Maybe just to clarify a few of the common points that keep coming up on various threads.
- It's not the only progestin you can use. It's become the go-to one, but it doesn't suit all women. (I was told it's a love-hate thing and not all women love it.) It's popular with drs partly as it's been pushed because of its (likely) better safety profile re. breast cancer, but this is more for women using it long term (over 5 years.)
- Other options are out there- the Mirena coil, Norethisterone (tablets along with gel/ patch/spray) or the tablet Femoston. This contains dydrogesterone which is almost identical to micronised progesterone (in terms of safety) and many women love it.
- Other types of patches, which have Norethisterone as the progestin.
The guidance of sequential and continuous regimes has not changed. Some posters are being allowed to use a continuous regime (Utrogestan daily) before they are definitely post-menopause. The reasoning behind this is that it can prevent low mood which may happen using it at a higher dose for 12 days.
Again, this is variable. Some women find daily doses a problem and prefer 12 days.
Using it daily can prevent a withdrawal bleed in some women, but not all.
Reason being - high estrogen during peri + HRT estrogen makes the lining thicker and 100mgs Utrogestan daily is not enough to control this. Spotting or full periods can happen at any time.
Even if this is 'acceptable' for women, the risk is that it's hard to tell if this is normal, or if it's actually post-menopausal bleeding that needs investigation.
Because women using HRT will never know when they are post-meno (if they were having periods when they started HRT.) And the guidance is that all post-meno bleeding must be investigated within the 2-week rule.
There is a lot of reference to Dr Newson and her guidance. Not all menopause specialists agree with Dr Newson, although some consultants will vary doses and regimes, which are closely monitored. Prescribing methods - similar to what her clinic appears to offer - have come in for some criticism from the BMS, namely very high doses of estrogen not matched by higher doses of progesterone, and using half the dose (alternate days etc.) What may be suggested to women under private care is not always suitable for everyone as it needs careful monitoring and adjustment.