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[FionaR]

I know that progesterone is a vital part of the menstrual cycle and for the maintenance of pregnancy. I know I must take progesterone while I take oestrogen as part of HRT. I had thought that progesterone was to aid in the exiting of the thickened lining of my womb, as part of the monthly bleed. But I am now 51. Even when I take HRT i only get a period every few months. If I continue with HRT should i be taking more progesterone to increase the incident of bleeds? If I am not bleeding will I have a higher chance of uterus cancer? I am trying to work out why i need progesterone as my hormone levels naturally drop and therefore I am much less likely to bleed. What is the progesterone then doing for me? Does there come a time when i can take only oestrogen supplements? The GP has explained this a few times to me but I still feel like I am unsure of the need for progesterone. Thanks.

[Hurdity]

Yes if you have a womb you will always need a progestogen of some sort if you take HRT which contains oestrogen. Oestrogen causes the womb lining to thicken and unless you take progesterone it can continue to thicken unchecked which can lead to breakthrough bleeding and ultimately potentially endometrial cancer.

You can take the progestogen cyclically or continuously. If you take it cyclically it acts like it does during the menstrual cycle - it converts the endometrium from proliferative (growing) to secretory ( changes the structure ready for fertilised egg and pregnancy). When you stop the progesterone it signals that fertilisation has not taken place so the lining is not needed and is shed as a bleed.

When you take continuous combined HRT ie progestogens all the time, eventually, if the doses are balanced, the progesterone intereferes with the capacity of oestrogen to cause the lining to grow so it (should) stay(s) thin - or rather within normal limits.

Whether or not you bleed on HRT depends firstly where you are in menopause and also what type/dose of HRT as well as other factors eg abnormalities such as fibroids or polyps. Not everyone bleeds on cyclical HRT (15% do not according to the stats on this website). If you are not bleeding and are taking cyclically ( eg on 28 day cycle) a proprietary combi HRT product that contains a progestogen then you don't need to worry - it means your lining is not building up. Usually it is abnormal bleeding that is a signal that something is wrong with the balance and potentially may need investigation, rather than lack of bleeding.

Maybe tell us what HRT you are on and for how long you've been taking it?

Hope this helps?

Hurdity x

[Sgtvhilts]

Hurdity
That is a great response and you have yet again clarified something that has been picking my brain for a while.  I genuinly thought once i was past say 53ish i coudl give up the prog, now i know.  So in effect , if istay on the 28 cycle HRT i will potentially bleed until i am 90!.  I guess long cycle sequi is the way to go when i get above that age.  Having periods beyond say 60 just feels 'wrong'.

[FionaR]

Many thanks for an excellent and educating reply. It really helps to understand. I confess that until i reached the menopause and started to investigate what my hormones do I had no real idea. I am grateful to other people for educating me.

[Hurdity]

Hurdity
That is a great response and you have yet again clarified something that has been picking my brain for a while.  I genuinly thought once i was past say 53ish i coudl give up the prog, now i know.  So in effect , if istay on the 28 cycle HRT i will potentially bleed until i am 90!.  I guess long cycle sequi is the way to go when i get above that age.  Having periods beyond say 60 just feels 'wrong'.

You can say that again SGtvhilts! I absolutely HATE having enforced periods - but the alternatives are worse - ie continuous progesterone ( and the potentially breast cancer implications), or stopping HRT ( at the moment...) so one grits one's teeth and bears it!!! Every time the cycle comes around and I finish the utro and the bleed starts I vow I'm never going to do that again but once it's done I'm back to normal so I continue....

FionaR - we've all been there once! Steep learning curve!

Hurdity x

[Ljp]

Should we have yearly ultra sound scans when on continuous regime to keep check on lining?
I doubt nhs would fund it? And it's expensive to pay privately 🙄