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[bombsh3ll]

Yes, absolutely some are lucky and can get away with a course of progestogen every 3 months.

Unfortunately though there is no way to tell who is going to be fine on less progesterone and who is going to develop hyperplasia, and as the NHS doesn't have the resources to scan everyone, they just have to err on the side of caution and have everyone on the dose that is known to protect even the highest risk women, usually in a continuous regime once postmenopausal.

Whilst this avoids endometrial cancers, it also means many women are over treated with progesterone.

[Banjo1973]

Thank you for your reply, there's so much scare mongering that goes on, i sometimes get panicky.

I'll keep doing what I'm doing and get regular scans.

[joziel]

Banjo, it's very possible you're not absorbing that estrogen very well. I'd want to get bloods done and see what your serum levels are. You want them to be at least 300pmol+ to get the health benefits of HRT.

Personally, on 3 pumps of gel, my levels were around 180pmol. I also wasn't bleeding - because I wasn't getting enough estrogen to cause any build up.

[Banjo1973]

Last time i was tested they were over 400 and i wasnt bleeding them either. I'm pretty sensitive to the effects of low estrogen as i get hot feet snd brain fog so i adjust id accordingly.

[Banjo1973]

Hi Joziel,

Judt checked it, it was 587. Like i said, i am very sensitive to low estrogen so i kind of know when things aren't working. When my boobs feel full, my orstrogen is good, when my boobs deflate and my energy and mood is low, then i know i need more orstrogen

[joziel]

Hmm, it could still be worth doing a check. I mean, your body can put out a spurt of it even early post-meno...

On the same dose I've had between 640 and 890pmol, for eg.

[Banjo1973]

I mean it's possible, but i always can feel low estrogen vsry very quickly so i don't believe it was a rogue result. Maybe some people dont need much progesterone because their lining doesn't build up?

[LittleClaire]

When I was on Evorel Sequi with the level 50 patch, I had a bleed when I finished the progesterone part. Since increasing to Evorel 75 and 200 progesterone pill I haven’t bled since, so does that still mean I’m not getting enough oestrogen even though it’s higher than the previous dose I was on? Granted I’ve only missed one period so far but I’m definitely not pregnant, so I need to increase oestrogen again to bleed?

[joziel]

The only way you can tell for sure is to test your levels. If you do have a cycle, I usually test on day 3 for estrogen - because it's when my own is most likely to be lowest so I'll best see what I'm getting from HRT. But if you don't have a cycle then just any time...  I also test every 3-4 months at the moment and don't 'believe' any one test result (due to my own fluctuations).

It might mean for example that your are absorbing your increase in progesterone really well, which is opposing the increase in estrogen...

[Banjo1973]

I don't really have the time/energy nor funds to get tested regularly. My body really does give a good indication of my oestrogen levels. My periods were pretty much always very light, and got lighter as i hit my 40s.

Maybe sone women just dont bleed much, if at all?

[joziel]

Assuming you're getting enough estrogen, and assuming you haven't had an endometrial ablation or some other procedure to stop bleeding, you should have a bleed.

[bombsh3ll]

I would say the estrogen should be adjusted to meet your needs and therapeutic goals ie all estrogen sensitive tissues in your body are functioning optimally.

Unless you are getting any therapeutic benefit from the progesterone, I believe the lowest dose that keeps your endometrium healthy is best, and there is evidence that certain longer term outcomes eg cardiovascular, brain, breast health are more favourable when it is not taken continuously.

Any withdrawal bleeding that occurs on a cyclical regime is just cosmetic, it is not an ends in itself and treatment that is working well for you doesn't need to be altered just for the sake of chasing an artificial bleed.

[Banjo1973]

I totally agree Bombsh3ll.

I've always felt that progesterone dosing is 'one size fits all' and maybe there are a few people who react badly to it because they just don't need that amount. Maybe my body makes it's own progesterone. Maybe my lining doesn't thicken. Who knows?!

As long as i get scans to check I'm not putting myself at risk, I'm going to keep up with my regime.

Thanks again x