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[hoping4best]

Ok, I have a potentially stupid question, but my current reproductive endocrinologist is not the most helpful. So I'll ask.

At age 41, my RE wants me to have a blood estradiol level of around 100. I just got my blood level back from last week. On my current regimen of 0.075mg patch + 200mg/day oral progesterone (prometrium/utrogestan) continuous, my estradiol is at 50. And I am bleeding intermittently, with cramps. Like, I bleed for 3-5 days, every other week. It sucks!

If I raise my patch *and* lower my progesterone dose, that should make more estrogen available, right? Like, the high continuous progesterone is part of what is keeping my estradiol level that low probably, right?

I'm so frustrated with my doctors right now. My RE *prescribed* continuous 200mg/day oral progesterone, and then last week was like "wow you're on a lot of progesterone!"

GAH.

[Annie0710]

Hoping4best

If I were you I would start a new thread in the menopause section where a lot more women will see and be able to give you answers

I have no experience of progesterone and can't say what's best to do

Start your new thread and wait for the knowledgeable ladies to answer

X

[Lizab]

Hello Hoping best! I'm also POF diagnosed at 38 and in the US. I'm not positive, but thinking that yes, that's a lot of progesterone. I think the continuous dose is normally 100 mg. So it could be that between that  between the low estrogen and high progesterone, your having some endometrial atrophy causing the breakthrough bleeds. Did they take a look on ultrasound and measure your endometrium? I don't think the progesterone actually cancels out as in lowers the levels of estrogen. I believe it can cancel out some of the positive effects that we feel, but not blood levels. I may be wrong on that. Either way, your solution of raising estrogen and lowering progesterone sounds like a reasonable plan.
As an aside, I have read that we POF ladies are more prone to breakthrough bleeds on continuous doses. Nothing is simple for us. I was also given continuous initially even though I hadn't even been a year without periods. Based on the information on this site, I declined and requested cyclical to start. I have trouble finding any US sourced info directed at early menopause except for women trying to conceive. I can't even get in to see an RE because I'm done having kids. It's a shame.

[hoping4best]

Hello Hoping best! I'm also POF diagnosed at 38 and in the US. I'm not positive, but thinking that yes, that's a lot of progesterone. I think the continuous dose is normally 100 mg. So it could be that between that  between the low estrogen and high progesterone, your having some endometrial atrophy causing the breakthrough bleeds. Did they take a look on ultrasound and measure your endometrium? I don't think the progesterone actually cancels out as in lowers the levels of estrogen. I believe it can cancel out some of the positive effects that we feel, but not blood levels. I may be wrong on that. Either way, your solution of raising estrogen and lowering progesterone sounds like a reasonable plan.
As an aside, I have read that we POF ladies are more prone to breakthrough bleeds on continuous doses. Nothing is simple for us. I was also given continuous initially even though I hadn't even been a year without periods. Based on the information on this site, I declined and requested cyclical to start. I have trouble finding any US sourced info directed at early menopause except for women trying to conceive. I can't even get in to see an RE because I'm done having kids. It's a shame.

Lizab, wow. Yes! I have a kid, am done. All POF support here is around fertility. It's really frustrating.

My lining, about a year ago maybe, was very thin. And I was bleeding then, too. I'm traveling pretty far Thursday to try a new RE. At least his website says he treats women with early menopause. I will ask him about cyclical HRT. My current RE was all "cyclical HRT is for women who are trying to conceive". Sigh.

Can I ask what kind of progesterone you're on? I was told 200mg prometrium/utrogestan for 10 days per month is what they give for cyclical "bioidentical" HRT, and oral (when I brought up vaginal progesterone she looked at me like I was nuts).

I'm sorry you're dealing with POF, too. It's quite frustrating!

[Lizab]

I'm on 10 days/month 200 mg prometrium orally and .50 Vivelle dot patch. I'm still trying to get settled on it. I started with a lower dose patch end of last year and increased to my current in the spring. Bleeding has not been a problem for me in the last two years. That settled before I started hrt. I'm mostly battling fluctuations in anxiety and energy levels now.

[hoping4best]

I'm on 10 days/month 200 mg prometrium orally and .50 Vivelle dot patch. I'm still trying to get settled on it. I started with a lower dose patch end of last year and increased to my current in the spring. Bleeding has not been a problem for me in the last two years. That settled before I started hrt. I'm mostly battling fluctuations in anxiety and energy levels now.

I was diagnosed with POF when I was 38, 3 years ago. My HRT bleeding had stopped initially. But I still have one ovary and they think it's been stimulated to sometimes ovulate. Along with the breakthrough bleeding I get, too. Whatever it is. Right now, I get a week of cramps and bleeding, a week or two off, then cramps and bleeding again.

I started out on a 0.0375 patch 3 years ago and slowly got to 0.1mg. I really hear you on the anxiety in particular. Progesterone seems to help me with that, so we will see how I do with it lower, and possibly cyclical. But I know everyone is different!

[Hurdity]

Ok, I have a potentially stupid question, but my current reproductive endocrinologist is not the most helpful. So I'll ask.

At age 41, my RE wants me to have a blood estradiol level of around 100. I just got my blood level back from last week. On my current regimen of 0.075mg patch + 200mg/day oral progesterone (prometrium/utrogestan) continuous, my estradiol is at 50. And I am bleeding intermittently, with cramps. Like, I bleed for 3-5 days, every other week. It sucks!

If I raise my patch *and* lower my progesterone dose, that should make more estrogen available, right? Like, the high continuous progesterone is part of what is keeping my estradiol level that low probably, right?

I'm so frustrated with my doctors right now. My RE *prescribed* continuous 200mg/day oral progesterone, and then last week was like "wow you're on a lot of progesterone!"

GAH.

Hi there - I presume you are in US or Aus and your oestrogen levels are being measured in pg/ml not pmol/l as they are here? if so yes 100 would be a good level although many women are lower than this and happy  - like me (don't know what mine are but not that...).

As Lizab says - high prog does not lower oestrogen levels - as when we are pregnant both are extremely high as they should be! However yes 200 mg daily is a high dose, although some women find that 100 mg daily oral dose is not even sufficient for low dose oestrogen. This is because the amount that is absorbed when taken orally is very variable - lost to digestion and metabolism through the liver. Because there are no half size capsules the only way to increase the prog (to protect the lining) is to go from 100 mg to 200 mg - so I presume this is why you have been given that  dose?

You may find if you reduce to 100 mg you get breakthrough bleeding or spotting.

The only way to know is to get your womb lining measured through US or TVS (scans). Oh I see you had a thin lining but depends on what you'd been taking and what they mean by thin - is is usually measured in mm. I would be surprised if it was ulcerated with a 75 mcg patch but who knows - if a lot of prog gets through into your system it could be a possibility.  Anyway as I said only a scan will tell you....

Ah if your ovary is working then this could explain all the odd bleeding....

Sorry I kept seeing different bits of your posts so a bit confused !!!

Hurdity x