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[Harebell]

Hi ladies

I’m 59 yrs old and using evorel 50 patches with Utrogestan 200mg every 6 weeks ie on a longer cycle with a bleed.

I’ve just been told by my doctor that I should be bleed free at my age and should start to take the utrogestan continuously.

However, I’m not very good with continuous progesterone as I’ve tried conti patches previously.

Any advice would be welcome. Is there an age limit?

Harebell xx

[C.Y.]

Hello Harebell,

I cannot speak from exact experience as I am a bit younger and have not been on cyclical hrt for very long, although it's definitely my no.1 choice for the long run!

You can perhaps find some very useful info & explanations from Dr. Felice Gersh. She's an experienced women's health & menopause expert and has many videos on Youtube (and she's thriving in her 70s!)

All the best!

[Harebell]

Thank you very much CY I’ll look her up 👍

[Hurdity]

Hi Harebell

Thanks for your pm. Here are my brief thoughts:

I'm over 70 and still on cyclical HRT. I have a proper review coming up next week as my HRT has not been reviewed for some years. Speaking to my GP on the phone she suggested I should be on continuous - because of my age, but I was adamant I would not.

There is no age limit for cyclical HRT but medics tend to prefer women to be on continuous combined HRT because of the known increased risk of endometrial cancer from cyclical HRT - the endometrium is better protected on continuous regimes.  However the absolute risk is still very small and provided one is sensible and is monitored, and there are no abnormalities or untoward bleeding, no reason to go on continuous HRT.

The joint BMS and Women's Health Concern 2020 recommendations don't even mention it - this is what they say generally about HRT:

"There should be a holistic and individualised approach in assessing menopausal women, with particular reference to lifestyle advice, diet modification as well as discussion of the role of HRT.

The decision whether to take HRT, the dose of HRT used and the duration of its use should be made on an individualised basis after discussing the benefits and risks with each patient. This should be considered in the context of the overall benefits obtained from using HRT including symptom control and improving quality of life as well as considering the bone and cardiovascular benefits associated with HRT use.

The HRT dosage, regimen and duration should be individualised, with annual evaluation of advantages and disadvantages."

https://thebms.org.uk/publications/consensus-statements/bms-whcs-2020-recommendations-on-hormone-replacement-therapy-in-menopausal-women/

In my case I seem to be getting spotting and bleeding at the wrong time, and last time 2.5 years ago my endometrium was thickened though no abnormalities found. I wonder if there may be an absorption problem but I will make a separate post about my situation in due course. I use utrogestan vaginally and GP suggested I try taking it orally which I also refuse to do! When I started Utrogestan I used to do a two monthly cycle but it has got shorter and shorter recently though I really don't like it!

If it's working for you, without problems then you should be able to carry on as you are, but just bear in mind that the situation may change in terms of how your body responds, as you get older, and maybe more so if using vaginally - though if your digestive system changes as you age then also potentially oral absorption may change too? As always there is insufficient research on this!

This answer may not be what you're looking for but hopefully is helpful?

Hurdity x

[Seasidegirl]

This is really interesting,  thanks for the wise words ladies. 

Is the idea that ideally progesterone avoids the build up of the womb lining?  Shedding the lining is then almost an additional "feature" but if the balance of oestrogen to progesterone is good then there is potentially no need for a bleed?

Accepting that the challenge is how go you know if the balance is right and that there isn't too much thickening.

I'm still trying to get to grips with all of this!

[Hurdity]

Hi Seasidegirl

No progesterone does not of itself avoid the build up of womb lining.

In anormal menstrual cycle oestrogen causes the womb lining to grow ready for fertilisation. When ovulation occurs the egg is released and the empty egg sac - called the corpus luteum - produces progesterone for the next 2 weeks or so. The progesterone changes the structure of the womb lining to enable implantation to occur. If there is no fertilised egg, the corpus luteum "dies" and stops producing progesterone. As the progesterone level falls, this signals no fertilisation has taken place and triggers various hormonal changes so the womb lining is shed and the whole thing starts again. Much more complex than that with various other hormones involved but in a nutshell that's it.

Cyclical HRT aims to mimic this by giving oestrogen, then then oestrogen with progesterone and then stopping the progesterone.

In the majority of women there has to be a withdrawal bleed on cyclical HRT to shed the lining. However if the oestrogen dose is very low and the progestogen high, then the two weeks (for example) on oestrogen only may not allow the womb lining to build up sufficiently to casuse a bleed. There is a proportion of women who don't have a bleed on cyclical HRT even at licensed doses, after post-menopause.

In continuous combined HRT, yes, the idea of the progestogen is to eventually prevent the womb lining building up - I did read about this a while back but can't recall the detail. Essentially interferes with the endometrium receptors so the endometrium does not proliferate from stimulation with oestrogen. Yes the balance has to be right to prevent thickening but it's not an exact science as our bodies vary in how much we absorb of the two different hormones and how our bodies react.  Licensed doses aim to ensure the balance is right for the majority of women.

Hope this helps

Hurdity x

[bombsh3ll]

There should be no arbitrary age limits on any type of treatment, guidelines clearly advocate for individualised care.

However in clinical practice at least in the UK, it is common for continuous to be recommended postmenopause as evidence shows a SMALL increased risk in endometrial hyperplasia if cyclical is taken more than 5 years.

If it were me, I would simply carry on with the treatment that you are happy with, but if doing so without your prescriber's knowledge or support, I would get a private scan once a year to ensure your lining remains thin.

[Seasidegirl]

Hi Seasidegirl

No progesterone does not of itself avoid the build up of womb lining.

In anormal menstrual cycle oestrogen causes the womb lining to grow ready for fertilisation. When ovulation occurs the egg is released and the empty egg sac - called the corpus luteum - produces progesterone for the next 2 weeks or so. The progesterone changes the structure of the womb lining to enable implantation to occur. If there is no fertilised egg, the corpus luteum "dies" and stops producing progesterone. As the progesterone level falls, this signals no fertilisation has taken place and triggers various hormonal changes so the womb lining is shed and the whole thing starts again. Much more complex than that with various other hormones involved but in a nutshell that's it.

Cyclical HRT aims to mimic this by giving oestrogen, then then oestrogen with progesterone and then stopping the progesterone.

In the majority of women there has to be a withdrawal bleed on cyclical HRT to shed the lining. However if the oestrogen dose is very low and the progestogen high, then the two weeks (for example) on oestrogen only may not allow the womb lining to build up sufficiently to casuse a bleed. There is a proportion of women who don't have a bleed on cyclical HRT even at licensed doses, after post-menopause.

In continuous combined HRT, yes, the idea of the progestogen is to eventually prevent the womb lining building up - I did read about this a while back but can't recall the detail. Essentially interferes with the endometrium receptors so the endometrium does not proliferate from stimulation with oestrogen. Yes the balance has to be right to prevent thickening but it's not an exact science as our bodies vary in how much we absorb of the two different hormones and how our bodies react.  Licensed doses aim to ensure the balance is right for the majority of women.

Hope this helps

Hurdity x

Thanks Hurdity that's really helpful.   It really is a whole new subject to get to grips with! 

[Jillyboo]

If you're getting spotting out of sequence (and can bear the thought!) you might like to try completely stopping your oestrogen for a week. I've read this can create a 'reset' and it definitely worked for me. I wish I'd saved links to all the research I've turned up over the years! I would of course add you should always get any unscheduled spotting or bleeding checked out. Better to be safe than sorry.

Remaining on a cycle is one of those 'at your own risk' issues. My view is that if all appears well (ie bleed occurring when it should) and the idea of daily progesterone is simply not up for discussion, we don't really have much choice if we need to remain on HRT.

[Harebell]

Thank you so much Hurdity for your reply. And everyone else who has added their comments.

It’s a big help as the whole menopause journey has been so hard to navigate.

I think my first step will be to book a scan. And take it from there.

I did actually order my recent hrt prescription from an online chemist as I didn’t want to speak to the doctor and have her recommending change to Conti. As she had mentioned this last year and I still hadn’t got my head round it and was reluctant to change. Tricky one xx

[Seasidegirl]

Thank you so much Hurdity for your reply. And everyone else who has added their comments.

It’s a big help as the whole menopause journey has been so hard to navigate.

I think my first step will be to book a scan. And take it from there.

I did actually order my recent hrt prescription from an online chemist as I didn’t want to speak to the doctor and have her recommending change to Conti. As she had mentioned this last year and I still hadn’t got my head round it and was reluctant to change. Tricky one xx

It's really complicated isn't it? I'm only in month 3 of HRT and trying to get to grips with progesterone.    I seem to struggle on 200 mcg but I think I feel better on 100mcg than without it.     Aged 54 and peri. 

Pre HRT I had joint pain in my hips in the second two weeks of my cycle and my anxiety was worse,   this went initially on oestrogen only but is starting to creep back, I started 100mcg again yesterday (I know it should be 200mcg) and my hips improved immediately.   

It really is trial and error!