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[Nici_j]

I have really struggled with continuous progesterone. I am 60 now and around the age of 56 I started taking Kliovance continuous but I had bad anxiety with it. So I changed back to having a bleed with Oestrogen and 200mg Progesterone 12 days. Then a year ago my doctor advised me to use continuous progesterone as it is recommended for older women. 100mg wasn't enough to stop bleeding and so I took 200 mg per day but I had a lot of problems with breakthrough bleeding, exhaustion, irritation below, dryness and generally just didn't feel good. I realised that I used to feel great on a sequential regime and decided to go back to that on a 6 week cycle. It's been two months now and I feel completely normal again. I have also recently asked my doctor to try testosterone and this has been good. So after a year of messing around and having a lot of problems with bleeding, and other unpleasant symptoms I feel great again with really good energy levels.

My question to anyone else who may still be having a bleed after 60 - should I now have regular scans to check my womb lining? (I have had a scan last year and all OK)

[Jillyboo]

I recently started a thread about being on cyclical HRT long term you might find of interest.

I don't think there is any medical reason to have scans if you're having regular withdrawal bleeds but you may wish to do so for your own interest.

I have been on sequential for over 15 years now. I did try conti but it never worked for me (lots of spotting and feeling exhausted all the time). I think we do well to listen to our bodies don't you?

[bombsh3ll]

There's no guidance on endometrial monitoring for long term cyclical use as most professional bodies advise/assume that postmenopausal women take continuous.

It really depends on your own preference and that of your prescriber.

If the estrogen dose is very low for example, it may be reasonable not to monitor.

However I think it is a good idea to get a scan every year or at least every 2 if deviating from the usual progestogen recommendations - particularly as you mentioned doing a 6 week cycle.

The specialists who offer more individualised care such as the late prof Studd all typically monitor endometrial thickness, as they have a duty of care as a prescriber to ensure safety is being maintained as there is a SMALL increased risk of endometrial cancer.

Your doctor would therefore be reasonable if they ask you to get a scan in order to continue your regimen.

[Hurdity]

Hi Nici-j

I am one of those older women on cyclical regime - I'm 71 and I've been on cyclical HRT more or less all the time since 2007. Firstly standard 28 day cycle and then after a blip extended the cycle to two-monthly with agreement from my gynae GP locally. Now down to 5-6 weeks due to odd episodes if unscheduled bleeding.

It is doubtful  that your GP will recommend monitoring scans in the absence of any symptoms to indicate a potential problem. The pathway for this is quite strict. The times I have had scans and hysteroscopies have been when I've had spotting at the wrong time, and the scan has revealed a thikcened endometrium but no issues other than that.. A couple of times I have had a private scan but those for whom this is an unaffordable option it is  fine to continue without them, say, if on a 6 week cycle but report to the doctor ANY issues of unscheduled spotting or bleeding.

Having said this the recent BMS detailed paper and guidelines about endometrial thickness and HRT, does I think recognise that older women may still be in cyclical HRT and do have a pathway for such cases (of unscheduled bleeding) . Whether GPs will follow it or not is another matter but it;s as well to have a look.
https://thebms.org.uk/wp-content/uploads/2024/07/01-BMS-GUIDELINE-Management-of-unscheduled-bleeding-HRT-JULY2024-A.pdf

Have just checked and there are major and minor risk factors (for endometrial cancer) identified that need to point to investigation being needed, in cases of unscheduled bleeding . Major risk factors include being on 3 monthly prog cycle for more than 12 months, or cyclical HRT for more than 5 years if over 45.  You would need to read the key messages.

You haven't said what your oestrogen dose or delivery method is? Also be guided by your withdrawal bleeds. If you are taking the licensed dose of progesterone and not getting much of a bleed the likelihood is that you are mot building up much endometrium (this is my case - on a medium dose of oestrogen), provided you're absorbing the progesterone adequately.

Hurdity x