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[Anglichanka]

hello all

I've been mostly stable for a couple of years, on 200mcg estradot, 200mg utrogestan 12-14 days a month, testogel and 50mg of sertraline. I don't like some of the sertraline effects -- emotional blunting, no sex drive, awful dreams -- but they are prices I will pay for not waking up in total dread every morning.

5 weeks ago I was told I had to switch to continuous progesterone as I've been on HRT for 6 years. No problem, I said. I'm sick of having "periods" at the age of 53 anyway, and although I have always reacted badly each time I've started taking the progesterone (deep depression), it only lasts a couple of days and then I would adjust. My logic was that continuous would presumably only involve that initial shock to the body, but then I would settle and and I'd be OK on it.

Ha ha HA.

I'm currently bleeding for the third time in 5 weeks. That is, several day-long episodes of bleeding. My right ovary throbs now and then (forgot to mention, I have grade 4 endometriosis). My mood is low and awful. Every day I wake up bleak and every day is a fight to get through. As for being productive, forget it. I don't know if my mood is because I'm so sick of having to constantly experiment with HRT, and here I go again, and I feel completely powerless. Or whether it's the progesterone. Or whether it's both. All I know is I'm really struggling, yet again.

I saw my GP yesterday who was lovely, but had no clue why I am bleeding so much. I went on the menopause support forum on FB, and was told firmly that I am on double the licenced dose of estrogen and also almost certainly not on enough progesterone. I mentioned this to my GP and she was fine with the estrogen dose btw.

So if you don't mind, can you let me know how your transitions to conti went/are going? Will it settle down? Will I ever stop bleeding?

And for the science minded, can anyone explain this: my scheduled bleeds with sequi were caused by me stopping progesterone, right? I stopped after 12 days or so, 2 days later got a bleed. So why am I bleeding when the progesterone is continuous? What is the physiological process?

[Dotty]

Latest advice from BMS is that unlicensed doses of oestrogen are likely to need more than the advised dosage of progesterone.

However, a Conti regime can take 6 months to settle. If you were happy on a Sequi regime then there is no reason to change.

[sheila99]

As above. Have you oestrogen levels been tested? If you're on a high dose because you don't absorb well and have 'normal' levels in your blood the utro should be suffient but probably not if you are absorbing normally. I'm still on long cycle sequi at 62 because utro gives me fatigue and I'd rather have a bleed than be permanently doped. I think there is a slightly higher risk this may but if it suits you it's your choice to stay on it. At 53 you may not be meno, some aren't until their early 60s.
Have you tried reducing sertraline? Anxiety can be a meno symptom so perhaps it's possible the hrt can control it (though some people do need both).

[Anglichanka]

I'm definitely meno, did you mean post-meno? I know I'm menopausal because I went on HRT because of hot flushes, night sweats, the full shebang, six years ago. Really hope that was a typo because why would I be on HRT for six years if I weren't menopausal?

I don't want bleeds any more, but I do want stability.

I reduced sertraline down from 100 to 50. I went on it because even on 200mcg oestrogen I was getting depression and other mental health issues. Sertraline has definitely helped me be more stable so for now I'm staying on it, even though I don't like it.

I had my oestrogen levels tested a few years ago at Newson Clinic. They showed that I absorb very poorly. Hence the high dose.

[Anglichanka]

Latest advice from BMS is that unlicensed doses of oestrogen are likely to need more than the advised dosage of progesterone.

However, a Conti regime can take 6 months to settle. If you were happy on a Sequi regime then there is no reason to change.

thanks and yes, I'm aware of the BMS guidance. by the way the ONLY place where any numerical figure is given to a "licenced dose" of oestrogen is on the BNF (British National Formulary). It's not in BMS, not in NICE. All their docs advise on adjusting the dose to suit the situation. FYI.

I was told very firmly that it would be better for me to change. I took them at their word. And anyway I was happy not to have bleeds any more otherwise I would have fought it. [laughs bitterly]

[sheila99]

Not a typo. Perimenopause is when you have symptoms but still have (often variable) periods, menopause is defined as one year without a bleed when not on any hormonal medication. Most people go on hrt because of symptoms in peri menopause. If you're peri and use a conti regime you may well get some bleeding. They told me to use a conti regime too but now accept why I made the decision to stay on sequi.

[Dotty]

Hi a licensed dose of oestrogen is 2mg oral tablet; up to 100mg patch; 3 sprays of Lenzetto; 4 pumps of oestrogel: Sandrena 1.5mg...anything else is not licensed.

[Anglichanka]

Not a typo. Perimenopause is when you have symptoms but still have (often variable) periods, menopause is defined as one year without a bleed when not on any hormonal medication. Most people go on hrt because of symptoms in peri menopause. If you're peri and use a conti regime you may well get some bleeding. They told me to use a conti regime too but now accept why I made the decision to stay on sequi.

Ah. Doh. Thanks. What I don't understand though is how they can calculate when my last period was as I've been on HRT for six years now and was still having irregular periods when I went on it.

[Anglichanka]

Hi a licensed dose of oestrogen is 2mg oral tablet; up to 100mg patch; 3 sprays of Lenzetto; 4 pumps of oestrogel: Sandrena 1.5mg...anything else is not licensed.

Thanks Dotty but can I ask where you are getting these figures from? The British National Formulary?

[Dotty]

Hi If you look on the Menopause Matters website under treatments , you will see all the doses of licensed HRT.

[Dotty]

Hi just found this document

https://menopausesupport.co.uk/wp-content/uploads/2022/02/Licenced-HRT-preparations-1.pdf

[Anglichanka]

thanks Dotty

[Anglichanka]

UPDATE
Five bleeds in six weeks so far. Or is it six? I've lost track. I tried decreasing my oestrogen to 150 but felt immediately awful, so went back to 200. I know that's unlicenced, but I've been on that dose for years, and I know I don't absorb oestrogen very well so I'm sticking with it. Instead I've doubled the progesterone to 200mg daily. So far, I'm still bleeding but less heavily, but the cramps and ovary throbbing have reduced. My sleep is still broken: since I switched to conti, I find it really hard to fall asleep, something I haven't experienced since very early peri days, six years ago. So I generally take half a melatonin, but the next day I am completely zonked. I'd go so far as to say I feel sedated.

Meanwhile I'm still waiting for a reply from my GP re her email to the menopause clinic. I've been trying to get through to my surgery to tell her I've changed my dose but I can't get through.

I remember when I switched to conti I looked at the sanitary pads in my drawer (the cloth kind) and thought, I won't need those again. HA HA HA HA HA HA.

hello all

I've been mostly stable for a couple of years, on 200mcg estradot, 200mg utrogestan 12-14 days a month, testogel and 50mg of sertraline. I don't like some of the sertraline effects -- emotional blunting, no sex drive, awful dreams -- but they are prices I will pay for not waking up in total dread every morning.

5 weeks ago I was told I had to switch to continuous progesterone as I've been on HRT for 6 years. No problem, I said. I'm sick of having "periods" at the age of 53 anyway, and although I have always reacted badly each time I've started taking the progesterone (deep depression), it only lasts a couple of days and then I would adjust. My logic was that continuous would presumably only involve that initial shock to the body, but then I would settle and and I'd be OK on it.

Ha ha HA.

I'm currently bleeding for the third time in 5 weeks. That is, several day-long episodes of bleeding. My right ovary throbs now and then (forgot to mention, I have grade 4 endometriosis). My mood is low and awful. Every day I wake up bleak and every day is a fight to get through. As for being productive, forget it. I don't know if my mood is because I'm so sick of having to constantly experiment with HRT, and here I go again, and I feel completely powerless. Or whether it's the progesterone. Or whether it's both. All I know is I'm really struggling, yet again.

I saw my GP yesterday who was lovely, but had no clue why I am bleeding so much. I went on the menopause support forum on FB, and was told firmly that I am on double the licenced dose of estrogen and also almost certainly not on enough progesterone. I mentioned this to my GP and she was fine with the estrogen dose btw.

So if you don't mind, can you let me know how your transitions to conti went/are going? Will it settle down? Will I ever stop bleeding?

And for the science minded, can anyone explain this: my scheduled bleeds with sequi were caused by me stopping progesterone, right? I stopped after 12 days or so, 2 days later got a bleed. So why am I bleeding when the progesterone is continuous? What is the physiological process?

[Dotty]

Hi Anglichanka…if you need 200 of oestrogen, then that’s what your body needs. Everyone is different.

If I was you, I’d consider going back to a Sequi regime. You may not be ready for a continuous regime. xx

[Anglichanka]

thanks Dotty. I'll wait to see what the menopause clinic has to say then reconsider.