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[AnnieFH74]

Hello,

I'm just turned 51. I started HRT almost two years ago and was using Progesterone tablets (inserted vaginally) two weeks out of four and Oestrogel (1-2 pumps) daily. I was having the monthly withdrawal bleed and had no real issues with being on HRT, although I did find the gel/tablet combo a bit of a faff. I went on HRT in the first place mainly because of low mood. I didn't have too much in the way of other symptoms. at that point.

I decided to stop taking HRT about four months ago as I wanted to see where I was it in terms of periods (obviously it was hard to tell whilst on HRT as I had a fake cycle). I had a normal period after the first month of stopping (around the early July) then nothing until early September which was a very, very light bleed, hardly anything.

This is all fine as it's helping me to see where I am menopause-wise, however, since stopping HRT I've been really struggling with hot flushes - I didn't have these before so it was a surprise to suddenly be experiencing them multiple times a day/night!!

I would like to continue without HRT until I know that my periods are finished, but I'm finding the flushes quite unpleasant and also concerned that other symptoms might appear as my oestrogen levels drop further.

My question is, how have others managaed this situation? If you've started sequential HRT whilst still having periods, have you come off HRT like me to see what's what? If not, have you just gone straight to continuous HRT after a certain age?

Also, what are your recommendations for hot flush treatments? I'm looking at evening primrose oil as a starting point.

Thanks so much 

[Aubrey]

Hi AnnieFH74, 

I can't give you advice I'm afraid but I thought I'd reply because your post is exactly my dilemma. I'm on the same regime of HRT as you, been taking HRT  for 5 years, and it's taken almost that long to get the dose right! But I also hate having periods, they're so painful and heavy so I want to come off HRT to find out where I am and if I can stop the sequential cycle. I dread coming off HRT because it's taken so long to get it right and sleep again, but I want to retire my womb, too.

Anyone else done this? What was your experience?

[bombsh3ll]

There is no value in stopping beneficial treatment just to see if your periods have stopped - this information is far less important than people think.

So what if you have a few more periods? What are you going to do differently?

And in the meantime you are suffering uncomfortable and completely avoidable symptoms and going without the health benefits of estrogen.

If you want to be bleed free, there are regimes that can achieve this even if you are not yet postmenopausal.

If you want to try continuous progesterone at this point, which doesn't typically stop periods but avoids withdrawal bleeding, then you just try it. If it doesn't suit you can either go back to what you had or try something else.

[Aubrey]

Thanks bombshell, that was useful actually.

I didn't know I could use continuous progesterone during the peri's,  my GP said I couldn't unless I was in menopause. Same old misinfo'. I'd really rather not stop HRT at all, I'd just like to end the heavy and painful withdrawal bleeds from sequential, and I know this can be achieved on continuous.

I'll have a go at continuous.

[bombsh3ll]

Just to clarify, if you are still menstruating naturally, continuous micronised progesterone is not generally strong enough to override that so you may still bleed.

However if you have actually become postmenopausal in the background and are purely having artificial withdrawal bleeds, then taking the progesterone continuously should put a stop to these.

If you are still menstruating and don't want to be, there are multiple other options that can achieve this, both oral and IUS.

There is no medical or safety issue if you are still peri and choose to take continuous micronised progesterone. The only reason some inexperienced providers stick rigidly to this guidance, - many of them couldn't actually explain the physiology, they are simply following a flow chart - but the reason sequential is generally advised in peri is because you MIGHT get some irregular bleeding if you took continuous.

The problems with this are;
 a) irregular bleeding frequently occurs on sequential as well
b) menstrual irregularity is a hallmark of perimenopause and occurs in untreated women as well
c) Bleed pattern is not the be all and end all and shouldn't trump your overall quality of life if you feel better on continuous eg due to mood sleep migraines, endometriosis personal preference etc.

[Aubrey]

Thank you Bombshell, That's useful advice.

[AnnieFH74]

Thank you so much for your responses and some really useful info re the reasons for being on sequential versus continuous. I wasn't aware that sequential was primarily offered in perimenopause to minimise risk of unwanted bleeding.

I've decided in the shot term, to go back to my original sequential regimen and get on top of the hot flushes, then in a few months I'll speak to my GP about changing my prescription to continuous.

This is such a helpful space, thanks again.