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[Kai_63]

I've tried both cyclical and continuous Utrogestan. I'm 47 (peri for 3 years) and also use Oestrogel 2.5 pumps.

Cyclical Utrogestan gives me bad side effects during the days I'm taking it (migraines, teariness etc). I get a very regular period like bleed though.

Continuous (25 days a month) was excellent and I had next to know side effects but unpredictable spotting.

The gynae has done a scan and says that as I'm so regular on cyclical I should stay on it.

But I've already been on it gor two years (aside from my continuous test). I thought you should move to continuous after a year due to higher cancer risks.

The gynae said that the studies showing higher risks for cyclical were based on 60 year old women, not my age and I've not been on it for a long time.

Should I worry/get another opinion?

[joziel]

There is no higher risk of cyclical progesterone until 5 years after taking it.

Even then it is a tiny increased risk and if it still suits someone to remain on cyclical because they are not yet post, that would make sense.

[sheila99]

IMO the nhs are far too quick to tell you to go on conti when your body isn't ready for it. The nhs meno clinic has agreed to me staying on conti at 63 because I have side effects from utro. They said there's an increased risk but it's small and for me it's worth it not to feel lousy all the time. If it was me I'd stay on whatever you feel best on. The 25/28 routine is the old way of conti and can be good in late peri as it allows a bleed if there's been a build up. If you're peri and go on a conti regime it's very likely you'll bleed anyway.

[bombsh3ll]

The risk of endometrial hyperplasia is SLIGHTLY higher with long term cyclical use.

Some women at older ages choose to accept this small risk as they feel better on cyclical.

However this doesn't appear to be your situation.

There's no medical reason why you can't take continuous, you may have to put up with some spotting but this isn't harmful in any way and personally I'd rather feel well and wear a panty liner.

Guidelines eg cyclical until postmenopausal, continuous thereafter are based on the assumption that bleed pattern is the only or most important variable rather than patient centred outcomes such as quality of life, and should not supercede individualised care.

The gynaecologist should have asked what your priorities were rather than paternalistically choosing for you.

[Kai_63]

Thank you, all very helpful!

@bombsh3ll - can you tell it was a male gynaecologist? 

Ordinarily I'd accept the spotting but I'm in a reasonably new relationship and intercourse is hit and miss as it is with my vaginal atrophy.

For now will stay cyclical and try conti again in a year or so.

[bombsh3ll]

intercourse is hit and miss as it is with my vaginal atrophy.

It doesn't need to be. You can use vaginal estrogen in addition to systemic if needed.

Alternatively increasing the systemic estrogen could address both the spotting and the VA.

[Kai_63]

Thank you.

I'm already on 4 days a week Vagifem plus daily vaginal moisturiser and still have issues unfortunately. That said maybe I could play around with doses a bit more on that front.

If the VA was under control I would definitely go back to continuous utro.