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[Sunnydays]

I understand (very basically!) the role of progesterone in the post menopausal women taking HRT i.e. to prevent the lining of the womb from building up but I'm not sure how it actually works.
If taking progesterone constantly does it overpower the lining of the womb that is being built up by the oestrogen, so in affect there is no bleeding(unless the  progesterone isn't strong  enough or other health issues)? On the other hand if it is taken sequentially the oestrogen will build up the lining, the progesterone is taken at a given interval, but there is no bleeding until the progesterone  is stopped. This is what I don't quite understand. Why does the excess lining not get shed until the progesterone is stopped?
I'm curious to how it all works. I'm using the term progesterone generally to cover all the different terms given to it.

[Hurdity]

Hi Sunnydays - the progestogens change the lining of the womb from "proliferative" - where it is growing, to "secretory" where there are stuctural changes getting it ready for implantation of the fertilised egg.  When you stop the progestogen, it signals that there is no egg and the lining comes away as it is not needed. This is under complex endocrine control but that's it in a nutshell. In the normal menstrual cycle the empty egg follicle produces the progesterone to change the womb lining until after fertilisation when the placenta (I think) takes over this function. It takes about two weeks (just under) until the egg follicle ( corpus luteum) degenerates - and lead to the fall in progesterone if fertilisation has not taken place.

Some women do bleed before they finish the course of progesterone and I'm not quite clear why this is - but increased progesterone can stabilise this. It can be partly due to the variability in absoprtion from oral progestogens so that the amount getting into thre system may vary  - so the lining is shed when there is a drop - even though the same dose is being taken orally. Does that make sense or have I over complicated it?!

Hurdity x

[Briony]

Out of interest, how are progesterone levels affected by a BCP or high dose patch which actually suppresses ovulation? The reason I ask is that a number of ladies are considering following NAPS's advice and taking 100mcg patches with 100mg Utrogestan for 7 days a month, in order to suppress ovulation and avoid the fluctuations it can create. (I'm one of the weird ones who would choose to take 100mg for 25 days, despite still having periods). Is this enough to protect the uterus? I presume - given that both Nick Panay and Studd recommend it - that it's OK, yet it seems very little for such a high dose patch. Does the fact ovulation is suppressed with 100mcg patches make any difference? 

[Sunnydays]

Hi Hurdity, tahnk you for this. No, you've not overcomplicated it at all. This explains why the drop in progesterone leads to the lining being shed. I understand this ( I think lol!)
Does this mean then that progesterone every day will be keeping the uterus in a 'secretory' mode and it will stay like that all the time you take progesterone regularly ie the progesterone is constantly offsetting the oestrogen build up?

[Pollie]

Really good question and really good answer thankyou Hurdity !

so here's another;

In someone taking continuous progesterone and therefore with a secretory lining, which presumably should be very thin, will an increase and then subsequent drop in progesterone cause a bleed ?

Pollie

[Sunnydays]

Well asked Pollie - much better out than mine!

[Hurdity]

Hi Sunnydays and Pollie

Not sure I can answer these Qs!

Fron what I've read - progesterone changes an "oestrogen primed endometrium" from proliferative to secretory and then the fall in prog triggeres the bleed. Also though if you are taking oestrogen, if you are taking sufficient progesterone at the same time, the prog intereferes with the oestrogen receptors ( I presume it binds to them?) to prevent the lining building up - the prinicple behind continuous combined HRT. Quite what this means in terms of the structural layer of the uterus I don't know! I mean I don't know if it is actually secretory  - because the lining doesn't build up - I would presume not??? I have tried looking this up but can't really find the info.

Also progestogens have the ability to thin the lining of the uterus (after it has been stimulated to grow by oestrogen) without it being shed - and there is research to show this. I presume this is why some women do not bleed even on sequi HRT?

Re your Q Pollie - again I can't say exactly (I don't know!) but I would suggest not, because if (the prog) it is doing its job and the lining is kept thin despite being also stimulated by oestrogen, then even though you increase the prog and then reduce it, there should be nothing to shed.  If you have too much progestogen compared to oestrogen on a continuous basis though this can overthin the lining causing ulceration and some spotting/bleeding - which is what happens to some women using the Mirena especially if they go into menopause and aren't also taking oestrogen.

This is all from my head/memory so apologies if it sounds a bit imprecise.

Hurdity x

[ellie66]

Hurdity

Thanks ever so much for this re the Mirena that is what happened to me in my late 30'S. Now I why!

Ellie

[Sunnydays]

Thanks for all this Hurdity. The point you make about the conti regimes is interesting. I've been having a good look over the information part of the sight (should have done this properly when I first joined) and I'm surprised to see that the amounts of progesterone in the tablets and patches have some inconsistencies ie the ratio of oestrogen to progesterone (even when comparing the same P) is not always relevant. This does lead me to think there must be an element of hit and miss in the amount of progesterone that our bodies are deemed to need in the conti regimes , plus maybe we all absorb differing amounts of oestrogen so the amount of P we need will vary.
Whilst in this subject I see that the information section under prescribable non hrt refers to P cream. There's a thread somewhere here that I can't now find from a  lady who was taking Sage drops and P cream. (I know this cream doesn't reduce the womb lining) but I wonder how someone would know to try the P cream rather than typical hrt.

[Hurdity]

Hi again Sunnaydays - I don't know why anyone would want to use prog cream as opposed to HRT because the evidence for its efficacy in treating menopausal symptoms is limited and anyway as you say - it is so weak that it can't even be used to keep the endometrium thin. If it were effective it would have been developed and licensed through NHS by now rather than as a supplement. The statement on this site about it is very woolly!

This is what the North American Menopause Society has to say about it:

"The evidence of efficacy of OTC topical progesterone cream for menopause symptoms is limited"

"Over-the-counter topical progesterone cream should not be used to provide endometrial protection with estrogen use, and any benefit for menopause symptoms is unproven"

http://www.menopause.org/publications/clinical-care-recommendations/chapter-7-nonprescription-options

Hurdity x

[Pollie]

Sunnydays - regarding ratios -

-  my very, very, simplified understanding of progesterone in a conti regime is that the progesterone 'switches off' the oestrogen receptors in the uterus (in a normal cycle I think it is something to do with enabling an embryo to embed) Therefore it's possibly not the progesterone to oestrogen ratio that is significant it may be the progesterone to receptor ratio. If most women have X number of receptors then X amount of progesterone is enough to oppose any amount of oestrogen ?

Could be completely wrong so I am definitely not saying that this is how it works, it's just the way my brain has made sense of it all !

Pollie

[Sunnydays]

Good thinking Pollie but wouldn't the oestrogen receptors be determined by the amount of oestrogen taken? Which if  the case, would mean that some of the conti regimes are giving say x oestrogen and y progesterone whereas some give x oestrogen but 2 X y progesterone ie a greater amount of the same progesterone. I say, I feel like a scientist - God help the science world haha!

[Hurdity]

From what I've read re the oestrogen and progesterone receptors it is extremely complex at a cellular and structural level with progesterone receptors being activated only in the presence of oestrogen, and as you say Pollie the progesterone also intefering with oestrogen receptors in the endometrium. One paper I looked at referred to both proliferative and secretory changes happening at the same time with high doses of oestrogen and progesterone, but still being effective in keeping the lining thin. I must admit I started to glaze over as I didn't get the precise answer I was looking for! I wanted a neat take home message. The only thing that has stuck from past reading is that the amount of progestogen needed to oppose the stimulation by oestrogen in continuous combined HRT is dose (and probably duration) dependent - and you can see that in practice with some of the tablets for post-menopause.

Hurdity x