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[Castaspella]

having seemingly moved to short cycles where I felt like I was bleeding all the time (including before I finished utrogestan)I am now on day 43,only very light spotting last couple of days, boobs like rocks and v painful. I have no clue what’s going on.

44, 2 pumps oestrogen, 200mg utrogestan for 12 days, 5th month(ish) of HRT

[bombsh3ll]

Assuming you are not pregnant this is pretty typical of perimenopause for periods to initially become more frequent and then start to space out.

It can be very uncomfortable if not managed appropriately - sequential HRT with micronised progesterone is not strong enough to shut down and override your own cycle, and in my opinion not the best choice in perimenopause.

At 44 you could still take the combined hormonal contraceptive pill continuously which would eradicate both the bleeding and the hormonal fluctuations, giving you a stable daily dose back which is typically more generous than that provided by menopause hormone therapy.

If you don't want or can't take the COCP,  you could still use a suppressive progestin to achieve the same ends paired with transdermal estradiol.

Nobody has to have periods at all, or ride an erratic hormonal rollercoaster unless they want to!

[Castaspella]

Thanks, I find it all so confusing. I thought I had to bleed to prevent a buildup of lining. I can’t take the contraceptive pill unfortunately

[sheila99]

Pretty normal for peri I'm afraid where the only thing that's guaranteed is that everything will be abnormal.

[bombsh3ll]

No you don't have to bleed at all, this is a myth that causes a lot of misery and suffering to women of all ages.

If you take a progestogen continuously it keeps the endometrium thin and atrophic, and over the long term this actually significantly reduces your risk of endometrial hyperplasia and cancer.

[Castaspella]

I have NEVER been told that. I was under the impression I had to have a withdrawal bleed. So does this still stand if not taking progesterone continuously but only for 12 days?

[bombsh3ll]

If you are only taking the progesterone for 12 days then you more likely than not will have an artificial withdrawal bleed in the days after you stop it.

This is a side effect, not the objective of treatment.

12 days (at twice the dose as would be used continuously) is enough to protect your endometrium.

Hormone therapy (and birth control) were originally developed in such a way as to patronise women with an artificial period every 4 weeks so they would not think they were pregnant.

However this confers no health benefits and it is a personal choice whether to accept withdrawal bleeding or not, whether on birth control or HRT.

[Castaspella]

Thank you so much, this is invaluable info and I can’t believe I didn’t know it!

[bombsh3ll]

Just be aware that if you are still having natural menstrual bleeding of your own, micronised progesterone at the doses used in continuous HRT is not strong enough to get rid of this, so you may still experience some bleeding on this.

If you are still perimenopausal and do not want to menstruate there are other progestins that you can use alongside your estrogen that will shut down your own cycle so most people can be completely bleed free if they wish.