Are regular bleeds normal on continuous Utrogestan?

[Plumspears]

I've taken Utrogestan continuously for about two years ( with estrogel). When my GP changed me from sequential, I seem to remember her saying she'd expect my bleeds to stop after a few months. They haven't changed at all. I just wonder is this normal? I don't actually have a clue

It stops in many cases but isn’t a given. I’ve been on it since November and still have regular bleeds, my DH is a GP and says this is perfectly normal and they don’t always stop. Had my HRT review today and GP wasn’t concerned at all.

Not an answer, but how can you or GP tell when to take it continuously? I've been on it on a cycle for a few months, as my periods were still coming a few times a year. Having a bleed every 28 days again is annoying. I get the logic of taking it on a cycle if you were still having periods when you started taking, but how does anyone know when they would have ended. Sorry if that doesn't make sense! I have review in about a month so will ask my GP but wondered if anyone knows.

@Purpleavocado I asked the same question as we were hoping taking it continuously would stop my bleeds (been struggling with lots of pain). She said you wouldn’t know for sure but what we would do is in a couple of years, try stopping it for a time and seeing if my periods returned. If they did, go back onto taking it continuously, then try the same at a later date.

@EssexLioness

It stops in many cases but isn’t a given. I’ve been on it since November and still have regular bleeds, my DH is a GP and says this is perfectly normal and they don’t always stop. Had my HRT review today and GP wasn’t concerned at all.

Thank you! That's reassuring. I'll stop worrying and just keep cursing the pain and inconvenience. I have been suggested a Mirena, but I'm too scared

I don't really understand this @Plumspears

You usually change to continuous once you have been period-free for 12 months at least OR are aged 54+ when most women are post menopause.

If you started HRT when your periods were regular, you'd only know if they had stopped by giving the HRT a break, OR waiting till age 54 OR assuming your regular bleed was still a period (so you'd go back to sequential.)

It's a choice anyway- not mandatory (I chose to stick to sequential all the time as I can't get on with daily Utrogestan.)

I have to disagree with @EssexLioness as it's not normal, no.

The medical guidance is that if women are still bleeding more than 6 months into a continuous regime, it needs investigating.
The options are to
-increase the dose of progesterone ( ie 200mgs daily not 100mgs)
-Revert back to sequential
-Do an ultrasound scan to see what's going on with the lining and ovaries.

I can link to this on the medical site Menopause Matters if you want to read the dr's version.

@EssexLioness That's not exactly right.
Bleeding on conti HRT is expected for 6 months while the estrogen+progesterone work in synch to thin the lining so it won't bleed.

The medical advice- see above - is it must be investigated of bleeding carries on after 6 months ( you are not there quite yet.)

It also means that if you have a regular bleed you are not post meno so should not be on conti yet.

see here www.menopausematters.co.uk/postmeno.php

POST MENOPAUSAL -
Continuous combined therapies.

"Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy. Start with low dose preparations and increase as necessary for symptom control. The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

When?

Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).
If sequential therapy started while still having periods, wait till age 54 years. At 54 years 80% of women will have cessation of ovarian function and are likely to settle on continuous combined (period-free) therapy.
Change from sequential to continuous combined by finishing the current sequential pack and start new therapy at the end of the expected bleed.

Thank you for the replies and I realise I wasn’t quite clear. I am on oestrogen and progesterone pill which I take a break from for 5 days a week. The progesterone I was referring to is extra in my case and is actually the mini pill which is safe to take continuously regardless of age. Sorry for the confusion. I have terrible brain fog atm and struggle to explain myself properly sometimes.

Thank you @JinglingHellsBells. As I understood it, you could change to continuous after a year or two on sequential. I read what you're quoting and wasn't sure if it referred to unusual bleeds like spotting or continuous bleed. I'm well confused. Probs best to make a call to the GP by the sounds of it.

I just had an appointment with a private menopause consultant (because utrogestan isn't licenced by my areas formulary annoyingly) and I queried using evorel conti (which my gp prescribed) as I'm only 46 and as far as I'm aware would still be having regular periods if not taking it. She said guidance has changed and continuous hrt is fine even if still having periods. So I don't think it matters anymore whether you've stopped your periods or not, whatever you feel comfortable with 🤷‍♀️ she did say that any continued bleeding after 6 months should be investigated but this has never been a problem for me x