accurate. I was 'diagnosed' as post meno nearly 2 years before I really was!