Continuous progesterone?

[J123456789]

So apologies if this has already been asked - I've searched through previous threads and can't find the answer to this specifically.
I'm 51, have been on HRT for just over a year. I'm on cyclical progesterone and feeling increasingly that I get more anxious and depressed during the days when I am not taking progesterone. I'm still having bleeds (although these are not nearly so regular as before I started HRT). So my question is - can you begin continuous progesterone even when you are still having bleeds? Does the cyclical HRT actually mean that you will always continue to have a bleed as it is mimicking your monthly cycle?
Thanks in advance for any words of wisdom....

I’m 48 and still have periods (although getting to be irregular in recent months) and have been on continuous progesterone for about 18 mths now I think. I did take 100mcg nightly with no break, this was upped to 200 recently. Seems to suit me

I should add, I used to take it cyclically and hated it, now I find it helps me get sleepy before bed and doesn’t have side effects

I'm still having bleeds (although these are not nearly so regular as before I started HRT). So my question is - can you begin continuous progesterone even when you are still having bleeds?

It sounds as if something's going on - either you're not sure how your HRT works, or you're possibly on a dose that isn't right for you.

Cyclical HRT gives a withdrawal bleed every month. (I have a friend 71 who prefers cyclical and yes, there is always a withdrawal bleed.) These are not normal periods. HRT creates an HRT cycle and will be there as long as you're using cyclical.

The bleed starts around 3-4 days after the last progesterone dose and this should happen more or less like clockwork each cycle.

Are you using 12 days x 200mgs of Utrogestan every 4 weeks?
What dose and type of estrogen are you using?

If you aren't bleeding regularly, when are they happening? Not at all, late, early?

Continuous progesterone is used in women aged 54 and over or without a period (natural one) for 12 months before they start this type of hrt.

You can try it sooner but the risk is your own cycle will break through and you will get spotting or irregular bleeds.

Thanks so much for responses. So - I am rubbish at noting when I bleed but I think it is roughly once a month. Just seems to come at different times in my cycle and not predictable. Definitely not like clockwork as I finished my progesterone cycle last Friday and no bleed yet. In fact I did bleed halfway through the progesterone 12 days.
Yes I'm on 12 days x 200mgs of Utrogestan every 4 weeks and Oestrogel - 3 pumps a day (2 morning and 1 night).
Is the idea that you don't bleed at all on continuous progesterone?
Thanks again...

I’m 47 and on continuous progesterone- Utrogestan. It’s been great for me, the cyclical made my mood so different in a bad, angry way. No bleeds. I think my body prefers to take the same medicines every day, not stop and start.

I'm 48, and have a mirena coil for progesterone. It's great. No periods. You can definitely use continuous progesterone under 54 and if you're still having periods. No breakthrough bleeding here.

Thanks all - this is where I'm getting confused as I think I'm better on continuous too but I was unsure whether I could start yet. It's impossible to know if I'm still having monthly bleeds as they are now probably caused by HRT....!!

First, you need to keep track of when you bleed because if you want to chat to your GP, you need to be armed with the facts.

Bleeding anything from 1- 5 days after the last progesterone dose is normal. The average is about Day 3 for it to start.

If you are bleeding more than once a month, this suggests that the dose of Utrogestan is too low. There are loads of links to this- advice from the British Menopause Society on progesterone in HRT ( do a search on Mumsnet or scroll through the threads here.)

For women on 3 pumps of gel who bleed irregularly, they suggest using 300mgs a day OR you could try 14 days x 200mgs per cycle.

Here is a medical site and info about continuous. You could try it but you ight get odd bleeding even more if you're too young for it.

Continuous combined therapies.

https://www.menopausematters.co.uk/postmeno.php

My GP will prescribe continuous progesterone orally, but not vaginally. I don't understand why not. I'm taking it vaginally anyway at 100mg, and I haven't had a period since I started this way. Can't take it orally, very bad side effects for me.

I've been put on progesterone from days 5-26. I am still having periods. The progesterone was helping my sleep so I didn't want to have such a long period off it.

I changed to this last month and it's been great (I'm 51 this year)

I tried continuous but abandoned as I think am still having periods. Definitely not just a withdrawal bleed. So I didn't like the idea of stopping my body doing its thing

Thanks so much for all of this. Really helpful. I think I'll try 14 days of 200mg at first to see if that helps. Sleep well everyone 😴

I am wondering the same thing! I’m 49, been on HRt for a year and I’m so much happier on the days I take progesterone. Days 15-26. I sleep better, don’t get the sweats at night. Periods still regular as they always were. The only reason I started HRT was for anxiety and the night sweats/lack of sleep. Now on the oestrogen gel only days, I feel awful. Sweats are so bad at night I have to change pajamas. Feeling really low. Menopause specialist at the GP said I can’t take continuous as I’m still getting periods. Why is there so much conflicting advice?

That's very interesting!
Did your periods stop when you started taking it daily?

If you have been on hrt for over a year then yes you can take continuous hrt. For the first few months you may have more bleeding and spotting but then it will settle. I changed to continuous and my hormones more balanced now and take 2-3 pumps oestrogel and 1 tab of utrogesterone nightly vaginally as less side effects as am very sensitive to it. Hope you get it sorted and things improve as I feel so much better on this and do not miss the heavy periods at all.

Tolacar if you are on hrt for over a year you can change to continuous if still bleeding as that is what I did and feel so much better for it. The first few mths will have spotting and maybe more bleeding but then it settles down and taking the progesterone vaginally you have less side effects. Haven't had a period for a few mths and do not know myself and my mood more balanced as not having the surge of hormones when on sequential.

Blackswan I take it vaginally as so sensitive to progesterone and no side effects now as felt suicidal taking it orally so try to talk to another doctor to get this change.

Thanks BOOTS52PollyPrissyPants

I am going to try this.
Thanks so much for this thread op!

I'm so sensitive to both the oestrogen and the progesterone.

onhersolidfoundations I think you should try to get an appointment at a menopause clinic as there has to be something that will help you and that you may not be super sensitive to. It took me ages to get the right balance and I also tell everyone check yr thyroid as I felt awful for years and blamed it all on peri-meno not realizing had underactive thyroid and have to specifically ask for an antibodies test. Thyroid is all connected to hormones so if a problem with it can wreck havoc with periods and make you feel absolutely exhausted. Get your bloods done with antibodies test and see if all ok. Hope you find something that helps you as do understand as went through years of hell and thought would never get through it.

Why is there so much conflicting advice?

Good question!

The reason is that many GPs are not well-educated on HRT and also that there is conflicting prescribing advice out there from various menopause experts.

The advice was always that combined continuous HRT was for women aged 54+ (as by that age 80% have no ovarian function.)
OR no natural period for a year, regardless of age.

Then, not too long ago, the 'advice' was changed to allowing any woman on HRT for a year, to try combined continuous. This is on the basis that her periods may have stopped or be irregular ( just a few a year) and that women (may) prefer a no-bleed sort.

This downside of starting continuous too soon is -

1 odd bleeding that doesn't settle down
2 natural periods that override the HRT
3 possible investigations if the bleeding continues at odd times (beyond the 6-months 'allowed' for newly on continuous.)
4 women not liking daily progestogen because of its side effects.

The downside of all continuous HRT is that there is a slightly higher risk of breast cancer if it's used long term compared to sequential.

All the women I know who are happy with their HRT are on continuous - whether as Mirena coil, Utrogestan +/- progesterone only pill.

All the women who are miserable and feel they can't get the treatment right are on cyclical.

Only my experience but a lot of my colleagues are on HRT so the discussion comes up a lot.

This is so interesting.