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[gillybilly]

Can anyone explain how extra progesterone makes the endometrium thinner, if it's already thick

I always though that a bleed would shed the womb lining, but taking extra progesterone stops bleeding,

I've googled and can't find the answer. This would be on continuous hrt

[Popmummy]

Good question. I’ve also wondered this. I can’t understand how progesterone works - oestogen can make womb thick so we take progesterone to keep it thin, yet P is used to prevent bleeding. 🤔

[bombsh3ll]

It depends on the duration of use.

Estrogen creates a proliferative endometrium ie thickening.

Progesterone then comes in the second half of the natural cycle and transforms the endometrium into what's called the secretory phase- designed to help an embryo implant.

Then if there is no embryo, both estrogen and progesterone fall and the lining sheds.

If the progesterone is taken all the time as with continuous HRT, this is different from the natural cycle and over time the endometrium becomes thin and atrophic.

It is perfectly possible, in fact common for someone to have a thick lining on a scan then go onto a continuous progestogen and have a thin lining on a follow up scan in 3 months or so without any bleeding at all!

If you take the progestogen cyclically you will mimic the natural cycle with repeated thickening then shedding, so it still doesn't become excessively thick, but you only get the very suppressed and atrophic lining with chronic use.

[Popmummy]

Thanks for that explanation bomb! You’d think at 55 I’d have a bit more understanding about the female body!
 
I recently had a scan (last week) and a pipelle biopsy as the consultant said my womb lining was a bit thick. As I hadn’t taken my Utrogestan for 8 I began a cycle of 200mg and at the end had the tiniest tiniest bleed. I would have thought that with a thickened lining I’d have at least bled more.
I’m waiting for my biopsy results and if all ok may go for mirena.