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[Salty]

When I first started experiencing menopausal symptoms 18 months ago, I had a  Mirena coil fitted, and was prescribed topical oestrogen (Sandrena), by my GP in the UK.

Unfortunately, I developed multiple, large, painful ovarian cysts and was advised by a gynaecologist (not in the UK) to have the coil removed and instead try oral progesterone.
She prescribed  Estima Ge 100mg orally, once daily, continuously and I continue with the Sandrena.

I recently read (CKS guidelines, UK) that peri-menopausal women should have cyclical and not continuous HRT.
Can anyone explain the rationale for this? I am still having periods so presumably should not be taking the progesterone continuously.

I am currently away from the UK, travelling long-term, and access to healthcare is problematic.

Any insights would be much appreciated.

[AM16]

Hi there, I’m 49 and have been on Everol Sequi for three months but the 14 days of combined patches with progesterone make me feel unwell so my GP has just switched me to 50mg eostrogen patches and Utrogestan tablets 100mg - but even though I was having irregular periods before I started she wants me to take them 25 days out of 28.

 I questioned her on this as I had read if you are having periods you shouldn’t take a continuous regime, but she assured me the only reason it isn’t always advised is that it can mean irregular spotting due to the continuous progesterone which some people don’t like. She said the plus side is many people adjust better as it’s a continuous dose and it helps with sleep and mood. So I’m going to give the continuous regime a go for a few months and see how it works out. The estrogen patches have stopped my night sweats and lifted my mood no end and I really hope it works out as I don’t want to give them up! Good luck with it all.

[TheBucketWoman]

I'm 46, have fairly regular periods, and take micronized oral progesterone continuously, rather than cyclically. The reason being that my migraines were getting worse on hormone therapy, and taking progesterone continously has evened out my hormone levels so I don't get the sudden drop in progesterone I was getting when I just took it for 14 days. My gynecologist says there's no harm in it, it's just not what most people do. She has ruled out any causes for concern with irregular bleeding, so if I do get a bit of spotting, I'm not too worried (luckily I haven't yet) I much prefer this regimen.

[joziel]

I’m 44yo and peri and I’m on continuous progesterone due to a history of mild endo. Continuous progesterone is recommended for women with endo even during peri.

I’m not getting any breakthrough bleeding yet but I was on desogestrel POP for 9 years before and am still on it now along with the utrogestan 100mg.

If I do get breakthrough bleeding I was going to try the 25/28 regime to try to schedule the bleed or perhaps do that every 3 months. It might not matter if it is predictable bleeding pattern. I’m not sure what a doctor would be worried about.

[Bungo]

I’m 44yo and peri and I’m on continuous progesterone due to a history of mild endo. Continuous progesterone is recommended for women with endo even during peri.

I’m not getting any breakthrough bleeding yet but I was on desogestrel POP for 9 years before and am still on it now along with the utrogestan 100mg.

If I do get breakthrough bleeding I was going to try the 25/28 regime to try to schedule the bleed or perhaps do that every 3 months. It might not matter if it is predictable bleeding pattern. I’m not sure what a doctor would be worried about.

I'm late perimenopausal. Was also on pop pill and stopped when started continuous hrt 2 months ago. Also no bleeding bar some light spotting occasionally. I'm taking the utrogestan every night with no break. What does 25/28 mean? Are you currently taking every night or just 28 days in the month? My GP wasn't au fait hrt so I told her what I wanted and so far so good. But wondering if meant to only be taking 28 nights in the month. Sorry, highjacking the thread!

[joziel]

25/28 just refers to the old style 'continuous' HRT where you take progesterone 25 days and stop for just 3. It's pointless if you really want continuous and are postmenopausal because it can cause a bleed. But if you are getting breakthrough bleeding on continuous because you are peri, you can schedule the bleed so at least you don't need to worry about it. (Or doctors don't.)

But I'm currently taking it every night as I haven't needed to do that yet. You are likely right to be taking it every night, that is standard.

I tried stopping the POP desogestrel when I started HRT, but after about 5 weeks I got a flare up of my endo symptoms again. I kept going for a few more weeks to see if it would settle but it didn't, so I had to restart the POP.

I am now supposed to be trialling 200mg of utrogestan every night and stopping the desogestrel again, to see if that will be enough to keep the endo away. If not, I'll have to stay on the desogestrel until menopause proper.