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[Karras77]

I had a slightly early menopause at 44 and was put on hrt after 11 months no period. Im now 48 and have been using cyclical hrt on 75mg evorel patch and utrogestan for 12 days as a pessary.

I always have a withdrawal bleed and have avoided moving to continuous as really struggle with the progesterone and thought the guidance was cyclical up to 50 years old if on hrt before menopause (essentially my argument was if I'd been put on hrt earlier know one would no id gone through menopause).

Anyway just had a gp appointment for something else and got suddenly thrown by an hrt interrogation! I was told I must be continuous, that new guidance had been issued, I was on high dose estrogen and when I asked for a scan to check womb thickness was refused a referral as I don't medically need one. She even asked me to go on 14 days in meantime (as i was resisting) and seemed to even be thinking of 200 a day utrogestan on continuous. I told her I needed time to think and have booked a private ultrasound anyway, but honestly faced with continuous utrogestan i might need to come off hrt. Has something changed with uk guidance? I spoke to a specialist in the past about cancer risk on cyclical and she said it really shouldn't be a significant risk if having withdrawal bleeding.

[bombsh3ll]

The specialist is right.

The guidance to move to continuous progesterone after either a certain period of time postmenopausal or by age 55 (not 50) is just that, guidance, not the law, and clinical judgement taking into account individual needs should always be used.

Sadly many GPs have neither the time, education or interest to go into this and also the NHS hasn't the resources to offer endometrial monitoring so they tend to just take the pragmatic but blunderbuss approach of overtreating the majority in order to protect those at highest risk.

It is sensible to get a private ultrasound yearly if you are deviating from these guidelines, in fact I believe this should be part of routine well woman care and I have one myself for ovarian screening.

If you are happy on your current regime and have neither irregular/unexpected bleeding nor a thickened endometrium on your scan, I would simply stick to your current regime given this is working well.

If your GP is being really rigid it would be better to order the increased amount of progesterone as if you are taking what they want, and hand back surplus to the pharmacy.

If you aren't comfortable going it alone you could have a consultation with a knowledgeable private specialist to back you up, as long as you had regular scans.

It is also worth knowing that micronised progesterone isn't your only option if tolerability is an issue, there are multiple alternative progestins that are often better tolerated due to them being modified to be effective at microgram or low milligram doses.

[Karras77]

Thank-you that's really helpful. I will wait for scan and go from there possibly privately. I would rather pay for scans than move to continuous if no medical reason too.