Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Lizab on February 17, 2016, 04:49:17 AM
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I am on estradiol patches with progesterone orally 10 days per month. Based on my two years of skipping periods for months and my fsh level over 100, the doctor initially offered me a combined continuous patch. I had read that until I've missed periods for 2 years (because I'm 39), I need to be on a sequential regimen. Further, because of negative experiences in the past with BCP and Mirena, I requested the micronized progesterone instead of synthetic progestin. The doctor obliged.
Now, in looking at my symptom calendar, I do believe I feel better on the progesterone days than on the estrogen only days. My first couple days on progesterone I feel sluggish, but then adapt and feel much calmer and happier the remaining days. I'm still grasping for a pattern to my moods, so I plan to observe this for one more cycle to be certain.
My question is: Is there any harm in going onto a continous combined patch before I'm officially post-menopausal? Aside from erratic bleeding patterns, are there other potential problems with it at this stage? If not, just how bad is the erratic bleeding, like lots of spotting, unpredictable light periods, or heavy anemia-inducing floods for weeks on end? I realize taking the Utro continously would also be an option, but for cost savings and convenience I may consider trying a synthetic for a short time.
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Hi lizab
I think that the erratic bleeding could be any of the above .....
The problem with bleeding when on a Conti regime is that you really are obliged to report it you your GP as unscheduled bleeding. Many GPs will then refer you under the 'two week cancer rule' for post menopausal bleeding, for a scan and possibly hysteroscopy and biopsies to be taken. This can be quite stressful for some women. Some women choose not to report the bleeding believing it is 'ok' to ignore....... ???
So you could go on a conti regime as your GP has suggested it and you may not have any bleeding at all but if you do are you ok to handle all the investigations ?
If you have had problems with BCP and Mirena is that not most likely to be an intolerance to the progesterone in which case a conti regime may not be the best option for you ?
Food for thought :)
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lisab - you are one of the lucky ones that feels good on the Utrogestan (I think that's what you are using??) - I felt very chilled on Utro. I would stick with the sequential regime for 2-3 months more and ask to switch to the 25 out 28 days pattern which is the continuous regime with this type of progesterone. As I experienced, sadly Utro isn't as powerful as the synthetic progesterones (which can bring more side effects) and this can result in erratic bleeding or spotting but only a small percentage of women have this issue.
You could try Provera which is also well tolerated by many women but I'd try the Utro in the conti regime first and hopefully you won't get the problematic bleeding. DG x
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Thanks for the replies.
Pollie, I'm not sure if it's actual intolerance or that my system is sensitive and easily thrown off balance (when in balance). I tried several different BCP and always had breakthrough bleeding except for one that seemed to work only if I set an alarm and took it the exact same time daily, a half hour late and I was bleeding. The Mirena was fantastic for the first year, then cysts, migraines, etc. After its removal I quickly returned to normal. At this point, I'd be willing to try. Hrt isn't supposed to be long term anyway.
DG, the 25 day with utro may be my best option. It's a significant cost increase over combined patches though, so I would like to try to get through this with the combined if it wouldn't cause other problems. I can't believe after I begged for the separate utro I'm going to go back and ask for what he originally tried to prescribe :bang:
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Lisab - If you are getting your hormones on the NHS it shouldn't cost any more for you as they would simply give the two prescriptions (one for the oestrogen and one for the Utro) but the Utro would be double the amount to cover 3 months use. DG x
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I'm in the US, Dancinggirl. My insurance is such that I pay all prescriptions out of pocket. It's costly. If I could go on BCP, I think that is free, but I test as post-menopausal, I'm over 35 and I smoke. So I doubt that would be an option.
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Also, if I were to try a synthetic, which would generally be preferred, norethindrone or levonorgestrel? I'm guessing everyone has to try for themselves, but maybe one is known for being awful?
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Didn't realise you were in the USA Lisab - sorry. Can you get a combined HRT that has Dydrogesterone in it ? - Have a look at the TREATMENTS section at the top of this page. This is a kinder progesterone and often suits women very well. There is also Medroxyprogesterone which is often in combined HRT pills. In the UK we have various options that have these progesterones.
Before trying something different do look at how much more it will cost to have Utro continuously - these things are not actually that expensive to buy on private prescription here in the UK and you will only need the 100mg dose for conti instead of the 200mg that is used fro the sequi regime.
I'm afraid you really ,really need to try and stop smoking as I believe this actually effects the absorption and effectiveness of the hormones in HRT.. DG x
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I'll not use another oral besides the utro. I was only considering switching to a combined patch. I feel like the doctor will only prescribe transdermal to me, because of smoking and family history.
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Lisab - I'd stick with your current regime for now if it's generally ok and reassess in 6 months. Look at finances to see what you can afford - maybe if you gave up smoking you could afford the conti Utro????? A win, win in every way??? DG xx
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Hi lizab
Norethisterone is notorious for causing extreme PMS in women who are intolerant to progesterone. It is the oldest synthetic progesterone and the strongest, so if you suffer with mood issues then it's probably best avoided (at all costs).
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DG, (un)fortunately, my smoking habit is not so strong to equal the cost of the utro, but yes, I've all but given up. I honestly have no intentions to drop my few cigs a day. And by few, I mean 3, if I'm home, fewer if I'm busy out and about. It's my only vice, and I enjoy it.
GRL, thank you. I thought one was preferred over the other.