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Menopause

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Cyclical to Continuous

3 replies

Psychonabike · 13/08/2023 14:39

I have had so much advice here in the past and now I need more! I am realising that proceeding with perimenopause/menopause and HRT is like small babies. Once one phase is done, a new one starts...

Background:

47, on HRT for 2 years (Sandrena oestrogen gel plus Utrogestan days 15-26).

Good points
Stopped my visual migraines that occurred in 2nd half of cycle starting for the first time in my life when I was 45, I can sleep again, no weird inexplicable physical anxiety that was occurring a lot at night, feel more alert and on the ball, no joint pain, energy and motivation to exercise, reduced hair loss, reduced acne, less irritable and angry.

Bad points
Now, there is nothing so bad that I would go stop HRT...but...
ARGH the weight gain. Depressing. I eat well, I track on MFP, I weight train 3-5x per week, I cycle. But still I'm stuck at a good 20lbs above a happy, healthy weight (and I don't have skinny standards). The withdrawal bleeds are really unpredictable. Apart from timing (my periods were regular) they were unpredictable in heaviness and duration before starting HRT. Now, I stop the utrogestan, I wait. I might get 6-8 days after stopping before my period arrives. There are fits and starts, false starts. Then I might get a sudden super heavy day -so bad I can't go out- then that's it. Other times I get the heavy day followed by a full 4/5 days of normal period. But always later than expected.

I did read that if it takes more than 4 or 5 days for your period to arrive after stopping utrogestan, you should move to continuous. Anyone know if this is true?

Will making a change to continuous HRT make the weight gain (and massive insatiable appetite) better or worse?

Are there better regimes for women prone to weight gain like me? (I have mild PCOS type symptoms and really did best with Dianette/Yasmin type OCPs when that was part of my life).

Thank you!

OP posts:
JinglingSpringbells · 13/08/2023 16:41

I did read that if it takes more than 4 or 5 days for your period to arrive after stopping utrogestan, you should move to continuous. Anyone know if this is true?

Is this some myth floating around online?
Because it's completely untrue.
It's absolutely normal for the bleed to start 2-4 days after the Utrogestan.

The issue might be that you have PCOS. I am no expert on this at all, but my understanding is that you will have unpredictable cycles. It could possibly account for the erratic or heavy bleeds and them not being controlled by the HRT.

You're too young for continuous and also not post menopausal. The lower dose of 100mgs daily is very unlikely to reduce the bleeding and you might bleed more often.

has anyone suggested the Mirena coil?

The weight gain- not sure why you're stuck if you are using MFP. I'm a long term HRT user and my weight hasn't gone up at all, but I am very careful with my food. Not saying you aren't.

You could try intermittent fasting and see if that helps at all.

Psychonabike · 16/08/2023 14:01

@JinglingSpringbells

Re the time until bleeding starts after utrogestan, I found that information in a medical menopause forum but not referenced. It stood out for me because I have found the time lengthening. When I first started this regime it used to be around 3-4 days but it's been taking longer and longer. I took my last utrogestan last Monday (7th August) and have had nothing more than the tiniest bit of spotting since then...

I have wondered if the Mirena would be better for me.

The weight -I don't know- I do need to get my thyroid checked as I'm getting to the age that many women in my family have run into problems with it.

OP posts:
JinglingSpringbells · 16/08/2023 14:11

medical menopause forum

Was it Menopause Matters?

It's just an opinion if it was posted by someone.
There is a section on that forum written by the Dr who runs it, explaining when to change to continuous, if a woman chooses.

I wouldn't get worried about the bleed. Around 20% of women don't bleed at all on sequential. If you have PCOS it could well account for the odd bleeding where your own hormones are overriding hrt.

There is no medical reason for anyone to move to continuous. It's actually a choice although most GPs seem unaware of this.

There are pros and cons.

The research shows sequential is slightly safer for the breasts because they are not being stimulated by both hormones every day.

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