Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: alibeau on February 15, 2025, 04:34:58 PM
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Hi,
So following on from my post about bladder leaks…..
I have an appointment to see a GP in three weeks time. It’s the first time I’ve had a HRT check up face to face in a long time.
About 18 months ago a nurse at the surgery advised that I needed to move onto continuous Utrogestan. I tried this for three months but I didn’t feel great at all. Fatigue and random spotting/bleeding quite often, things just didn’t settle down at all.
So I decided to just switch back to sequential.
I’ve just placed an order for my first pack of Gina to try to help with bladder leaks/VA in case this is relevant.
I’d really prefer to stick with sequential as everything is ticking along ok on three pumps of Oestrogel and 2 Utrogestan tablets for 12 nights out of 28, I have a bleed each month, some months lighter than others.
If the GP advises again for me to switch to continuous can I say no?
Is it ok for me to stick with my current regime?
I am 52 and have been on HRT for approx 6 years.
Thanks in advance.
Ali x
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The reason continuous progesterone is recommended in postmenopause is due to a small increase in endometrial cancer risk with the long term use of sequential.
However this has to be balanced against other important outcomes including your quality of life.
Your GP may not be comfortable continuing your estrogen prescription if they know you are using the progesterone cyclically, as the NHS doesn't have the resources to offer endometrial monitoring.
From their point of view they could face a potential malpractice claim if they sanctioned this and you subsequently developed endometrial pathology. A reasonable and confident NHS prescriber may agree on the condition that you have an annual scan, which you would have to self fund.
If you do decide to make an informed choice to continue cyclical without your GPs knowledge - after all the overall quantity supplied is the same either way so how you take it is within your gift, then I would recommend getting a private scan yearly to ensure endometrial safety.
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What R U using for vaginal atrophy?
GPs do not have to prescribe ........ nor do they have to refer. MayB think about going to a dedicated menopause clinic via your GP, both NHS and private sector have waiting lists.
Quality of Life is important so risks have to be considered. Personally I don't believe that if a patient is doing well on a regime that there should be alterations - in any speciality.
I agree with bombsh311 - getting a private scan may be the way to go in order to remain as well as possible and not worry about potential risks. Every thing we do after all, has risks: from getting out of bed .......... ;)
Do let us know how you get on.
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Thank you both.
I am so confused.
I thought that taking the progesterone cyclically would be better for me as I have a monthly bleed?
Whereas taking it continuously I was not supposed to gave a bleed? Therefore this would be more risky?
I feel so stupid!! I am 52 years old and don’t know how my own body works :-\
I am happy to give continuous another try, it was just the random spotting etc was a pain, as well as the fatigue…… but it was a while ago so I could try again.
Re VA I’ve only just come to the realisation that this is an issue for me, my main concern was bladder leaks but I can now see the two are connnected and I have been experiencing more vaginal dryness than I realised (I know that also sounds a bit stupid!) I am due to see my GP in 3 weeks to discuss this….
In the meantime I have ordered my first pack of Gina to see if this helps?
I just feel a bit foolish, like I should know all this stuff….
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Don’t feel foolish at all. I didn’t know anything about menopause and have had to educate myself. I’m still learning and I’m 60 and still finding ways of navigating it. xx
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Thanks all.
I am still confused ???
If I take my progesterone cyclically and have a bleed each month this sheds my womb lining.
If I switch to taking it continuously I thought the idea was that I do not have a bleed at all so therefore my womb lining could build up, therefore more of a risk?
Could anyone please explain to this dimwit where my thinking is going wrong?
Thanks so much x
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Taking continuous progesterone keeps the lining thin and atrophic and stops it building up, so there's nothing to shed.
Withdrawal bleeding with the birth control pill and early HRT formulations was built in for social reasons not medical ones.
It is a relic from a very paternalistic era in women's healthcare, and whilst it does still serve some women, spending every 4th week bleeding is never anyone's only option.
Ironically whilst cyclical progesterone can help reduce fear of endometrial cancer by producing regular bleeding (typically in post or late perimenopause - good luck trying to time it if you are still menstruating naturally), continuous progesterone is better at reducing actual risk of endometrial cancer.
PS don't pay for Gina, you can get vaginal estrogen free on NHS prescription from your GP.
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Thank you so much, that makes sense.
I understand now.
I am a week into taking my cyclical utrogestan so at the end of my usual 12 nights I will try continuous again.
I stuck with it for 3 months last time I tried but the spotting did not settle down…..
I am just paying for Gina as hopefully a one off, I am due to see my GP in a few weeks time to discuss…..
Many thanks for your reply. :)
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Spotting is common in the first 6 months or so of any new hormone therapy regime.
This is not harmful in any way, or a sign that anything is wrong.
If it doesn't settle after that, your treatment can be tweaked to get it under control.
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alibeau, for another perspective, go to YouTube and search for Dr Felice Gersh and what she has to say about HRT regimes.
She is strongly in favour of trying to mimic a natural cycle as far as possible. There is evidence to suggest that taking continuous P down-regulates the E receptors and counters some of the benefits of taking E in the first place as a result.
She is a HRT prescriber in her 60s herself, and on sequential HRT.
There are members of this forum who choose to stay on sequential HRT because they just prefer it or do better with it. We really don't have enough research into sequential vs continuous and cancer risk since the only research we have used synthetic progestins and also since dosages of P are all over the place - especially in the UK. It is not possible to compare apples and oranges, for eg. One woman taking 200mg of oral P is not going to have a serum P level the same as another woman who is also taking 200mg. We all absorb it differently, just the same as transdermal E products.
For more info, take a look at this wiki article - especially the graphs further down the page comparing P levels with oral, vaginal and rectal P: https://en.wikipedia.org/wiki/Pharmacokinetics_of_progesterone
You'll see that far more is absorbed (on average) with vaginal and rectal P than with oral. Furthermore, in the UK it is impossible to test serum P levels with the tests we have available if you take oral P. This is because if you take it orally, it is processed by the liver and that creates a lot of P metabolites which the test registers as useable P - when they are not, they are useless and excreted. IF you take vaginal or rectal P, on the other hand, the tests we have available ARE relevant and you CAN test your P levels reliably. (In the US they have a test called the LC MS P test, which gives a reliable result even if you take oral P - but we don't have that in the UK. So the only way to test here, is to take it vaginally and rectally.)
My experience has shown WHY we need to test P: I am on a high E dose. So I wanted to be sure I had sufficient P to oppose my E. I was taking 300mg P vaginally at night (sequentially), which is already a higher dose than most women - and vaginally usually sees a higher level than orally. My result was only 5ng, which is barely inside the minimum recommended amount. So I have now increased my P and am taking another 200mg vaginally in the AM. P has a short half life, so many women take it twice a day (in the US, anyways....).
In short, just like there are bazillions of women, walking around and thinking they are 'taking HRT' - and therefore protected from dementia, cardiovascular disease, osteoporosis etc due to the estrogen - except they are wrong, because their E levels are incredibly low and were never tested.... So there are bazillions of women thinking they are protecting their endometriums with their P dose - except they are not, because they are not absorbing enough of it to get their serum P levels high enough to do that.
So to then throw research in there about sequential vs continuous P is just a huge load of misleading codswallop really. Because how many women in either group were on enough P (full stop)? Was this controlled for? Were their serum P levels tested or was this just about dosage administered? (The latter.) And so on.
HRT is still an evolving field. We are all biohackers. The women are ahead of the doctors, many times. (Except for the enlightened few doctors.)
I plan to continue to take sequential P, for all the reasons Dr Gersh gives. I am also on a very decent E dose (as she advises). And I take my P vaginally (again, as she recommends) - because it is not natural to take such high doses orally and cause such high GABA levels which effectively is functioning like a sedative. There has been no research into whether or not that increases the risk of dementia, for eg....
Sorry, I am going on a bit - but you get the picture.
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Thank you so much for your in depth reply, I appreciate you taking the time.
I'm now not sure whether to go straight onto continuous or talk to my GP first?!
It's not a GP I have seen before so no idea how 'clued up' they are going to be.... I have an appointment early March.
I feel bad going in and saying I have not been taking P continuously given this is what I was advised to do but...... prior to Covid they would not issue another HRT presciption without a chat/check up, since Covid I think I've had one telephone chat with a Nurse and that's it.... so i've just left things to tick along...
When I think back now, I went for a scan during covid to check that my bladder was empyting properly (sorry I am jumping around on topics, this refers to my other thread). I was told the scan was fine, all was well but there was never any follow up at all, so again I let things drag on with my bladder leaks but clearly I've had an issue for a number of years.
I've had so much going on in my life that its just too easy to let things drift, I'm now of a mind set that I need to look after myself better :)
Thanks everyone, I'm waffling now!!
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Really, it's not a huge big deal or decision. People switch back and forth. People trial stuff and then inform their GP that it works.
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You are of course right! Thank you for being the voice of reason!
:thankyou: