Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: dangermouse on March 28, 2016, 03:19:52 PM
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I've been told that you feel better post menopause due to the higher ratio of testosterone to oestrogen, more energy and drive being the main boost, but then there are clearly lots of women on here who prefer to stay on HRT indefinitely suggesting that's not the case.
Are you able to allow your hormones to switch to post meno and then go back on HRT if it doesn't suit you or do you just have to make a decision either way and stick with it?
I do like the idea of the higher energy testosterone state but also don't want to put myself at risk of heart disease too early so wondered how others work it out.
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I'm not sure what you mean dangermouse by "allowing your hormones to swtich to post-meno"? Do you mean stop and start HRT? If you stop HRT and are post-meno then your oestrogen levels will fall and you will risk all the health problems due to its deficiency. Not sure what you've been reading that makes you think it would be a good thing? We are women remember - and high oestrogen is our functioning state!
I'm not sure where you read that about feeling better post-meno due to the higher ration of T to O - how can that be? We feel at our best during our fertile years when oestrogen is high and testosterone is normal.
Oestrogen declines drastically until it sinks to an all time low from approx 2 years post-menopause. Testosterone gradually declines throughout life from maturity onwards. It is the absolute values of oestrogen and testosterone that determine how we feel in terms of energy, drive etc - not the relative amounts. If your oestrogen and testosterone levels have both declined then you will feel less energetic and have less drive.
After menopause it is the case at least initially that oestrogen falls dramatically so that you become more testosterone dominant - hence the change in shape to apple, and the hairy chins some women complain about. However the T is still lower than it was and continues to decline.
Also there is some inter-conversion between O and T but I am not certain of all the controlling factors.
The main aim of T replacement is to try to achieve physiological levels (for women) without becoming too T dominant and risk the androgenic side effects. In my case I have been replacing oestrogen for 9 years (I am almost 63) and Testosterone for almost 12 months. I use a tiny blob of testosterone - for the reason that I do not want to become T dominant and risk the male side effects. I don't increase my oestrogen because I don't ewant to take progesterone more often than I do ( every two months) - and it's sufficient to keep away flushes and sweats.
I only started using HRT when I was late peri-menopause.
Hurdity x
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Thanks! Well my mum didn't have a bad perimenopause like I'm having but she said she felt alot better post meno and my sisters neighbours have said the same thing. They're all very active and it exhausts me just watching them! However, I guess as you say that initial boost will decline so maybe the energy is short lived. My mum does also now have osteoarthritis (she's 73) - although still more active than me of late!
On the other side, my aunt said she felt better on HRT but was made to stop it (when they had that 5 year rule).
I wasn't sure if once you'd let your oestrogen levels naturally fall and the testosterone rise, by not having or stopping HRT, whether you could take it later on or if there was a cut off if you let it slip too long.
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I certainly feel much, much better post meno. My last two years of peri were pretty bad but as I have never taken HRT I can't comment on how that makes anyone feel.
What I would say though is that there is an awful lot of women out there that don't take HRT and I have seen no evidence that they are disadvantaged by not taking it (post meno wise).
It would be interesting to read any evidence, both research and individual experience, if there is any.
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I have been lucky in that my menopause has taken what I consider to be the 'normal' route, i.e. I went through less and less bleeds as oestrogen dropped off: a few years where itchiness was problematic but not over-so; only a few months of flushing. Having suffered horrendous periods for years I was relieved when it all stopped.
I have days when I feel more tired but don't know how much that is menopause or a combination of my medication. On the days I am good we do a lot, others we chill ………
If you have a good day/week go with it ;). "ours is not to reason why" ?
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Hi Hurdity
Oestrogen declines drastically until it sinks to an all time low from approx 2 years post-menopause
This interests me - where is the oestrogen coming from after menopause (last period) ?
Do the ovaries still produce oestrogen even though we are not ovulating or having periods ?
Presumably it is not enough to stimulate the lining ... ???
pollie
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My personal observation (family, friends and colleagues) is that an awful lot of women not taking HRT end up on some form of anti-anxiety medication and are often also being treated separately for VA, osteoporosis etc. Fair enough if they're not able to take HRT ... but if they can ... I do question why they wouldn't at least want to try it??
Don't know that I can agree with this??
If Oestrogen were essential to prevent anxiety then why do men not suffer all through their lives. Also many take ADs well before the meno or even peri.
As for VA and osteoporosis, I can only speak for myself and family here but we have not had these problems dispite no HRT.
There are 3 reasons why women don't take HRT.
1st, they cannot.
2nd, they don't want to, for various reasons.
3rd, they just don't need to.
I don't think we should question anyone's reasons for not taking HRT, it's their choice.
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Blossom60....it does my heart good to read that you feel better post meno. I'd love to see an uplifting thread in the forum ( maybe even a sticky) for women who had rough or even normal perimenopause who came out the other side and are feeling good.
I'm still in peri and now feeling much better but for several YEARS all I wanted to do was hear from women who turned out OK. I didn't think I was going to make it, and it might all come back again as I'm not through it yet.
I think a lot of the women on this site who are peri want the same thing. To know there's life after perimenopause.
t
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Men do have oestrogen. If they don't have enough they lose their libido and put on weight... sound familiar? ;D I'm not sure what role it plays in male anxiety though.
It is good to hear of a happy post meno story. As for VA my mum didn't begin to have problems until she hit her late sixties and began oestrogen treatment. The same has happened to a couple of friend's mums who began to develop cystitis type symptoms in their early seventies and, due to both having up to date GP's, were prescribed topical oestrogen which cured the problem. I believe that some women's levels drop quicker than others so some of us have problems from our fifties and others not until they are quite a lot older.
Positive Post-meno experiences would be very welcome. Have we had a thread on that already?
Taz x
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Often those that feel better go away from the Forum ::)
Maybe ladies don't talk about VA etc.? Certainly it isn't a conversation I would have with anyone outside of the Forum, my GP and DH! Even if a lady doesn't have flushing etc., they may well have other symptoms that require medication outside of HRT. I was taking ADs and BBs years before I went into peri.
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Maybe because their depression isn't meno-related? I had depression and bad anxiety years before peri. Of course, we mustn't forget that GPs often reached for ADs because that's how the patient presented in Surgery - in tears, unable to cope - so knowing that ADs can help, a prescription was offered. Also, ADs can help some menopausal symptoms :-\
Once ladies have gone through peri and their meno-symptoms have settled, they should be able to get on with Life with less and less problems. How long is a piece of string, it can be different for each one of us. I have better days and those when I am really tired, for a combination of reasons - I have learnt not to plan too far ahead nor say 'yes' too often ……. that way I don't tire myself out by finding reasons to back out of the 'yes' situation ::).
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I agree with much of what you say, Stellajane.
I think many women are put off HRT because it seem such a complicated process. You only have to read the post on this forum to see that.
Also for a lot of women ADs are just short term, and can be for many reason such a life changes and bereavement.
There certainly isn't a 'one size fits all' with the meno.
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So true. That's why it is so difficult to decide on what treatment may be required. At a time when a lady already feels ill it is so hard to make ourselves clear about symptoms and how badly they affect us!
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The fact that I am 54 and feel roughly the same as I did at 30 is reason enough for me to be an HRT lifer. It's taken me a very long time to find the right medication and get the combination of oestrogen/progesterone right but I have finally arrived and really hope I can help other women on here. If I can feel as good as this then others can too.
If someone doesn't want to take HRT for any number of reasons and they are sure they are happy with that decision then fine. The real problem that comes across loud and clear on this forum is the dreadful way in which so many women seem to suffer from life ruining symptoms, have a doctor who knows nothing about HRT and then prescribes duff medication i.e. outdated forms of HRT. Also, too many women are put on ADs etc. when they really need hormones.
Men produce sex hormones all their lives and women don't which, in my opinion, is a fault in the female make up. Oestrogen is like a control centre for so many vital functions and without it, things start to go wrong. My mother didn't have troublesome menopause symptoms but has suffered with endless problems related to oestrogen deprivation in later life. I look at old photos of my aunt who completely lost her zest for life around the menopause and her depression comes across in the photos. She ended up frail by the age of 57 and, sadly, died of a stroke which was devastating for us.
I worry for women who are not getting the right advice or treatment and from what I can see, it's not getting any better.
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We need dedicated GP training for menopause! We need more leaflets in GP Surgeries?
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I certainly feel much, much better post meno. My last two years of peri were pretty bad but as I have never taken HRT I can't comment on how that makes anyone feel.
What I would say though is that there is an awful lot of women out there that don't take HRT and I have seen no evidence that they are disadvantaged by not taking it (post meno wise).
It would be interesting to read any evidence, both research and individual experience, if there is any.
Blossom60 - I am glad you are feeling well post menopause. However - you ask for evidence/research - the possible consequences of oestrogen deficiency are well documented as Stellajane has said. You can start by looking at the information on this website eg
Osteoporosis http://www.menopausematters.co.uk/osteoporosis.php
http://www.menopausematters.co.uk/benefit.php
Vaginal and bladder problems
http://www.menopausematters.co.uk/vaginalsymptoms.php
Heart disease – possibility
http://www.menopausematters.co.uk/cvdhrt.php
In addition there was a paper produced for World Menopause Day in October and published in Climacteric. Unfortunately it doesn't seem to be freely available as full text any more – well I can't seem to get it - but the abstract is here: http://www.ncbi.nlm.nih.gov/pubmed/24969415 There is a vast body of evidence about the role of oestrogen.
Here is the abstract in full:
Women may expect to spend more than a third of their lives after menopause. Beginning in the sixth decade, many chronic diseases will begin to emerge, which will affect both the quality and quantity of a woman's life. Thus, the onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern. Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above include lifestyle management, cessation of smoking, curtailing excessive alcohol consumption, a healthy diet and moderate exercise, as well as mentally stimulating activities. Although the most recent publications from the follow-up studies of the Women's Health Initiative do not recommend menopause hormonal therapy as a prevention strategy, these conclusions may not be fully valid for midlife women, on the basis of the existing data. For healthy women aged 50-59 years, estrogen therapy decreases coronary heart disease and all-cause mortality; this interpretation is entirely consistent with results from other randomized, controlled trials and observational studies. Thus. as part of a comprehensive strategy to prevent chronic disease after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered as part of the armamentarium.
The issue about just taking HRT for symptom control is a whole different matter – many (lucky?) women just get a few flushes and sweats during the peri-menopausal years and then they disappear so they have “got over itâ€. However the long term health implications are completely separate – as Stellajane says – and especially now as life expectancy continues to increase and we are spending a large proportion of our life post-menopause and in an oestrogen deficient state - as the paper recognises.
As I've said before - I am actually pleased that I had really bad flushes and sweats which meant that I found out about menopause and decided to take HRT – because from the evidence that I have seen so far – this is likely to be better for my health overall, despite the possible small increased cancer risk – which I try to mitigate through lifestyle factors.
Of course it is an individual choice - but needs to be made in full possession of the evidence we have for and against - benefits vs risks - which we each need to weigh up. Your third reason, blossom60, for women not taking HRT - they just don't need to - cannot be answered except in retrospect. Personally I don't want to do the experiment on myself - because once you have found out - say age 80 that you needed to - or it would have been better if you had - it's too late!
Hurdity x
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Thanks! Well my mum didn't have a bad perimenopause like I'm having but she said she felt alot better post meno and my sisters neighbours have said the same thing. They're all very active and it exhausts me just watching them! However, I guess as you say that initial boost will decline so maybe the energy is short lived. My mum does also now have osteoarthritis (she's 73) - although still more active than me of late!
On the other side, my aunt said she felt better on HRT but was made to stop it (when they had that 5 year rule).
I wasn't sure if once you'd let your oestrogen levels naturally fall and the testosterone rise, by not having or stopping HRT, whether you could take it later on or if there was a cut off if you let it slip too long.
I'm not sure if your question has been answered ( haven't read all the replies in detail!).
But yes there is a cut-off point. There was a study carried out re heart disease and HRT showing that there is a window of opportunity at which taking HRT is beneficial and does not cause any increased risk to the cardiovascular system. This window of opportunity is either within 10 years of menopause or under 60 (to start HRT). From memory this has something to do with the blood vessels, cholesterol and plaque formation such that if HRT is started after plaques form ( which is some time after menopause) this can lead to problems eg stroke. Sorry this is off the top of my head and not necessarily precisely accurate although the gist is correct. I'll find some more info later as have to go now!
Hurdity x
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Thank you so much everyone - all very helpful! Most people I speak to seem to still be under the illusion that HRT is dangerous, probably because that's the last thing the media left in our minds as not much seems to be written about it now, unless you come to forums like this to research it.
At the moment I'm having to put up with artificial hormones from the pill as not sure the HRT could control the surges which caused debilitating nausea, I do miss my own hormones though as even when I had the worst days over the last 6 months pre-pill, I felt more uplifted in the evenings when surges calmed down. Its also a tricky time for me as I only have until the end of the year to make my business work as this was meant to be my big break where I finally could go full time working for myself, writing a book and studying for my masters after waiting years for redundancy - for my hormones to then cruelly floor me! So need to feel driven, creative, uplifted... and not feeling any of that on the pill, just very exhausted and demotivated :-\
Have to keep reminding myself how I was last month though, where my only priority was getting enough sustanance to avoid having to crawl back to A&E for yet another 7 hour wait for a drip! Hopefully, once the background surges calm down I can move onto HRT and feel more myself or may even try that sooner than later as, even though my GP said HRT couldn't control the surges of perimenopause, it seems to be working for some of you.
Agree its nice to hear all the positive stories for those who have come out the other end, with or without hormonal help!
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GP's don't understand The Change ! have a browse, make notes ;)
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Hi Hurdity
Oestrogen declines drastically until it sinks to an all time low from approx 2 years post-menopause
This interests me - where is the oestrogen coming from after menopause (last period) ?
Do the ovaries still produce oestrogen even though we are not ovulating or having periods ?
Presumably it is not enough to stimulate the lining ... ???
pollie
Post-menopause the predominant oestrogen is estrone rather than estradiol (which is produced by the ovaries). This is produced by fat cells amongst other places and as far as I understand some oestrogen is also produced in other peripheral tissues ie not the ovaries. Women with more fat have more estrone. There is also interconversion between estradiol and testosterone and vice versa, and between estradiol and estrone - but it all seems endocrinologically complex from what I've read (or rather skimmed!). Some hormones are produced by the adrenal glands even after menopause. As for the stimulation of the endometrium - I am not clear about this. On the one hand I read that fatter women are more at risk of endometrial cancer (thought to be due to higher levels of oestrogen), but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen - otherwise we would all have thicker and thicker endometria over the post-menopausal years and be bleeding regularly.
There is a lot of information out there but quite bitty and I haven't tamed it all yet (in my head) so that I am clear about what it all means - or maybe the scientific establishment isn't completely clear either!
Hope that explains a wee bit!
Hurdity x
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OK as a meander: I still have my uterus. Peri came and went, leaving me without periods, no flushes - I get itchiness in various places, hair and skin OK otherwise. So oestrogen and testosterone levels have dropped. I'm OK health wise and have good levels of energy.
So those hormones which triggered my ovaries to release an egg which then went via the fallopian tube/s into the uterus ……… no longer active enough to encourage a monthly bleed. That bit I get.
However: if a lady has a hysterectomy but keeps ovaries presumably initially there's enough oestrogen to trigger the egg? therefore, where does it go ………. the uterus has gone ……… :-\. Eventually the lady's hormone levels drop ……
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The egg floats around for a bit and is then absorbed back into the body. It's all explained here http://www.netdoctor.co.uk/ask-the-expert/sexual-health/a11258/what-happens-after-a-hysterectomy/
After hysterectomy the ovaries normally fail within five years so even if you are post meno you can notice symptoms worsening as the ovaries no longer produce even the tiny amounts usual in post meno. Not many consultants explain this and just assume that if you are post meno you wont need HRT.
Taz x
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:thankyou: wonder how much hormone is included in the egg ? After all, the uterus is a receptical without input to anything other than holding the baby.
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Thanks Hurdity your comments are always so knowledgeable
But ....
but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen
I have heard this too .. But then why the heck do we need progesterone ??!!
And here's another bit of the puzzle I just can't get;
Some women who use Mirena for contraceptive purposes before menopause continue to experience periods. All perfectly normal. Some do some don't. No rhyme or reason apparently.
After menopause that same group of women can use oestrogen hrt with Mirena and expect not to bleed or have a build up of lining.
How so ??!!!?
Anyone ?
Pollie
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pollie, yes it is strange. I can only give you my personal experience but I had a Mirena coil from 1998 (for contraception purposes) and before the menopause, I always had periods. However, my periods stopped while I was part way through my second Mirena coil and I wondered why. I thought perhaps the new coil had a slightly different formula but it transpired that I was post menopause. I remember the doctor saying that as I had always had periods before with the Mirena, there was no reason for them to suddenly stop other than the menopause and that is why I had the tests.
I then started using a 50mcg oestrogen patch with the Mirena coil still in place but I never had a period. I didn't find the 50mcg patch very effective and it clearly was not delivering enough oestrogen for my needs but I imagine that had I been using the oestrogen gel like I am now, I would probably have built up enough lining to have periods.
I don't know if that explains it.
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I have also wondered about the mirena coil, my daughter has it fitted, several years now, for contraception. She always had long heavy periods.....now, with the coil.....nothing, no bleed!! I've often talked with her about this and said " well if you can can have extra estrogen and no bleed why can't I ?" Why isn't the lining of her womb building up or does her body's natural progesterone deal with this. Sorry if I'm being dense but I don't understand that!!
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The mirena coil only contains progesterone skkb - was that your question? It works in two ways. It thickens the cervical mucus so that sperm have problems moving through it to reach the egg and it also thins the lining of the womb so that any egg which does manage to get fertilised is not able to take hold. In some women it also stops the egg being released. There isn't any oestrogen involved.
You can read how it works here http://www.nhs.uk/conditions/contraception-guide/pages/ius-intrauterine-system.aspx
Taz x
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:thankyou:
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Isn't it that when you withdraw the progesterone you have the bleed? So with the Mirena or taking the pill back to back you are still having progesterone to protect the womb, but without gaps for the lining to temporarily fall away.
As long as you are having the progesterone then you can have the oestrogen. The bleed is surely just a side effect of having a gap?
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but I also read that there is some mechanism whereby post-menopause the structure of the endometrium changes so that it is not responsive to oestrogen
I have heard this too .. But then why the heck do we need progesterone ??!!
Anyone ?
Pollie
Sorry I can't reference the article (we are supposed to on here!) - it was one of those bits of information from my meanderings through the web - looking into stuff about the endometrium. However it was referring to the post-menopausal endometrium in its natural state, in the absence of HRT - the endometrium becomes atrophic and thin usually - so perhaps the oestrogen receptors eventually go dormant or something. There will be exceptions I presume which is why some women get endometrial cancer. Also the predominant oestrogen post-menopause is estrone so the endocrine balance/dynamics of all this presumably has something to do with it? Sorry that sounds vague and thinking aloud, but you can't find all the info easily in one place! The article didn't seem to explain the mechanism and it may well not be known exactly. We need progesterone when we add oestrogen as part of HRT because it continues to stimulate the oestrogen receptors and causes the lining to thicken - this is a different "unnatural" scenario ie reversing our oestrogen deficient state!
Hurdity x :)
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pollie, yes it is strange. I can only give you my personal experience but I had a Mirena coil from 1998 (for contraception purposes) and before the menopause, I always had periods. However, my periods stopped while I was part way through my second Mirena coil and I wondered why. I thought perhaps the new coil had a slightly different formula but it transpired that I was post menopause. I remember the doctor saying that as I had always had periods before with the Mirena, there was no reason for them to suddenly stop other than the menopause and that is why I had the tests.
I then started using a 50mcg oestrogen patch with the Mirena coil still in place but I never had a period. I didn't find the 50mcg patch very effective and it clearly was not delivering enough oestrogen for my needs but I imagine that had I been using the oestrogen gel like I am now, I would probably have built up enough lining to have periods.
I don't know if that explains it.
Re the Mirena
The amount of progestogen needed to oppose oestrogen and prevent the lining thickening is dose dependent - so whether or not you get periods on Mirena is directly related to the amount of oestrogen in your system - either your own or from HRT. Those women with high oestrogen levels and heavy periods - will get lighter periods but they may not stop completely (while they are fertile).
As you get towards peri-menopause and in peri - your oestrogen levels will drop and therefore periods may well stop. However if your periods stop while using the Mirena - this absolutely does not mean you are post-menopause in fact it is most likely that you are not!! It means you are peri-menopausal - probably will be for a certain length of time which is impossible to determine - could even be a couple of years or more before being post-menopausal. Blood tests do not help because as we know the levels of FSH go into the post-menopausal range even very early in peri sometimes. We have had several examples of women on here being told they are post-menopausal on the basis of a single blood tests - or even several - and one women was told this after one missed period and that she would never have another period - which of course she did very soon!
So - you cannot date your menopause from periods stopping using the Mirena, nor from a blood test. You would have to stop using the Mirena and wait 12 months to see if you were post-menopausal or not!
Hurdity x
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Isn't it that when you withdraw the progesterone you have the bleed? So with the Mirena or taking the pill back to back you are still having progesterone to protect the womb, but without gaps for the lining to temporarily fall away.
As long as you are having the progesterone then you can have the oestrogen. The bleed is surely just a side effect of having a gap?
You only get a bleed when you withdraw the progesterone if the lining has built up sufficiently. It isn't a foregone conclusion! In continuous combined HRT for example, after the settling in period of time, there should be no bleed if the dose of progestogen is just right compared to the oestrogen - such that if you then stop the HRT you should not get a bleed. If you do then the progestogen dose was not sufficient to do its job properly.
The pill - from what I gather this is designed to have a gap in which you have a bleed (therefore there is excess oestrogen compared to progesterone) so I presume it is accepted that the lining builds up - which is why taking back-to-back of the pills that normally have a week's gap - is not advisable for longer than 3 months. Sometimes a continuous dose of progestogen will continue to thin the lining so I imagine that's what happens with this type of pill - even so I imagine there would be a bleed after 3 months and then a week's gap? Sorry just thinking aloud here!!! Don't know much about the pill!
Hurdity x