Bleeding on progesterone

[NorthangerAbbess]

Hi everyone, new to this board and just reaching out for a bit of support/advice around progesterone and periods.

I'm 46, started daily oestrogen gel and progesterone tablets 2 weeks on, 2 weeks off in April 2025. When I started HRT, my GP was specific about when in my cycle I should start the progesterone for the first time (I feel like it was around day 15), and the idea was that when I completed the two weeks, I would have my period. She explained I might take a while to settle into a pattern but within 6 months I should be consistently having my period during the 2 weeks I was off progesterone each month, and that if I was bleeding outside of this pattern by then, this would warrant investigation.

It took a few months but I did eventually fall into the pattern she described. However, over the past 4 - 6 months, I've been consistently getting my period during my 2 weeks ON progesterone each month. I've moved house during this time and when I spoke to my new GP, she said I should try to take the progesterone during 2 weeks of the month where I knew I wouldn't be on my period- which is quite different advice to the previous doctor.

My periods are still fairly regular, every 21 - 25 days, so obviously over the months that will have impacted where I'm at in my cycle when I start progesterone each time.

Sorry if I'm being thick! Can anyone offer any advice? Thanks so much in advance.

Copied my post to another poster yesterday here.

The best way is if your periods are regular, start progesterone on Day 14 (half way through the cycle, so it's the same as your own cycle. ) If you don't have a regular cycle, do it this way.

Whatever you do, don't try to follow your own cycle because it won't be regular - even if it is at the moment.

The easiest way is to start the 12 or 14 days of progesterone on the SAME DATE every month which creates an HRT cycle, with a regular withdrawal bleed around about Day 30 of the cycle. If your mid cycle falls on 20th August, take 14 days then, and then another 14 days from 14 Sept etc.

If you are not having regular monthly cycles, take it at any time and keep to the same DATE.

(This is the same as packs of pill or patches where there are 28 days in a cycle, with progestins for 14 days. women on patches or tablets don't try to start the patch or tablets based on their cycles.)

Thank you so much for replying - I'm still a bit confused though.

My periods are still fairly regular at present but are you saying I shouldn't try to follow my own cycle as they won't be regular forever?

Yes, exactly that.

IF you want to start the 'new ' HRT cycle, if you're in a bit of a muddle, wait till your next period- you can still use just estrogen for a week or two - then when you get to mid cycle, start progesterone.

Whatever DATE that is when you take the first 2 capsules (eg 15th Sept) start the next course/cycle of progesterone on 15th October.

For women using tablets, the tablets are 14 only estrogen, then 14 estrogen+progesterone. (Same with patches.) They don't wait to start the estrogen +progesterone around their own periods, they just follow the bubble pack of 28 tablets.

Gel + utrogestan is no different- they are just 2 items packaged separately.

Ok, I've got it now. Thank you so much for taking the time to help me with this, massively appreciated 🙏

@NorthangerAbbess this is the issue I've been having too. Spoke to GP and had a scan which had endometrium at 6.5mm so right on threshold as over 7mm is for further investigation (it was the day before I began to bleed though so would have been at max thickness).
GP seems unbothered but I'd be keen to try and land somewhere a bit more predictable. Have begun bleeding today which is day 7 of the 12 day prog phase. So I think what @JinglingSpringbells is suggesting is that I ignore what's gone before and start taking the prog again 14 days from now (28th Aug) and hope that sorts it? Would I be best also finishing off the 5 days of prog due this cycle? Wah why isn't this straightforward!!

@TimestentenIt's definitely not as straightforward as my original GP made it sound! And yeah, it's the lack of predictability that does my head in too 🙄

Yes, that's right.
Just keep taking the few extra days. Even though you are bleeding you're still using estrogen which will build up the womb lining, but the progesterone will counteract that..

I have asked my consultant this before and that was their advice.

Try to think of this sort of HRT as the same as a 28 day pill pack.
Women don't juggle it around periods. Or delay taking the tablets waiting for a bleed etc.

They take 14 tabs of estrogen and 14 tabs of estrogen+progesterone.
Gel and utrogestan are no different. Just 2 separate hormones not 1 tablet.

The 7mm limit for the lining before a bleed is not that important (again I've been advised.)

In the sequential phase right before a bleed it can go up to 9mm before any investigations are considered, and even then it would usually only be if you had erratic bleeding.If it was 9mm right after a bleed ended (eg Day 5) that' s different to Day 28. Ideally all scans should be done as soon as the period has stopped.

@NorthangerAbbess @JinglingSpringbells thanks both! It's too hot to think straight 😫