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[0114tw]

Hello all. I have been on HRT for about 5 years and period free for 6 months now.  Using gel daily and progesterone for about 2 weeks a month. Should I go onto continuous progesterone now? Do I need to wait another 6 months until I’m officially thought to be post-menopausal? if I do need to wait, is that okay in terms of womb lining? I had a scan a year or so ago and it was fine. Thanks in advance.

[CLKD]

Peri-menopause are the years leading up the last monthly period = menopause.  We are advised to count for at least 12 months since our last bleed, even then Nature might throw a curved ball depending on what our hormones are doing.

If your current regime works, why change it 

[sheila99]

When you're on hrt you can't usually tell if you're meno but after 5 years you'll be pretty close if not actually there. It's fine to try a conti routine now though if you're not meno you might get breakthrough bleeding. It can be useful to take utro 25/28 in late peri as it allows a bleed if there's been a build up.

[Hurdity]

When I had been on HRT for about 4 years I stopped having a withdrawal bleed as I was late-50's but as sheila says this doesn't count as being period free because you're on HRT. You will never know when you actually stop ovulating and become menopausal, not that this matters. I didn't want to go onto conti HRT because I hate the progesterone phase but if you're OK with it, then give it a try as you can always go back to cyclical if necessary. The 25/28 is a good idea - that is actually the licensed way to take it for post-meno women, according to the manufacturer (when I last looked!).

Hurdity x

[0114tw]

Thanks everyone. Yes, I get what people mean with ‘why change  the regime’ but I was thinking that I needed to have a bleed to protect lining build up but maybe not(?) Does this not matter?
So does 25/28 literally mean taking progesterone for 25 days out of 28, having 3 days off progesterone and then starting again?
Thanks for your responses everyone.

[sheila99]

Yes. Once you know you don't bleed at all you can change to every night.

[VanillaLover]

Hi, I’m interested in this……I take it you don’t get a withdrawal bleed when you stop taking the prog? Have you ever had one? Or have you been having your own periods alongside/instead of withdrawal bleed?

I don’t get a withdrawal bleed either although I still have (fairly) regular ish periods of my own still. I’m wondering what will happen when they stop!

[sheila99]

VanillaLover you might be better tweaking the hrt cycle to fit in with your own as they've got out of step. I found my own cycle was always stronger than the hrt one.

[VanillaLover]

Unfortunately my cycle goes from 16 days to 57 days at the moment and I’m not really sure when/if I ovulate any more.

I’m not sure how I would tweak it to fit…grateful for ides how to? Thanks

[0114tw]

Hi VanillaLover. Yes that’s right, I no longer have a withdrawal bleed. I used to but not for 6 months. I’ve been unsure ‘what’s next’ or what to do for the best in terms of HRT. I am not thinking of stopping it but want to ensure I’m using it as safely or optimally as possible. My cycle was a bit all over the place a year or so ago. Period really close together and then further apart. I feel more on an even keel now, emotionally.

[VanillaLover]

Thanks op. Great that you are feeling stable now. Gives me hope!

If I were you I would ask GP or menopause specialist as it’s been six months since a bleed. I guess it’s just that your uterine lining is not building up enough any more to give a bleed, but they *may* want to check the thickness directly via a scan.

Worth asking for advice anyway maybe just to be sure you are on the right track!

[0114tw]

Good advice. Will do. I sort of avoid the GP as they’re always so busy. Feel like I don’t want to bother them. ‘Hangover’ from covid, I guess. Anyway, thanks.

[VanillaLover]

When I stop the progesterone I don’t have a bleed, no. I asked my NHS consultant about it and he said that as long as you are bleeding sometimes (I have “independent” periods still) then it’s OK. The question is what to do when those natural periods stop I guess? For me. OP is in a slightly different position that her withdrawal bleeds have now stopped. I guess as the uterine lining is no longer getting thick enough.

[0114tw]

Yes that’s right. I no longer have a bleed at all. I do two weeks on and two weeks off progesterone with daily gel and no bleed for 6 months, hence the query. I’ll speak to my GP I guess.

[VanillaLover]

Well it’s a good point.

 I *guess* they say to change to a continuous regime after menopause as women don’t want to have any more regular bleeding. Which is fair enough.

But as OP is not bleeding any more anyway, as you say,  what’s the difference?


I’m not sure if there is a *actual* medical reason ie progesterone opposition/uterine lining reason why continuous lower dose of utrogestan is better than cyclical after the menopause or whether it’s just for convenience… maybe someone knows?