Bleeding more often after switch to continuous progesterone

[Hrtquery]

Sorry if this has been discussed elsewhere already, I did look but couldn't find an answer.

I'm 46, been taking HRT for a couple of years on sequential basis, evorel 75 patches plus utrogestan 200 for two weeks of the month. To my knowledge I'm still getting "real" periods, i.e. I'm not postmenopausal.

Last month I switched to taking utrogestan 100 on a daily basis. This was due to mood swings on the previous regime - I was really suffering whenever I withdrew from progesterone and feeling extremely bad for at least one week of each month. It was like pmdd, really not good.

Since switching my mood has stabilized hugely and I absolutely want to carry on with this approach. In fact I would rather quit HRT altogether than go back to the sequential regime.

However, since switching I've been bleeding every two weeks, slightly heavier than normal period and I'm now getting a bit exhausted.

I'd previously discussed with GP that this might happen and she'd suggested that if so, I should also take a progesterone only pill (desogestrel I think?) to control the bleeding.

I'm a bit confused about this though. If I need more progesterone, can I not just take more utrogestan? Would this not also control the bleeding?

From what I can see online, desogestrel is synthetic and therefore poses higher risk for breast cancer and stroke (I get migraines). Also I took a POP many years ago (can't remember type) and didn't like it, mood-wise.

I tried to discuss these issues with her and she seemed to concede what I said but then just restated that she would offer a POP if bleeding was an issue.

Does anyone have any insight into this? Why can't I just take more utrogestan?

Hi how long have you been in the new regime? Apparently it can take a few months to settle down and it can be normal for bleeding within the first 6 months whilst you body gets used to it. But like you I’m wondering why you can’t just have more utrogestan if the bleeding doesn’t settle. Hopefully someone else can be a bit more helpful x

It's only been six weeks since I switched but my periods now last a full week so I'm bleeding around 50% of the time. It doesn't seem sustainable to carry on like this for much longer let alone six months. My ferritin levels weren't great beforehand and I'm starting to feel really wiped out already.

Hoping I can find a solution because emotionally I really like being on utrogestan and it's been great for my sleep and even my eczema.

Mirena coil maybe?

Sadly that is not an option for me, due to past medical trauma.

You could try using the utrogestan as a pessary? I tried this and it was too strong for me so I switched back to the tablets. I think more gets absorbed that way.

Thanks for the suggestion, I actually started off taking them that way. Unfortunately they irritated my skin so I had to switch to taking them orally.

Have you not been on any other sort of progestrone already just the utrogestan? I was told that you need the 2 types of progesterone while you're still fertlie (i.e in peri) so you take the utrogestan as the HRT and then you either get a mirena coil or take the mini pill to give you the other type and prevent pregnancy. This is what I do as I don't want a mirena coil. I'm 49 and had been on mini pill for years so a couple of years ago I started HRT and stayed on the mini pill, adding in estrogen patches and taking utrogestan every night. I haven't ever had any bleeding but I'd say that's because my body was already used to the mini pill?

@Tiramisulover
Is there any reason for the other type of progesterone other than to prevent pregnancy? I don't require (hormonal) contraception at the moment.

As far as I know, as well as preventing pregnancy it protects the lining of the womb and is needed while you're still peri/having periods (or would be if you weren't taking anything?)

Sorry to derail your thread I know it's not actually answering your question! But hopefully someone with expertise will come along and clarify it for you. It's a pity you don't have much confidence in your GP. Mine was useless (and she's a woman in her 50s you'd think she'd know about it!) so I went to a menopause specialist instead.

Please don't apologize I'm grateful for any input.
I was initially prescribed my HRT privately as my GP refused to do it. Unfortunately I can only stretch to the cost of the initial appointment.

It's so ridiculous, the number of women who can't get good advice from their GP. You'd think that a condition affecting literally half of the population would be universally well understood by now.

Bumping this because my GP is calling tomorrow for a medication review.

I started bleeding again yesterday plus I think my natural endogenous hormones are still fluctuating in the background as I had PMT type symptoms in the run up.

Has anyone here been prescribed utrogestan 200 per day continuously? Or know of any sources saying that this is safe/advisable (or not even)?

Please help!

Also name dropping @jinglingspringbells because they seem to be a fount of wisdom!

I take 200 ultragestan continuously as I use 4 pumps of oestrogel and was having problems with bleeding. This was recommended by a menopause specialist.

Thanks so much for your reply. As it happens I just came off a call with my GP and to my surprise she agreed to double my dose without any resistance!

In case it's helpful to anyone else reading this, I did find an RCOG recommendation that prescribers should consider increasing progesterone if breakthrough bleeding is a problem. I mentioned this during the call - whether it helped me to get my prescription I don't know.