If you have periods whilst only taking Oestrogen do you NEED to take progesterone also?

[StarlightMcKenzee]

Have started on HRT and the Oestrogen means I can move and function a bit better but the progesterone part means I'm a total write-off for 14 days and 3 kg heavier by the end. I have ditched the progesterone but I know I'm not supposed to. But I have periods 4 weekly. Does this mean that my own progesterone levels are opposing the oestrogen and I don't actually need the progesterone medication? Any help with this would be very gratefully received as there is zero information anywhere that I can find.

There is not enough information out there about this but but as I understand it you have to take the progesterone in order to prevent endometrial hyperplasia. There is a cancer risk. Progesterone thins the endometrium. Your own body won't be producing enough by itself. But it might be possible to use the progesterone vaginally, or for fewer days.

Thank you for replying. Do you know why my own full on heavy periods (normal for me) isn't enough to thin the endometrium as I'm assuming I must make shed loads of my own progesterone which is why I react so badly to the medication (taken vaginally). I got to a stage where I cried 2 days before I had to start taking it not just all the 14 days of taking it. It was really very awful. But I can't manage without the oestrogen. My GP doesn't really understand my question and I can't find this information anywhere at all. Surely if my oestrogen levels are being topped up to normal, but I'm having periods, the progesterone hasn't dropped yet!?

There are a few options.

The first is that for women in peri, you have the option of a 3-month cycle. That is taking progesterone for 12-14 days every 3rd month (or before 84 days of the cycle.) This is in the NICE guidance that was updated not long ago. (I've posted this a lot recently if you want to search the site here.)

The second option is that you swap from Utrogestan to something else, maybe Femoston, which is almost as body-identical.

HRT is supposed to be individualised, so it's pointless to keep taking something that doesn't suit you.

The issue over if it's safe it debatable because of tow things- first is that you will eventually miss cycles and have no progesterone of your own, and secondly the amount of your own progesterone now may not be enough with added HRT estrogen.

You can also use Utrogestan for 12 days on a monthly cycle. The 14 days is so women 'remember it more easily' according to the dr who wrote the guidance for GPs (as if women can't count to 12.)

Thank you so much for the information. I did find those NICE guidelines but my GP said that it was for women taking continuous HRT and they meant you could have a break from the progesterone for 2 weeks every three months if it was a problem. She said I could have an extra week of Oestrogen only whilst she got advice and would call me but it has been 5 weeks now and I haven't managed to bring myself to call her as I have had such a rest from the misery and don't want it to start again. If I absolutely have to take progesterone of course I will, but it currently seems a bit unnecessary as surely my lining falls out of me each cycle with my period. I also HATE having to have a period after 3 weeks of none when my whole life it was never less than 5 weeks without. (46 day cycle regular and the reason I never took the pill as I wasn't gonna part with that and no-one told me I could take it continuously).

Oh, typically and always.

Good grief.

I did find those NICE guidelines but my GP said that it was for women taking continuous HRT and they meant you could have a break from the progesterone for 2 weeks every three months if it was a problem

How did your GP qualify as a dr if she can't read some basic info in the NICE guidance? What she has said is complete nonsense!

can anyone provide a link to the new guidelines?

I’ve just been moved from combined patches (2 weeks oestrogen, 2 weeks combined) to oestrogen patches plus progesterone tablets for 12 days each month. I’ve switched because the combined patch was making me feel meh. Hoping the tablet, as it’s bio identical rather than synthetic, will improve my symptoms, but it would be a dream come true if I could do the tablets once every 3 months!

No idea. She's the surgery Menopause specialist. Maybe she hasn't phoned me because she researched it and didn't prioritise me for a call if I'm safe in general. Let's hope. I am happy to add in extra progesterone if she wants me to whenever I don't mind feeling really shit now and then if there is something about accumulative life-time dose that is important. But I cannot cope with either the side effects OR having to bleed twice as much than I have ever before. Poor women, now I know what it is like - how on earth do you MANAGE with 28 day cycles? I suppose I had better go and see my GP again all the same just so she doesn't see my repeat prescription at some point and get a shock and haul me in.

I used mine vaginally as they are suppose to produce fewer side effects. Not had any for about 6 weeks though and life is way better. I think the Nice Guidelines are easy enough to find if you google NICE prescribing HRT or something.

Use the site search or try googling- NICE meno guidance sept 22.
Sorry but I've posted it a lot and it's out there- not too hard to find.

Can you not see a different GP?
Given her reading ability is not great, why go back to her?

I can't get over her idea that women on combined continuous HRT 'miss' progesterone for 2 weeks.

I'd also go as far as correcting her on her mistake.

Why won't you consider a different type of HRT?

Is there a different type? My life isn't worth living on Levonorgestral, Norgestrel and Norgestimate. After a Desogestral attempt I completely gave up on combied contraceptives (also due to having to have more periods each year than I felt natural) In fact the only progesterone that has been tolerable (but still causes depression and brain fog) is Drospirenone which the GP made me take before she would refer me back to the dermatologist for acne treatment. The brain fog was getting me down though.

I have severe acne and Drospirenone is the only one that doesn't make it worse also. But Utrogestan inserted didn't seem to make my acne worse either but it produced way more severe side effects than even Levenorgestral which was BAD.

Sorry I missed your suggestion of Femostan. I've never heard of that. The GP said that Utrogestan was body identical. Is that prescribed in the UK? Is it likely to be better than the others?

Femoston is almost as body-identical as Utrogestan. It's a tablet so not suitable if someone has a risk of blood clots but otherwise is safer than other types of HRT.

Thank you. I'll see what they say. I've used some of the links/suggestions in some of your other posts I've found and seen that if I take progesterone according to my normal cycle for 10 days (every 6 weeks) I'll be almost doubling the accumulative annual amount that would be taken on a 3 monthly cycle so hopefully that will be a compromise my GP agrees is okay. But I'm not spending 2 out of 4 weeks in bed getting larger and one out of 4 weeks bleeding waterfalls, however good the remaining week feels.

Would you consider correcting her on her misunderstanding of what a 3-month cycle is? (BTW there is a tablet form of HRT called Tridestra. If she is unaware of how a 3-monthly cycle works, then she should look at the ingredients of that type which shows very clearly that it's over 12 weeks with progesterone added only for the last 14 days.)

It's up to you but the confusion over mis-prescribing is a serious issue, and you'd be within your rights to bring it to her attention if necessary in writing because she may be making the same mistake with other patients.

Having avoided a mirena for more than a decade I found it very easily tolerated as the progesterone element of my HRT.

Like @Abra1t i have a Mirena coil. It took a few months for the hormones to settle but now it’s great. I still had periods regularly up until the coil was inserted. I use transdermal oestrogen alongside it (Oestrogel) and it’s working really well.

You can take it for 12 days not 14 might help a bit?

My GP told me to switch to one 100mg tablet instead of 2 as am on low dose estrogen so thats what I've been doing for last few months and it's been much better. No idea if that's safe though with respect to endo build up.

If you take the progesterone every third month would that be enough to safely clear the endo lining down? Surely it takes longer than 3m for any cancer to form?

Yes. Of course I’ll correct her. Ti be fair she did say she would go and check what I was saying when I insisted she was not reading it right, and then get back to me.

She hasn’t got back to me in almost 6 weeks so I’ll need to check whether she checked or just forgot.

Surely knowing this would help her navigate the Utrogesten shortage for her other patients too?

Thank you so much for your help and pointers.

If I understand correctly the decision is one of benefits versus risks though the increased risk of 3 monthly is small. There is a preference for women to have monthly bleed for no reason I can fathom but maybe it is to make it easier for them to monitor what their body is doing!?

The 3-monthly regime is discussed on the NICE prescribing guidance. It is for women who are intolerant to progesterone (any- not just Utrogestan.)

The risk of hyperplasia is low, especially in women in peri who are having some natural periods anyway.

Just to update, my GP has agreed to 3 monthly cycles provided I agree to annual pelvic scan. Given that a pelvic scan isn't going to ruin my life in the way that progesterone does it is a very satisfactory outcome.