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....

My experience is the opposite.

A friend (aged 70) is still on cyclical as am I.

We both find daily progesterone gives side effects that aren't tolerable for long-term use of HRT.

It's pretty clear we don't all react the same way to hormones.

Interesting on the slightly higher risk of breast cancer with continuous. I’m aware of it but have never quite understood why it’s the progesterone that increases the risk of breast cancer and not the oestrogen, particularly since women with hormone receptive cancer get tamoxifen which blocks oestrogen.

Just started my progesterone last night and I feel horrendous this morning.

I may be reaching the end of my tether with HRT 😢

Interesting on the slightly higher risk of breast cancer with continuous. I’m aware of it but have never quite understood why it’s the progesterone that increases the risk of breast cancer and not the oestrogen, particularly since women with hormone receptive cancer get tamoxifen which blocks oestrogen.

@Jedstre It's been known for decades that estrogen-only HRT is safer than estrogen+ progestogen AND less risk for BC than not using any HRT at all!

women using estrogen-only HRT have fewer cases of breast cancer than other women NOT using HRT. So estrogen on its own appears to be protective.

It's also been known (by specialists) that adding in progesterone is what causes the BC risk. There is also an order of risk for the different progestogens.
And, the stats show that daily use is a higher risk than sequential.
One theory is that when the breasts go through a cycle (on cyclical HRT) it allows the 'shedding' of any irregular cells (in the same way that the womb lining sheds.)

This is a theory. A paper, by researchers.

The reason for blocking estrogen in women who've had cancer is to stop the growth of any cancer cells that are already in distant sites but are too small to show on scans.

So their own estrogen won't cause cancer, but will help the growth of existing cancer cells that may have migrated to other organs. Scans can only pick up tumours of a certain size.

Am I right in saying that the mainstream (NHS...) view is that Utrogestan, for eg, shouldn't be taken continuously during perimenopause. Presumably that's because of the perceived/actual cancer risk?
If so - why then are perimenopausal women given the Mirena coil, which is also continuous? I know there's a difference between Mirena and Utrogestan, but is it that different from a breast cancer risk perspective?

Totally lay/barely informed, I'm just interested to understand. Particularly because I really like being on Utrogestan continuously and I do not miss my periods or PMS one bit.

Am I right in saying that the mainstream (NHS...) view is that Utrogestan, for eg, shouldn't be taken continuously during perimenopause. Presumably that's because of the perceived/actual cancer risk?

No @BlackSwan
I've left 2 links in this thread to Menopause Matters which explains why continuous combined HRT is for women post menopause.

(and obviously many women use HRT for many years not just in peri, so the risk would apply to them too- but it's not for the reason you think.)

Have a read of the links.

What I was quoted by a GP (who refused to prescribe continuous Utrogestan, alone, for perimenopause) was this from the British Menopause Society:
"Progestogen intake is recommended with HRT in non-hysterectomised women in a sequential regimen in peri-menopausal women and continuous combined regimen regimens in postmenopausal women."

14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf (thebms.org.uk)

How do I rebut this?