Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[AnderH]

Hi everyone,

I started having bad perimenopause symptoms 8 months ago, mainly anxiety and insomnia. I was put on 40mg of citalopram which helped a bit but started HRT 5 months ago, perimenopausal, age 44 200mg of Utrogestan for 14 days and two pumps oestrogel. Felt better for a few weeks then massive crash and HRT increased to 3 pumps and 300mg Utrogestan. Since then had ups and downs and unscheduled/erratic bleeding, but feeling much better on the Utrogestan phase and struggling coming off and on the Utrogestan every two weeks, getting withdrawal for about 5 days, migraines, insomnia and anxiety, all of which is much worse during the non Utrogestan phase. My GP suggested I try Slynd with the three pumps of oestrogel, day 5 of this and not sleeping, anxiety high, etc.

I was told I can’t take Utrogestan daily on a continuous regime as still getting my own periods. My question is, is this right?  Can I not take 300mg of Utrogestan and three pumps oestrogel continuously?, can I take Slynd with lower level Utrogestan to help prevent periods and help with the anxiety and insomnia?.


Sorry for long post I’m just confused about what I can do!. All advice welcome!

[bombsh3ll]

Absolutely you can take micronised progesterone continuously if you want.

The only reason, and it tends to be GPs who lack knowledge or confidence in menopause prescribing who stick rigidly to guidelines recommending sequential progesterone if still menstruating Vs continuous is postmenopausal, is the belief that a) sequential will lead to a more regular bleed pattern, and b) that bleed pattern is the be all an end all, trumping other outcomes such as sleep, quality of life, mental health etc.

Whilst continuous micronised progesterone MIGHT lead to a less regular bleed pattern, the briefest search of this forum will reveal many, many women diligently taking sequential and still having menstrual irregularity. This is also common in untreated perimenopausal women.

Another argument is that irregular bleeding on continuous may result in invasive investigations, however this need not being the case in the hands of a skilled clinician who understands the difference between explained and unexplained bleeding, and can diffrrentiate a low risk from a high risk patient for endometrial pathology.

Many specialists advocate continuous combined HRT from the start for individuals with cyclically aggravated conditions such as migraine, endometriosis or mood disorders.

Luckily the dose for continuous is generally half that used sequentially, so it will usually be in your gift to take it whichever way suits you without needing the prescription changed.

The important thing is that you take enough, ie not less than the overall dose prescribed per month, which it sounds like you are happy to do.

[AnderH]

Thank you very much for replying, I suspected this might be the case with my GP as I have read on here that a lot of women in Perimenopause are on continuous regimes.

[bombsh3ll]

The initial prescription of an antidepressant also points to your GP not being particularly confident or up to date with peri/menopause care.

[Therese83]

I'm 41 and perimenopausal (still having periods) and was started on a continuous regime immediately. The Dr I went to does specialise in this kind of thing.

[bombsh3ll]

The most important thing is to listen to the person and find out what their individual needs and priorities are, and tailor treatment towards that rather than rigidly sticking to one size fits all guidelines.