Is this a progesterone or oestrogen issue?

[Wonderbug81]

I'm perimenopausal, 46, on 3 pumps oestrogel and Vagifem.

I have been on 12 day cycle 200mcg Utrogestan for a year. Generally Ok but sometimes got diarrhea and mood swings.

Decided to move to continous (25 days a month, gynaecologist confirmed) 100mcg. After some inital challenges I seemed much better on this and had a very light two day bleed on thr 26th day of the cycle (the days off).

But a week later I now seem to have really bad headaches, some anxiety and also nausea.

Could this be related to the 25 day cycle and/or does it now point to oestrogel issues (too high or too low)?

It may be the continuous Utrogestan.
I tried it for a few weeks daily and got migraines.
I have stayed on sequential for many years because of that.

The other point is that although the dose on the leaflet gives 25 days as an option, most women using continuous combined hrt use it every day.
This brings it into line with all other types of CC HRT (patches, tablets, Mirena coil) where the progestogen is daily with no break at all.

One reason your Dr may have suggested the 3 day break to promote a bleed is because you are still young and in peri (and combined continuous is not recommended for women at that stage of peri, because it rarely controls periods/ bleeding.)

I left this link for someone earlier today. From Menopause Matters website written by a consultant gynae.

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.

Thank you, oh so maybe I'll have to rethink it again.

Yes the doctor put me on 25 days due to being 46 and only 2 years or so into peri.

I just don't know if I can cope with the 12 day dose as my digestive issues were pretty bad.

I only moved to continous about 6 weeks ago so will see if things settle down and suffer the other effects in the meantime!

@Wonderbug81 Has your consultant suggested vaginal use of Utrogestan?

They should know of that option as it's been around for a long time.
This is off-licence in the UK but a very common way of using it in Europe, especially France.

I use it that way and my consultant prefers women to use it that way if they can as it reduces side effects and can be more effective.

You just pop 2 capsules in before bed as high as you can go.

There is a 200mgs capsule (for vaginal use as it's used for fertility treatment too) which is the same but bigger and you might be able to get that prescribed.

Your other option is to ditch Utrogestan altogether and try either tablets- like Femoston- or a patch.

Utrogestan doesnt suit everyone .

Thanks. Yes I was considering vaginal but would prefer it as a last resort due to vaginal atrophy issues I'm also trying to sort! It might well be the next step.

I don't know much about the other options. I understand it's better take the non-synthetic types but that will be the step after trying vaginal I think!

@JinglingSpringbells this is interesting - I've been on hrt for a while and initially it was a godsend for stopping my migraines, but over the last few months they've come back. My GP keeps telling me they're probably due to spikes in estrogen and has been fiddling around with lower doses & different patches/gels, but so far nothings worked and I now think my estrogen is probably too low as I'm getting other symptoms back. However I was also switched to continuous progesterone a few months ago - because I'd been on cyclical for a year I think was the reason I was given? - and at no point has it been suggested that the progesterone could be the issue.....